Using Research in Practice: The Benefits of Using Literature Reviews to Guide the Peer Quality Case Review Process

1
Using Research in Practice The Benefits of
Using Literature Reviews to Guide the Peer
Quality Case Review Process

• Susan Brooks
• Northern California Training Academy
• August 2009

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What well look at

• Why evidence matters
• The benefits of using research evidence in
  practice
• How research can be used
• Factors that help hinder evidence use
• Some examples of using research to inform the
  Peer Quality Case Review Process

Material adapted from Module 1 of The Evidence
Guide, Barnardos, 2006
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Why make use of evidence?
By making research work better for services we
can

• Improve outcomes for service users avoid
  investing in approaches that make no apparent
  difference
• Improve accountability to stakeholders
• Increase objectivity and fairness in
  decision-making
• Increase confidence in and quality of decisions
• Develop good practice and increase the
  credibility of services
• Develop more skilful and knowledgeable
  practitioners
• Question ourselves and our beliefs and have their
  worth confirmed, or discard them as appropriate

(The Evidence Guide, Barnardos, 2006)
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Some questions for services

• How are services planned?
• What information/evidence is used?
• How relevant and current is it?
• How do we know services work?
• Is it the best way?
• What are the alternatives?

(The Evidence Guide, Barnardos, 2006)
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How can research be used?
See Macdonald (2001)
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Models of increasing research use

• The research-based practitioner model
• Focus on professional education training to
  develop practitioners' skills in using research.
• The embedded research model
• Evidence about 'what works' becomes embedded
  in policies, guidelines and practice tools
• (Approach used in the Peer Quality Case Review
  Process)
• The organisational excellence model
• Emphasis on developing a 'research-minded'
  culture within the organisation.

SCIE Knowledge Review, Walter et al, 2004
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Levels of Evidence

• Effective-achieves child/family outcomes, based
  on controlled research (random assignment), with
  independent replication in usual care settings
• Efficacious-achieves child/family outcomes, based
  on controlled research (random assignment),
  independent replication in controlled settings
• Not effective- significant evidence of a null,
  negative, or harmful effect
• Promising-some positive research evidence,
  quasi-experimental, of success and/or expert
  consensus (typically what is cited in child
  welfare research)
• Emerging -recognizable as a distinct practice
  with face validity or common sense test

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Using research to INFORM practices
Appropriate for this client?
Contextual Assessment
Clinical State Circumstances
Valid Assessment?
Clinical Expertise
Client Preference or Willing to Try?
Client Preferences and Actions
Research Evidence
Effective Services
Cultural Barriers?
Source Shlonsky and Wagner, 2005
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Overall Purpose of the Peer Quality Case Review

• PQCR increases understanding of local practice
• Informs SIP strategies
• (Practice changes system changes that support
  changed practices)
• Use literature reviews (the research) to better
  inform the practice of attaining understanding of
  local practices and SIP strategies

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Example of using a literature for the Peer
Quality Case Review
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Factors, Characteristics, and Practices Related
to Former Foster Youth and Independent Living
Programs A Literature Review
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Purpose of this Review

• Examine
• Factors related to experiences former foster
  youth face in transitioning to independent living
• Characteristics of Independent Living Programs
  (ILPs)
• Factors related to successful transitions for
  former foster youth
• Use this review to guide county Peer Quality Case
  Reviews (PQCRs)
• Case Review Tools
• Interview Tools

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Background on Emancipating Foster Youth

• Some of most vulnerable citizens in California
  due to higher rates of
• High school drop outs
• Homelessness
• Criminal Involvement
• Hospitalization for injury
• Risk for mortality and morbidity
• Dying from violence and accidents
• (Barth, 1990 Piliavin, Wright, Mare,
  Westerfelt, 1996 Sabotta Davis, 1992 Widom,
  Ireland, Glynn, 1995)

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Routes for Exiting Foster Care

