Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the...
-
Upload
amie-griffin -
Category
Documents
-
view
223 -
download
1
Transcript of Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the...
![Page 1: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/1.jpg)
Implementing & Sustaining Effective Trauma-Mitigating Interventions
“Trauma Interventions in the Real World: Examples and Resources
Child Trauma Group MeetingZanvyl and Isabelle Krieger Fund
November 19, 2013
![Page 2: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/2.jpg)
Trauma Matters• Trauma is gaining
recognition in the lay public for its impact on:– Short-term functioning
• Thinking• Behavior• Physiological response
– Longer term health (via ACES concept applied to today’s children & families)
![Page 3: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/3.jpg)
Listening Carefully to Healing Neen• The public health paradox …– Trauma informed care is based on giving
alternatives to self-coping with trauma• TRUE
– Trauma informed care flips treatment upside down• MAYBE, but only if it was punitive confrontational
treatment– Trauma informed care complements consistent, responsive,
contingent responding by caregivers
• What trauma-informed services helped Neen?
![Page 4: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/4.jpg)
Overview
• Fidelity• Common Elements and Factors• Implementation and Sustainability
![Page 5: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/5.jpg)
Beyond Treatment Fidelity
• Strength of fidelity research base is over-estimated– In key studies, treatment adherence is in part
measured by caregiver satisfaction with the therapist and agreement that the therapist is working in ways that matter• surely this is correlated with how much improvement
there is in the case
![Page 6: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/6.jpg)
3 Parts of Treatment Fidelity• Competence: The level of skill and judgment used in
implementing the procedure (Can they do it?)
• Adherence: Uses prescribed procedures (Are they doing it?)
• Differentiation: Do treatments differ on critical dimensions (Are the core elements delivered the way that this manual says)
• Schoenwald, et al., 2011• Berliner et al., (2013 ) Everyday competence and fidelity for EBP
organizations: Practical guide—2013.pdf
![Page 7: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/7.jpg)
But Fidelity Costs A Lot: Fidelity Alternatives
• Self-reported Fidelity– Are they using the elements that they should be
using given the diagnoses?• Client-reported fidelity• Therapist behavior sampling
![Page 8: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/8.jpg)
Fidelity Summary
Focusing so much on externally verified fidelity puts us on a track to frustration
![Page 9: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/9.jpg)
Efficient Trauma-Focused EBPs: Focus on FLEXIBLE use of Building Blocks Not
Manuals
![Page 10: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/10.jpg)
“It is improbable for any service array composed entirely of EBTs to serve all members of a diverse public mental health system.”
Southam-Gerow, et al. (in press).
![Page 11: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/11.jpg)
How will I ever master all these Manualized
Evidence-Supported Treatments???
If only I could figure out the basic elements… I
could and mix and match as needed.
![Page 12: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/12.jpg)
EBPs Matter But Not So Much with Youth Referred from Other Services
![Page 13: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/13.jpg)
The Common Elements Approach• Using elements that are found across several evidence-
supported, effective manualized interventions
• “Clinicians ‘borrow’ strategies and techniques from known treatments, using their judgment and clinical theory to adapt the strategies to fit new contexts and problems” (Chorpita, Becker, & Daleiden, 2007, pp. 648-649)
• Actual treatment elements become units of analysis rather than the treatment manual
• Treatment elements are selected to match particular client characteristics
![Page 14: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/14.jpg)
Common Elements as one Answer
LA Implementation of Common Elements: Outcomes for youth treated with MAP were strong, with effect sizes ranging from .59 to .80 on the Youth Outcome Questionnaire.
“These data support the notion that scaling up a mental health services approach in a system can be achieved through a strong and broad partnership among relevant stakeholders, can involve a train-the-trainer model, and can result in strong outcomes...”
Southam-Gerow, et al. (in press).
![Page 15: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/15.jpg)
Weisz, J. R. et al. Arch Gen Psychiatry 2012;69:274-282.
Weisz et al. RCT Shows that Modular Approach to MH Treatment Works with Depressed, Anxious, or Conduct
Disordered Children
![Page 16: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/16.jpg)
Can Differentiation Really Matter?
![Page 17: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/17.jpg)
Follow the steps exactly
In the Beginning
Have the right ingredients; systematically apply within the model
Once you have Done it by the Book
Berliner et. al., CBT +
![Page 18: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/18.jpg)
Toward Common Factors
• Engages client in meaningful work• Provides a logic to change effort• Generates hope• Measures progress
![Page 19: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/19.jpg)
Common Factors
• Focuses on the client-therapist alliance– Listened to me; I felt heard, understood, respected– What we did and talked about were important to
me– I liked what we did today; the therapists approach
is a good fit for me– I hope we do the same kind of things next time;
overall the session was right for me
![Page 20: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/20.jpg)
Common Therapeutic Factors of Trauma are Also Emerging
• Kathryn Collins, Chris Lane, and others are working on these as part of a NCTSN effort– They include common factors and elements used
in effective Trauma interventions
![Page 21: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/21.jpg)
Continuous Assessment May Be Most Important of Common Factors
• RCT: Clinicians at 28 sites in 10 states completed assessments of youth (ages 11-18) functioning and symptoms every week. Dose response relationship—the more feedback passed on to the clinician the better the results. (Yet, feedback effect sizes were only .18, .24, and .27 for youth, clinicians, and caregivers, respectively.)
