Bethany R. Lee

Evidence-based practice at a crossroads: The timely emergence of common elements and common factors

Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of manualized evidence-supported treatments. For social work, the path to implementing the delivery of science-informed practice remains at a crossroads. This article describes two emergent strategies that offer a plausible means by which many social workers can integrate an EBP model into their service delivery—common factors and common elements. Each strategy will be presented, and related evidence provided. Tools to implement a common elements approach and to incorporate client feedback consistent with a common factors perspective will also be described. These strategies will be placed in the broader context of the EBP framework to suggest possible advances in social work practice and research.

Examining Externalizing Behavior Trajectories of Youth in Group Homes : Is there Evidence for Peer Contagion?

Although concerns about peer contagion are often cited in critiques of group treatments for troubled youths, few studies have examined the effects of exposure to deviant peers in residential group care settings. This study used administrative data of youth served at Boys Town, a nationally-known group care provider. Using latent class growth analysis, this study identified the externalizing behavior trajectories of youth in group care as well as the behavior trajectory of the peers with whom they lived, assessed the relationship between youth trajectory classes and individual and peer group characteristics as well as the relationship between an individual youth’s behavior pattern and the behavior pattern of proximal peers. Several results suggested the presence of peer contagion in group care: a trajectory class of gradually increasing externalizing behavior problems, the strength of deviant peer density in predicting an individual youth’s externalizing behavior trajectories and significant associations between behavior patterns of youth and proximal peers. While there is some evidence that suggests an increase in problem behavior during care, results from this study indicated that over 90% of the youth did not have an increase in problem behaviors and that positive peer influences may also be protective and inhibit problem behaviors.

Outcomes of Group Care for Youth: A Review of Comparative Studies

Objective: The purpose of this study was to review empirical evidence of the effects of placement in group care compared to other interventions. Method: Two-group empirical studies were identified and effect sizes for all reported outcomes were calculated. Results: Nineteen two-group studies were found that compared group care with family foster care, treatment foster care, no placement, and different group care models. Most effects were small to moderate, with strongest effects for shorter lengths of stay for family-centered group care models and decreased delinquency for Multidimensional Treatment Foster Care (MTFC) compared to group care. Conclusion: Based on the limited number of two-group studies of varying quality, outcomes of group care are often worse than alternative interventions. However, some group care models seem more promising than others.

Translating the Common Elements Approach: Social Work's Experiences in Education, Practice, and Research

The expansion of the use of evidence-based practices (EBPs) in mental health services is well under way and social work seeks to further its appropriate implementation in both specialty and nonspecialty mental health settings. The common elements approach is now recognized as demonstrating promise for use in a range of settings. This article discusses the attractiveness of the common elements approach and describes several efforts to integrate its content into social work education and to disseminate this approach into the field. Then the article presents research initiatives regarding two areas of nonspecialty mental health practice with children and families: (a) engaging clients in mental health services and (b) preventing the need for out-of-home placement for youth. Finally, we consider the challenges of the common elements framework for social work education and practice and future directions for research.

Evidence-Based Practice at a Crossroads: The Emergence of Common Elements and Factors

Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of manualized evidence-supported treatments. For social work, the path to implementing the delivery of science-informed practice remains at a crossroads. This article describes two emergent strategies that offer a plausible means by which many social workers can integrate an EBP model into their service delivery—common factors and common elements. Each strategy will be presented, and related evidence provided. Tools to implement a common elements approach and to incorporate client feedback consistent with a common factors perspective will also be described. These strategies will be placed in the broader context of the EBP framework to suggest possible advances in social work practice and research.

Measuring Quality in Residential Treatment for Children and Youth

SUMMARY As residential programs face increasing accountability, measuring performance takes on added importance. This paper presents several frameworks for understanding what quality is and how it can be measured in a residential treatment setting. To assess performance, quality indicators and standards must be created. Two contributions to measuring program quality are presented and reviewed. Recommendations are made regarding future directions in developing quality measures. Research advancements in measuring performance must be guided by practitioners and other stakeholders. Research-practice collaborations will be pivotal in moving quality residential care forward.

Identifying and predicting problem behavior trajectories among pre-school children investigated for child abuse and neglect.

OBJECTIVE Young children involved with child welfare services are at high risk for behavior problems. This study aims to identify externalizing behavior paths that preschoolers in this high-risk population follow over a 6 year period, and the predictors of membership in normative and problematic pathways. METHODS Using data from the National Study of Child and Adolescent Well-being (NSCAW), the sample included 246 4-year-olds who remained home after investigation. Latent class growth analysis (LCGA) was used to estimate the number, size, and shape of subgroups of preschoolers following distinct behavioral pathways. Early predictors of membership in the resulting groups were then examined. RESULTS Four groups of preschool children following distinct behavior trajectories over 6 years were identified. Weighted results show that more than half (61%) of the children followed a low/normal problem behavior trajectory while just over one tenth (12%) were on a persistent high trajectory, remaining in the clinical range throughout the study. Improving (23%) and worsening (4%) problem behavior groups were also identified. Internalizing problems, attention problems, child ethnicity, and maltreatment type reported at age 4 predicted membership in the trajectory groups. CONCLUSIONS Internalizing behavior problems and maltreatment type may distinguish preschool children who are more likely to experience worsening or persistent problematic externalizing behaviors from those likely to follow a normal behavior trajectory. PRACTICE IMPLICATIONS Identifying early indicators of externalizing behavior problems and addressing them with evidence-based interventions to reduce negative behaviors may avert long-term negative outcomes.

Program and Practice Elements for Placement Prevention: A Review of Interventions and Their Effectiveness in Promoting Home-Based Care

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

Outcomes for Youth Residential Treatment Programs Using Administrative Data from the Child Welfare System: A Risk-Adjustment Application

This study assessed whether administrative data from the public child welfare system could be used to develop risk-adjusted performance reports for residential mental health programs for adolescents. Regression methods were used with 3,759 residential treatment spells for 2,784 children and youth to determine which outcomes could be adequately risk adjusted for case mix. Expected outcomes were created for each residential program given its case mix; then, expected and achieved outcomes were compared. For most programs, achieved results did not differ significantly from expected results for individual outcomes. Overall, outcomes achieved were not impressive. Only one quarter of spells resulted in a youth being maintained in a single less restrictive setting in the year following discharge. Methodological implications of this study suggest further refinements are needed for child welfare administrative data in order to develop risk-adjusted report cards of program performance.

Circle of Courage: Reaching Youth in Residential Care.

ABSTRACT The Circle of Courage, based on traditional Native American philosophy, emphasizes belonging, mastery, independence, and generosity. This study assessed the prevalence of the Circle of Courage values among youth in a residential facility and examined the relationship between these ideals and indicators of placement success. After 12 weeks in placement, youth (n = 29) completed a semi-structured interview about their experiences with the four Circle of Courage values. Twelve weeks later, the interview was re-administered to 26 youth still in placement. Administrative records were used to measure youths success in placement. Findings suggest a positive relationship between youth reports on experiencing the Circle of Courage values and achieving success in placement.