• Majority exit when reunited with families,
  adopted, or emancipated
• Alternate routes running away, incarceration,
  entering psychiatric hospital, or death (Courtney
  Barth, 1996)
• 10,363 foster youth ages 16-18 exited all types
  of care in California in 2008 (Needell et al.,
  2009)

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Understanding the Transition to Exiting Foster
Care

• 1st step Examining conditions and
  characteristics that lead to each type of exit
• Factors associated with method of exiting foster
  care
• of foster care spells (time between entry and
  exit)
• of weeks in foster care
• Type of last placement

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Understanding the Transition to Exiting Foster
Care (continued)

• High of spells in foster care associated with
  unsuccessful exit
• Youths who spend more time in foster care are
  more likely to be emancipated
• Placement in group care associated with lower
  chance of emancipation

• McCoy, McMillen Spitznagel (2008)
• Some youth discharged prematurely for arbitrary
  reasons and/or without notice
• Troubled youth (those with behavior problems,
  drug alcohol consumption), youth with multiple
  placements in last year, and youth with history
  of living on streets leave care earlier than
  other youth
• Study suggests most troubled youth need early
  services to prepare them for transition to
  independence or an Independent Living Program
  (ILP)

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Independent Living Programs

• Assists current and former foster youth to become
  self-sufficient in transition out of foster care
  system (Foster Care Independence Act of 1999)
• Those eligible
• Foster youth prior to day before 21st birthday
• Foster youth in system between their 16th and
  19th birthday
• Youth participated in Kinship Guardianship
  Assistance Payment Program (Kin-GAP)

• ILP services in CA
• Housing assistance
• Employment assistance
• Educational resources
• Financial assistance with college/vocational
  schools
• Daily living skills
• Money management
• Decision making
• Self esteem programs

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Benefits of ILPs

• ILP youth (vs. other foster care) in California
• More likely to receive information about
  financial aid in high school
• Significantly younger when beginning college
• Receive information on training associated with
  independent living opening bank account,
  obtaining care insurance, balancing checkbook,
  finding place to live
• (Lemon, Hines, Merdinger, 2005)

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Factors Associated with Successful Transitions

• Resilience factors for foster youth in transition
  to adulthood and independent living (Daining
  DePanfilis, 2007)
• Child Factors
• Gender Females have higher rates of success than
  males
• Age Youth with an older age at exit have higher
  rates of success
• Mental Health Youth with lower levels of
  perceived stress have higher rates of success
• Relationships with Family Higher levels of
  social support from friends and family associated
  with greater resilience

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Factors Associated with Successful Transitions
(continued)

• Mentoring Relationships
• 75 of former foster youth identified supportive,
  non-kin mentor but 25 of youth could not
  (Munson McMillen, 2009)
• Having a mentor associated with fewer symptoms of
  depression, less perceived stress, and greater
  satisfaction with life 6 months later (Munson
  McMillen, 2009)
• Support of long-term mentor associated with lower
  likelihood of being arrested and less perceived
  stress (Munson McMillen, 2009)
• Researchers suggest mentors be included in
  service provision process inform mentors about
  resources available to foster youth and provide
  funds to buy youth necessary instrumental items
  (Greeson Bowen, 2008)

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Factors Associated with Successful Transitions
(continued)

• Service/Program Factors
• Different outcomes for residential education
  (e.g. boarding schools) vs. therapeutic
  residential treatment programs
• Residential education programs place emphasis on
  education (Barth Lee, 2009)
• 50 of youth enrolled in these schools enter
  college
• 19 enter vocational program or military
• 18 enter the workforce
• These programs provide lengths of stay that
  promote educational stability, encourage family
  involvement in youths education, and provide
  family-type environment with live-in house
  parents
• Viable alternative for foster youth facing
  instability in the system, but who are committed
  to education

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ILPs and Youth Outcomes

• Research suggests ILPs are beneficial for youth
  (Montgomery, Donkoh, Underhill, 2005)
• Nearly all studies report higher rates of high
  school enrollment and completion, and vocational
  school or college attendance
• Majority of studies report positive associations
  with employment outcomes
• All studies reported generally favorable housing
  outcomes (e.g. living independently and paying
  own expenses)
• Limited/Inconclusive research in associations
  between ILPs and homelessness, health outcomes,
  criminality, and self-sufficiency

