Defining standards: a step towards evidence-based practice for children and youth with behavioural...

Defining standards: a step towards evidence-based

practice for children and youth with behavioural disorders

Dejana Bouillet, Assistant ProfessorThe Institute for the Social Research in Zagreb

Antonija Žižak, Full ProfessorFaculty of Education and Rehabilitation Sciences, University

of Zagreb

MALTA, 15. SEPTEMBER 2007. : SEBD CONFERENCE

Some Fact about Croatia

Surface: 56.542 km2

Surface of the territorial sea: 31.067 km2

Number of islands, cliffs and reefs: 1.185

Population: 4.381.352

Capital: Zagreb, 770.058

Children and youth: 37,26%

Children in foster care: 2.331

Children in institutions: 5.360


Croatian Government Committee for Prevention (2002 / 2003)

Two tasks:

1) Proposing standards• Literature study• Focus groups with stockholders• Creating and proposing standards

2) Matching proposed standards with existing programs


Proposed standards of good practice / programs

FIRST LEVEL STANDARDS

(professional values and principles)

1. Service users’ perspective

2. Orientation towards development of individual, family and community assets

3. Needs assessment as bases for intervention planning

4. Local, regional and national network of services

SECOND LEVEL STANDARDS

(conceptual aspects)

1. Promoting prevention

2. Integration of theory, science and practice

3. Support to the basic societal institutions- family and school

4. Alleviation of entry to formal social structure

5. Place on the continuum of interventions

6. Supportive to quick and effective intervening

7. Supportive to diverse and alternative interventions

8. Culturally sensitive intervention


9. Supportive to multimodal approach

10. Supportive to integrated approaches

11. Supportive to the intervention system flexibility

12. Relying on quality indicators and code of

ethics

THIRD LEVEL STANDARDS

(programme framework

dimensions)

1. Presence of long term, and short term goals

2. Clear mechanism of beneficiaries’ identification and selection

3. Clear statements regarding activities, performance and roles

4. Statements regarding education and supervision

5. Statements regarding monitoring and evaluation

6. Statements regarding sustainability


Proposed standards of good practice / programs

First assessment - program characteristics:239 programs:

• 83,7% primary prevention• 44,3% free-time programs• 30,1% social welfare programs• 0.4% juvenile justice programs• 90% short time programs


First assessment - 4 independent evaluators:

1. None of assessed programs matched all proposed standards

2. Fourteen programs matched more than half standards – “potential model programs”

First assessment - matched standards:

Most present standards Least present standards

1. level

standards

Orientation towards

development of individual,

family and community

assets

Needs assessment as

bases for intervention

planning

2. level

standards

Supportive to integrated

approaches

Relying on quality

indicators and code of

ethics

3. level

standards

Clear statements

regarding activities,

performance and roles

Statements regarding

monitoring and evaluation


Second assessment – basic information about programs:

11 potential model programs: • 10 programs led by non-governmental organizations• Target population:

2300 children and their parents130 adolescents and their parents440 school staff140 other professionals60 college students

• Duration - 5 to 15 years• Coast estimation: from 34 to 300$ per subject


Potential model programs – two examples

Programs: Key program goals: Target population:

MMPI • strengthen family, school and community in

supporting development of academic, social and

emotional competences• strengthen positive child development• strengthen parents in developing parenting skills • reduce behaviour problems – impulsive, violent • behaviour and substance use• increase sensibility of local community for children and

families at risk• coordinate community resources for best quality care

100 children

180 parents

50 school staff

23 professionals

2 decision makers

Miraculous Croatia

• strengthen healthy, positive approach to life• enable positive experiences in peer groups• develop tolerance for differences• improve communicational skills• reduce conduct problems• reduce consequences of traumatic experiences• increase interest for nature, activities and skills for • healthy life in nature

250 children

14 adolescents


Graph 1: Programs According to Total Number of Points (Maximum Number of Points = 122)

73

72

74

73

82

74

91

76

94

94

89

76

79

83

86

91

92

98

104

107

108

110

0 50 100 150 200 250

Miraculous Croatia

"Benjamin"

Easier Through School

To School Through Play

From the Problem to the NGO

Upbringing for Love and Nonviolence

The House of Children "Borovje"

Big Sister Big Brother

Contact

MMPI

The POP Program

Year 2002 Year 2007


Results – percentage of matched standards

First assessment Second assessment

Increase

All standards 59.0% to 77.0% 62.3% to 90.1% 2.5 to 22.9%

1. level

standards 50.0% to 80.7% 57.7% to 92.3% 3.9 to15.4%

2. level

standards 52.0% to 76.0% 58.0% to 88.0% 2.0 to 30%

3. level

standards 56.5% to 84.8% 60.9% to 93.5% 4.4 to 23.9%


Second assessment - matched standards:

Most present standards Least present standards

1. level

standards

Orientation towards

development of individual,

family and community

assets

Needs assessment as

bases for intervention

planning

2. level

standards

Preventing increase of

existing disorders

Support to basic social

institutions

Support to diversion and

alternative interventions

Support to flexibility in

intervention system

3. level

standards

Clear statements

regarding activities,

performance and roles

Mechanisms of identification

and selection of beneficiaries

Presence of long and short

terms goals

Statements regarding

sustainability


Concluding remarks:

Question:was this a step towards evidence-based practice?

Answers:• standards were proposed through ad-hock

procedure• a great number of programs voluntarily

participated in assessment• What else is possible in a country of “small

numbers”


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