Evidence based approaches to assessment of children and families

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Evidence based approaches to assessment of
children and families

• Liza Bingley Miller
• National Training Coordinator
• Child and Family Training
• www.childandfamilytraining.org.uk

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Assessment Framework A map of relevant data
(information) to be collected
Health
Basic Care
Education
Ensuring Safety
Emotional Behavioural Development
Emotional Warmth
Identity
CHILDS DEVELOPMENTAL NEEDS
PARENTING CAPACITY
CHILD Safeguarding promoting welfare
CHILD Safeguarding promoting welfare
Stimulation
Family Social Relationships
Guidance Boundaries
Social Presentation
Stability
Selfcare Skills
FAMILY ENVIRONMENTAL FACTORS
Income
Community Resources
Housing
Employment
Familys Social Integration
Family History Functioning
Wider Family
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Evidence-based assessment tools to gather data

• In collaboration with the Department of Health
  and the
• Department for Children, Schools and Families
• Family Pack of Questionnaires and Scales
• Home Inventory
• Family Assessment
• In My Shoes
• In collaboration with Royal Holloway, University
  of London
• Attachment Style Interview

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Principles underpinning the Assessment Framework

• Assessments
• are child centred
• are rooted in child development
• are ecological in their approach
• ensure equality of opportunity
• involve working with children and families
• build on strengths as well as identify
  difficulties
• are inter-agency in their approach to
  assessment and provision of services
• are a continuing process, not a single event
• are carried out in parallel with other action
  and providing services

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Using evidence-based assessment tools

• Goals
• The goals are to
• Develop an understanding of the nature and level
  of a childs needs
• Gain an understanding of factors affecting the
  child, and their needs
• Develop partnerships
• Prepare for intervention if necessary

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Using evidence-based assessment tools

• Value
• Research into Practice
• Standardisation stimulus, administration, what
  is scored and how it is scored
• Norms, reliability statistical validity
• Structured assessment process
• Give a "voice" to respondents
• Guidance on strengths needs (child development
  factors affecting their needs)
• Additional data
• Assessment of change

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Using evidence-based assessment tools

• Limitations
• defined focus
• statistical validity (for scoring) but for
  individual case in particular context on
  specific occasion cannot guarantee validity
• Good assessments use multiple sources of
• information. An assessment should not rely
  on one source of information.

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Evidence-based assessment tools
The HOME Inventory (Home Observation for
Measurement of the Environment)
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Introduction to the HOME Inventory

• The HOME Inventory is a standardised assessment
  of a childs home environment.
• The HOME uses a combination of direct observation
  along with an interview with the main carer and
  child
• There are three HOME inventories for children
• 0 - 3 years
• 3 - 6 years
• 6 - 10 years
• Early adolescent
• Disabled childrens inventories
• Each inventory contains groups of scales to
  assess different aspects of parenting and the
  childs environment.
• Each scale contains a number of items scored
  according
• to a glossary.

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The HOME inventory contents of record form

• Parental actions
• Household objects
• Family events
• Residential conditions

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Contents of the HOME Inventory sub-scales
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The Strengths of the HOME Inventory

• The HOME is one of the few instruments that
  addresses most aspects of the home environment
  that directly impact on the child, including the
  parenting capacity domain of the Assessment
  Framework
• Gives information about other issues and areas of
  the child's life
• The HOME has a number of sub-scales and therefore
  identifies areas of strength as well as difficulty

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The Strengths of the HOME Inventory

• Its approach is similar to that already used by
  social workers - it is interview-based, with some
  observation
• The HOME is a very flexible tool - there is no
  single way to conduct the HOME
• Requires some training but is relatively easy to
  administer
• User-friendly for families
• The different inventories have been shown to good
  predictors of a childs development cognitively
  (i.e. language and IQ), socially and emotionally

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Evidence-based assessment tools
Family Pack of Questionnaires and Scales
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The Family Pack of Questionnaires and Scales

• Strengths and Difficulties Questionnaires
• Parenting Daily Hassles Scale
• Home Conditions Scale
• Adult Wellbeing Scale
• Adolescent Wellbeing Scale
• Recent Life Events Questionnaires
• Family Activity Scale
• Alcohol Scale