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Future Focuses for ILPs

• Focus on access to stable housing
• Collaborations with local housing providers,
  local landlords, subsidized rent (Naccarato
  DeLorenzo, 2008)
• Focus on educational stability
• Emphasize birth family involvement in education
  throughout educational career
• High teacher and case workers expectations for
  achievement
• Connections between child welfare agencies and
  schools (Naccarato DeLorenzo, 2008)

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Future Focuses for ILPs (continued)

• Focus on establishing/maintaining supportive
  relationships
• Find suitable foster families for most troubled
  youth
• Incorporate relationship building services into
  ILPs (e.g. relationship-focused therapy)
  (Berscheid, 2003)
• Focus on employment experiences
• Emphasize vocational training and formal training
  programs that result in employment
• Collaborations between child welfare agencies and
  employers can promote long-term, stable
  employment opportunities for former foster youth
  (Naccarato DeLorenzo, 2008)
• Californias Regional Occupational Program offers
  variety of educational/job training services
  throughout local school districts with more than
  100 occupational areas

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Specific Recommendations for ILPs

• Develop and provide ILPs tailored to needs of
  each youth with clear goals and outcomes
• Provide aftercare services post-discharge,
  especially case management and crisis
  intervention
• Collaborate with caregivers and other service
  providers responsible for youth
• Develop and maintain sufficient housing programs
• Encourage youth to attend and complete college
• Do not set low expectations for foster youth
• Share information about effective ILP strategies
  and practices amongst ILP coordinators
• (Naccarato DeLorenzo, 2008)

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Promising Practices

• Use of mentors and advocates!
• Provide emotional and instrumental support
• Advocate enrollment and continued participation
  in ILPs for youth
• Provide a reliable network for assessing needs
  and services
• Early introduction of ILP services
• Youth need ILP services long before they are
  ready to emancipate
• Most troubled youth likely to exit system
  unsuccessfully around the time they become
  eligible for an ILP
• ILP services should start as youth enter
  adolescence
• Youth should be a part of the decision making
  process for their transition

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Applications for the Construction of Case Review
and Interview Tools

• We know that
• Foster youth that are older have higher success
  rates than those that exit the system at younger
  ages
• Question What services does our county offer to
  encourage and promote youths willingness to stay
  in the system to meet eligibility requirements
  for ILPs?
• For a specific case review What range of
  services did this child receive prior to exiting
  foster care?

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Applications for the Construction of Case Review
and Interview Tools

• We know that
• Mentoring relationships are vital for youth both
  during and after exiting foster care
• Question What type of advising/mentoring
  services does our county provide for youth in the
  foster care system and upon entering into ILPs?
• For a specific case review Was this child
  offered any opportunities for developing
  mentoring relationships?

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Applications for the Construction of Case Review
and Interview Tools

• We know that
• Youth need ILP services long before they are
  ready to emancipate
• Question What type of services are foster youth
  provided and when are they receiving them?
• For a specific case review What services related
  to independent living did this child receive and
  how long did the child have to wait before
  receiving such services?

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Inform Focus Groups for PQCR

• Who to include
• Based on the literature,
• Have a group of foster youth who recently
  emancipated
• Have a group of foster youth who are currently
  receiving ILP services and have not emancipated
• If feasible include a group of youth
  participating in residential education programs
  and therapeutic residential programs
• Also include a group of staff who work in these
  two different residential settings

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Conclusion

• Former foster youth are at a distinct
  disadvantage in early adulthood in the areas of
  education, housing, employment, economics, and
  health - BUT
• Research suggests ILPs positively contribute to
  youth outcomes in domains of education and
  employment
• Focus on early enrollment in ILPs, fostering
  mentor relationships, and providing extended
  aftercare services!