(Bickman et al, 2011)
![Page 22: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/22.jpg)
![Page 23: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/23.jpg)
Hawaii Looks at Practice & Outcomes
Monthly Treatment and Progress Summary form (MTPS) measures:– the service format and setting, – treatment targets, – clinical progress, – intervention strategies (e.g., exposure, logical
consequences, emotional processing), – and outcomes on a monthly basis.
![Page 24: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/24.jpg)
Implementation• Active Learning Strategies
![Page 25: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/25.jpg)
What Active Learning Helps Avoid…
![Page 26: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/26.jpg)
Sustainability• Agency Readiness to Implement and
Implement and Implement
– Does it fit agency culture and funding
![Page 27: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/27.jpg)
What We Also Want To Avoid…
![Page 28: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/28.jpg)
EBPs: Treat to the Target and Match Organizational and Therapist Values
![Page 29: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/29.jpg)
Competency-based Selection
www.ncwwi.org A Service of the Children’s Bureau, a Member of the T/TA Network
The better the fit between the requirements of the job and competencies of the job holder…
… the higher job performance and retention
will be.Select people for training who have the initial competency and a high likely to be longterm providers
![Page 30: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/30.jpg)
Ongoing Consultation and Coaching
Purposes:• Teach effective practice• Ensure good judgment• Secure fidelity but prize competency• Increase staff satisfaction through support and
skill acquisition
![Page 31: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/31.jpg)
Proposed EPB Sustainability Standards
• Training on how to do ongoing fidelity checking should be made available to subscribing organizations
• Train-the-trainer should be made available to local organizations by purveyors
• Use of local websites or MISs should be allowed vs. required use of ongoing provider/developer organizational websites
![Page 32: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/32.jpg)
Partial ReferencesAarons, G.A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model
of evidence-based practice implementation in public service sectors. Adm Policy Ment Health, 38: 4-23.
Aarons, G.A., Sommerfeld, D.H., Hecht, D.B., Silovsky, J.F., & Chaffin, M.J. (2009). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect. Jrnl of consulting and Clinical Psychology, 77(2), 270-280.
Barbee, A.P., Christensen, D., Antle, B., Wandersman, A., Cahn, K. (2011). Successful adoption and implementation of a comprehensive casework practice model in a public child welfare agency: Application of the Getting to Outcomes (GTO) model. Children and Youth Services Review, 33: 622-633.
Barth, R. P., Lee, B. R., Lindsey, M. A., Collins, K. S., Strieder, F., Chorpita, B. F., . . . Sparks, J. A. (2011). Evidence-Based Practice at a Crossroads: The Emergence of Common Elements and Factors. Research on Social Work Practice. doi: 10.1177/104973151140844
Bickman, L., Kelley, S. D., Breda, C., de Andrade, A. R., & Riemer, M. (2011). Effects of Routine Feedback to Clinicians on Mental Health Outcomes of Youths: Results of a Randomized Trial. Psychiatric Services, 62, 1423-1429.
![Page 33: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/33.jpg)
Partial ReferencesDickinson, N.S., & Perry, R.E. (2002). Factors influencing the
retention of specially educated public child welfare workers. Evaluation Research in Child Welfare, 15(3/4), 89-103
Fixsen, D.L., Naoom, S.F., Blasé, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A syntnesis of the literature. Tampa: University of South Florida.
Fixsen, D.L., Blasé, K.A., Naoom, S.F., Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19(5), 531-540.
Glisson, C. Kukes, D., & Green, P. (2006). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children’s service systems. Child Abuse & neglect, 30, 855-880.
![Page 34: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/34.jpg)
Partial ReferencesSchoenwald, S. K., Garland, A. F., Southam-Gerow, M. A., Chorpita, B. F., & Chapman, J. E. (2011).
Adherence Measurement in Treatments for Disruptive Behavior Disorders: Pursuing Clear Vision Through Varied Lenses. [Article]. Clinical Psychology-Science and Practice, 18(4), 331-341. doi: 10.1111/j.1468-2850.2011.01264.x
Southam-Gerow, et al. (in press). MAPping Los Angeles County: Taking an evidence-informed model of mental health care to scale. Journal of Clinical Child and Adolescent Psychology.
Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., . . . Res Network Youth, M. (2012). Testing Standard and Modular Designs for Psychotherapy Treating Depression, Anxiety, and Conduct Problems in Youth. [Article]. Archives of General Psychiatry, 69(3), 274-282. doi: 10.1001/archgenpsychiatry.2011.147
Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61, 671–689.
Weisz, J. R., Kuppens, S., & Eckshtain, D. (2011). Effects of psychotherapy with children and adolescents: Interim report of a meta-analysis. Unpublished manuscript, Harvard University, Cambridge, MA.
Zlotnik, J., DePanfilis, D., Daining, C., & Lane, M. (2005). Factors influencing the retention of child welfare staff: A systematic review of the research. Washington, DC: Institute for the Advancement of Social Work Research.
![Page 35: Implementing & Sustaining Effective Trauma-Mitigating Interventions “Trauma Interventions in the Real World: Examples and Resources Child Trauma Group.](https://reader038.fdocuments.in/reader038/viewer/2022110100/56649de75503460f94ae07e9/html5/thumbnails/35.jpg)