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Using the Questionnaires and Scales in Practice
Questionnaire and Scales Discussion
Guidance on presence and extent of problem
Increased understanding of the familys situation
Shared by
Parent(s) Child or Young Person Practitioner
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Evidence-based assessment tools
The Family Assessment assessment of family
competence, strengths and difficulties
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The Family Assessment model of family functioning
Roles and responsibilities and adapting to family
life cycle
Promoting development
Nature of attachments
Making decisions and problem-solving
Guidance care and management
Conflict management
Wider family and community
Expression and reception of messages
Individual autonomy
Family togetherness
Involvement
Intergenerational boundaries
Continuity
Expression and reception of feelings
Couple
Parents
Nature of relationships
Parent-child
Involvement
Siblings
Atmosphere
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The Family Assessment assessment of family
competence, strengths difficulties

• model of family functioning
• methods and techniques for
• working with families
• structure process for collecting
• and recording information and for
• analysis, assessment and planning

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Family Assessment process
Observation/Listening
Description
Quantitative
Qualitative
Evidence based assessment evidence
Analysis
Planning interventions and outcomes
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Developing an Evidence Based Qualitative
Assessment
General/Abstract Specific Vague
Examples details of specific
behaviours/interactions Ambiguity
Clarity Opinion Fact Opinion speculations
or assumptions
Hypothesis for testing need for more
information to confirm\disconfirm hypothesis
or
Information/facts professional judgements
evidence-based assessment
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Elements of The Family Assessment Family Profile
Current identified problem
Outcome for meeting needs of child/young person
The family profile
Profile of family competence, strengths and
difficulties
Comments by parents/carers
Family context and history
Impact on children
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The Attachment Style Interview (ASI) Bifulco et
al. 2002

• A semi-structured interview exploring and
  assessing partner relationship, quality of other
  support and attitudes about closeness/distance
  and overall adult attachment style.
• An hour-long interview and further time for
  coding and scoring
• 4-day training
• Manual and consensus meetings for reliability
• Practitioner researcher training available.

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The Attachment Style Interview

• Areas explored in semi-structured interview
• Demographics
• Parental loss and upbringing
• Current contact with parents and siblings
• Recent Life Events Questionnaire
• Support and attachment to partner/very close
  others
• Ability make and maintain relationships
• Attitudes towards relating to others
• Overall Attachment Style
• Parenting Style

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Attachment Style Interview (ASI)

• Assessment of
• Quality of marriage/partnership
• Quality of close supportive others
• Ability to make and maintain supportive
  relationships and use of support
• Secure, avoidant and ambivalent attitudes to
  attachment
• Overall attachment style and impairment in
  relating

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In My Shoes

• A computer assisted interview for communicating
  with children and vulnerable adults

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The matrix people, settings and emotions
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The matrix people, settings and emotions
people
emotions
settings
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(No Transcript)
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Assessment Framework A map of relevant data
(information) to be collected
Health
Basic Care
Education
Ensuring Safety
Emotional Behavioural Development
Emotional Warmth
Identity
CHILDS DEVELOPMENTAL NEEDS
PARENTING CAPACITY
CHILD Safeguarding promoting welfare
CHILD Safeguarding promoting welfare
Stimulation
Family Social Relationships
Guidance Boundaries
Social Presentation
Stability
Selfcare Skills
FAMILY ENVIRONMENTAL FACTORS
Income
Community Resources
Housing
Employment
Familys Social Integration
Family History Functioning
Wider Family
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Steps in analysis, planning interventions
identifying outcomes (1)

• Gathering information using the assessment tools
• What additional information do we need?
• Extracting information using the Assessment
  Framework
• Is the information in the correct domain and
  dimension?
• What do we know about the dimensions in each
  domain of the Assessment Framework triangle?

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Assessment Framework A map of relevant data
(information) to be collected
Health
Basic Care
Education
Ensuring Safety
Emotional Behavioural Development
Emotional Warmth
Identity
CHILDS DEVELOPMENTAL NEEDS
PARENTING CAPACITY
CHILD Safeguarding promoting welfare
CHILD Safeguarding promoting welfare
Stimulation
Family Social Relationships
Guidance Boundaries
Social Presentation
Stability
Selfcare Skills
FAMILY ENVIRONMENTAL FACTORS
Income
Community Resources
Housing
Employment
Familys Social Integration
Family History Functioning
Wider Family
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Steps in analysis and outcomes focused planning

• Met childs developmental needs
• What needs of the child are being met - and how?
• What are the consequences for the child if each
  particular need continues to be met
• (a) in the short term
• (b) in the long-term?

