Monthly Archives: September 2013

IFPS and Evidence-Based Practice, Part 2

Last week we introduced the topic of evidence-based practice.  This week we look at how the state of Washington is implementing evidence-based practice that includes IFPS.

In 2012 the Legislature passed E2SHB 2536 with the intent that “prevention and intervention services delivered to children and juveniles in the areas of mental health, child welfare, and juvenile justice be primarily evidence-based and research-based, and it is anticipated that such services will be provided in a manner that is culturally competent.”  Washington is one of the few states to have enacted a law for implementation of evidence-based practice. You can view the legislation here:
(PDF, 29Kb) http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/House%20Passed%20Legislature/2536-S2.PL.pdf

Two independent research groups were designated to create an inventory of  evidence-based, research-based, and promising practices and services.

One of these research groups, the Washington State Institute for Public Policy (WSIPP), had previously conducted an extensive review of IFPS.  WSIPP reviewed all rigorous evaluations of IFPS programs that included a comparison group and then sorted the evaluations based on fidelity to the Homebuilders® model. IFPS programs with high model fidelity had a significant reduction in out-of-home placements of children and produced $2.59 of benefits for each dollar of cost. IFPS programs that did not adhere to the Homebuilders® model produced no significant effects.  You can view the full study here:
(PDF, 45Kb) http://www.wsipp.wa.gov/rptfiles/06-02-3901.pdf

Because fidelity of IFPS programs to the Homebuilders® model is key to their effectiveness, it’s important for the IFPS field to be informed of the fidelity measures.  The more familiar measures include

  • 24/7 availability,
  • caseload of 2 families at a time,
  • meetings with family 3–5 times a week, and
  • services provided for 4 weeks.

Other measures include

  • standards for supervisors,
  • comprehensive assessment,
  • goal setting and service planning,
  • engagement and motivation enhancement, and
  • cognitive and behavioral approach.

For a complete list of the Homebuilders® fidelity measurs and accompanying performance measures, see:
(PDF file, 82Kb) http://www.institutefamily.org/pdf/HOMEBUILDERS-FidelityMeasures-Abridged-2-6.pdf

If your agency is considering implementing or strengthening an IFPS program, you can easily incorporate these standards and performance measures into the design.

Washington State is the birthplace of the Homebuilders® program and thus state policy makers had access to a good example of evidence-based practice. Homebuilders® IFPS is included in two places in the current state inventory of evidence-based programs. You will note in the inventory chart (see link below) that Intensive Family Preservation Services (Homebuilders) is the fourth item in the child welfare category and is ranked as an evidence-based program (top ranking). It is also listed in the mental health category under “serious emotional disturbance” as a research-based practice, based on a single evaluation. You will find the rankings for many other familiar programs in the chart.

WSIPP Inventory Chart:
(PDF file, 66Kb) http://www.wsipp.wa.gov/rptfiles/E2SHB2536-3i.pdf

We have seen in this series of posts how evidence-based practice has developed and where IFPS fits in. The field of IFPS is heavily dependent on the Homebuilders® model of IFPS for its inclusion in evidence-based practice. Charlotte Booth and Shelley Leavitt at the Institute for Family Development (parent agency of Homebuilders®) have spent decades building, maintaining, and training on model fidelity, and contributing data on their program. You can join me in publicly thanking them by posting a comment below.

Thank you, Charlotte and Shelley and all IFD staff, for your dedication and commitment to make IFPS one of the most effective programs for families!

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Posted by Priscilla Martens, NFPN Executive Director

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IFPS and Evidence-Based Practice

There is perhaps no more frequently used term in the child welfare field today than “evidence-based practice.” In this series of posts, we look at the definition and evolution of evidence-based practice, why it is important, where IFPS fits in, and how one state is implementing evidence-based practice.

In 2005 the National Association of Public Child Welfare Administrators (NAPCWA) published guidelines for evidence-based practice. NAPCWA noted the following issues surrounding evidence-based practice:

  1. The base of solid empirical research on child welfare practice is still developing.
  2. Child welfare practices cannot simply be divided into “evidence-based” and “non-evidence based.” There is a continuum from highly research supported practice at one end to very questionable and concerning practices at the other end.
  3. There is no universally accepted definition or classification of evidence-based practice.

NAPCWA adapted a definition of evidence-based practice from the Institute of Medicine that combines three factors:

  1. Best research evidence
  2. Best clinical experience
  3. Consistent with family/client values

In order to operationalize these factors and provide objective measures, the California Evidence-Based Clearinghouse for Child Welfare (CEBC) was established. A practice is rated based on the following criteria:

 1. Well-Supported by Research Evidence

2. Supported by Research Evidence

3. Promising Research Evidence

4. Evidence Fails to Demonstrate Effect

5. Concerning Practice

NR. Not able to be Rated

The CEBC relies on published, peer-reviewed research to determine the rating.

Why is using an Evidence-Based Practice important?

A CEBC advisory committee member’s response to that question follows.

Evidence-based practice:

  • Ensures that families are referred to the most effective and efficacious programs that the community provides.
  • Helps child welfare workers and supervisors empower families in crisis to resolve their own conflicts, using well-tested programs.
  • Allows child welfare workers to refer families to services that have been scientifically researched and proven effective, which in turn may cause the families to make a greater commitment to participation.
  • Provides child welfare workers with a better understanding of the range of programs available so they can make informed choices when referring families to services.

How does IFPS fare in the CEBC rating system?

Homebuilders® IFPS has been rated by the CEBC in the areas of:

  • Interventions for Neglect,
  • Post-Permanency Services,
  • Reunification,
  • and Family Stabilization.

The rating assigned to each of these areas is a “2” with a detailed report available. (Click here to view one of these detailed reports.)

The CEBC website ( http://www.cebc4cw.org/ ) is user-friendly and contains a wealth of information about evidence-based practice and programs. Because IFPS is an evidence-based practice, the IFPS field should be aware of and support other evidence-based practices. Be sure to check out the CEBC website!

Next time we’ll look at how one state has implemented evidence-based practice that includes IFPS.

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Posted by Priscilla Martens, NFPN Executive Director

Ethical Dilemmas

When I was very young and starting my social work career as a probation officer, I was surprised to find myself facing ethical dilemmas.

For example, my probationers often had the television on while I visited and frequently at top volume, especially if they didn’t like me. What to do? I would start talking in long sentences but say certain words above the volume of the television. These words included “curfew,” “good behavior,” and “early release.” Whereupon the probationer would leap to his feet, turn off the television, and take the chair next to me, listening with rapt attention. I would then explain in a normal tone of voice that the curfew would remain the same until the behavior improved and then we might consider early release from probation.

A more awkward situation occurred when I left the bar with my friends at 1:00 a.m. and encountered a probationer on the street, out after her curfew. What to say? The probationer broke the silence by asking, “You have friends?” That focused my attention on the immediate need and I responded, “You know that you’re out after curfew. Get home right now and be in my office at 9:00 in the morning—ummm, make that 10:00.”

We’ve all done stupid things. Looking back I realize inexperience contributed to many of mine. I was only five years older than many of the probationers I was trying to help and I had a lot of maturing to do. Amazingly, five years later I encountered far fewer ethical dilemmas.

Here’s something that young IFPS therapists today will have a hard time believing: I started out with no mobile phone, laptop, computer…not even a beeper! I did have a tablet (white paper with lines) on which to keep notes. The advantage I had was that my mistakes were viewed by and mainly of interest only to those who were present at the time. Now, everyone is only a click away from fame or infamy. I know, it’s not fair!

There are many resources available to guide us through ethical dilemmas, and I’ll provide a link to one of them at the end of this post. I understand now that one of the reasons why supervisors and administrators are so important is they can offer advice about how to handle ethical dilemmas. What seems confusing and complicated gets much easier to unravel when two people are looking at the situation.

The following are some things I’ve learned over the years that may be of help:

  1. Never violate your conscience. You only have one and you need to be able to rely on it. Violating it continually will render it useless when you need it most.
  2. Never do anything that you (or your mom!) wouldn’t mind reading about on the front page of the newspaper. I learned this handy rule early on during 18 years of legislative work. Unfortunately, some of the legislators learned it the hard way.
  3. If you like second chances, offer them to others. I have many opportunities to recall my own wrong behavior when I observe what others are doing. People forgave me and willingly offered me another chance to get it right. I can make a choice to do the same for others.
  4. Seek friends, mentors, supervisors, and administrators with the highest standards. These people will help you grow in the right direction and you’ll become a better person than you ever thought possible.
  5. Suffer fools gladly. You’re sometimes one too! Say, “I’m sorry,” overlook offenses, reduce defensiveness, and be ever on the lookout for ways to make other people happy.

The North Carolina Family Based Services Association has graciously shared their Ethical and Safety Guidelines which can be viewed here:
http://nfpn.org/articles/ethical-and-safety-guidelines

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Posted by Priscilla Martens, NFPN Executive Director

What Can Supervisors Do To Keep Workers Safe?

ifps-safety2In the last article, we discussed how IFPS practitioners can keep themselves safe while in the field. In this post, we would like to focus on what supervisors can do to assist their workers in staying safe in the field.

There are three types of things supervisors can do to help their IFPS practitioners stay safe when working with families in their neighborhoods and homes:

  1. Training and preparation
  2. Preparation for specific family situations
  3. Availability in emergencies

Training and Preparation

  • Prevention is the first line of defense. Take steps to ensure the safety of all practitioners before they are needed.
  • Conduct in-house training to be sure that practitioners understand the importance of keeping themselves safe and have strategies for doing so (e.g., plan an emergency escape route).
  • Offer ongoing training on verbal de-escalation techniques.
  • Identify high-crime neighborhoods.
  • Make sure you are approachable to so that practitioners feel comfortable talking about how they feel in the field.
  • Encourage practitioners to report back to you immediately if they feel they or their clients are at risk.
  • Keep a session log to document the practitioner’s whereabouts.
  • Know the types of cars that your practitioners drive.

Preparation for Specific Family Situations

  • Complete a risk assessment for each client family.
  • Plan in advance with the practitioner what safety measures are needed with each family or when going into a specific neighborhood.
  • Ask practitioners to check in by phone at pre-arranged times when they are in potentially risky situations.
  • Establish procedures if a practitioner does not call in at expected times.
  • Assist in the field when needed. Offer—don’t wait to be asked.
  • Implement a buddy system, as needed.

Availability in Emergencies

  • Be available to offer support during emergencies by phone or in person.
  • Keep your phone with you at all times.
  • Ask another team member to be on call if you know you won’t be available.
  • Offer strategies to defuse the situation.
  • Provide effective and clear communication in emergencies.
  • Don’t hesitate to call the police when necessary.

Supervisors around the nation, we would like to hear from you. Please share your experiences and your safety tips for keeping your practitioners safe. We will all benefit from your suggestions.

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Posted by  Moneefah Jackson