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Steps in analysis and outcomes focused planning

• Unmet childs developmental needs
• What needs of the child are not being met - and
  why?
• What are the consequences for the child if each
  particular need continues to be unmet
• (a) in the short term
• (b) in the long-term?

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Model of analysis and outcomes focused planning

• Principles in Analysis

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Principles underlying analysis

• In analysing the information we have collected,
  we need to consider
• Pattern the pattern of processes/influences
• Impact the impact/weight of factors and
  processes

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Principles underlying analysis
IMPACT

• Severity of difficulty the weight of negative
  processes.
• or
• Magnitude of strength the weight of positive
  factors processes

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Impact Severity of Difficulties and Magnitude
of Strengths (1)

• When considering severity/strengths of
• factors and processes, explore
• Intrusiveness the more a factor intrudes upon
  others the greater the concern/ benefit.
• Pervasiveness the greater the number aspects of
  child development, people, situations etc are
  impacted across, the greater the concern/benefit.
  

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Impact Severity of Difficulties and Magnitude
of Strengths (2)

• Modifiability to what extent do other actions or
  experiences alter a factor/process.
• Frequency the more frequent a factor/process,
  the greater its impact.
• Duration the longer duration of a
  factor/process, the greater the weight.
• Unusualness the more unusual a factor/process
  the greater likelihood of it being severe.

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Principles underlying analysisSummary
In general

• the more dimensions of domains that show
  difficulty
• the more frequently those difficulties are
  manifest
• the longer the difficulties have existed
• the less the difficulties are modifiable
• then the greater the severity of the problem

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Assessment Framework A map of relevant data
(information) to be collected
Health
Basic Care
Education
Ensuring Safety
Emotional Behavioural Development
Emotional Warmth
Identity
CHILDS DEVELOPMENTAL NEEDS
PARENTING CAPACITY
CHILD Safeguarding promoting welfare
CHILD Safeguarding promoting welfare
Stimulation
Family Social Relationships
Guidance Boundaries
Social Presentation
Stability
Selfcare Skills
FAMILY ENVIRONMENTAL FACTORS
Income
Community Resources
Housing
Employment
Familys Social Integration
Family History Functioning
Wider Family
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Planning interventions

• What are the options for interventions which
  might
  
• (a) help support strengths /or (b) help meet
  the unmet needs?
• Towards which met/unmet need is each intervention
  targeted?
• What resources are available?
• Which of those available is the family most
  likely to cooperate with?
• Which intervention is likely to produce the most
  immediate benefit and
• which might take time?
• Which should be the sequence of interventions and
  why?
• What is the likelihood of achieving sufficient
  change within the childs
• timeframe?

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Assessing Outcomes

• What would indicate whether the intervention(s)
  have worked or are beginning to work?
• Interventions may be directed to any dimension in
  any domain

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Assessing Outcomes

• The key outcome is the childs developmental
  progress
• The aims are to assess
• Whether the child has progressed and in which
  dimensions
• How improvements or deteriorations have come
  about.

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Hypotheses

• The analysis of pattern and impact leads to
• hypotheses about where interventions might be
• directed

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Assessing Outcomes

• To assess the childs developmental progress and
  whether interventions are working there must have
  been a baseline assessment of
• Childs Developmental Needs
• Factors hypothesised to be affecting them

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Assessing Outcomes

• Baseline and follow up measures need to be
• Valid measure what they are intended to measure
• Reliable replicable over time, and give the same
  results when used by different assessors

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Assessing Outcomes

• Measures can be
• Standardised or
• Case specific

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Standardised measures

• Standardised measures are operationally defined
  in that
• the range of answers for Questionnaires is
  specified
• the ratings for scoring semi-structured
  interviews are guided by glossaries
• Standardised measures often provide population
  norms provide scores that can help understand the
  significance of any change

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Assessing Outcomes

• For case specific measures to be operationally
  defined they need to have agreed criteria for
  specified behaviour or experiences which can be
  counted or rated
• For example, how is it known that the parents
  relationship has improved?
• Frequency/number of times confided in last month
• Frequency/number of rows in last month
• Joint activity in last month

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The Prognosis for Change

• A hopeful outlook is present when there is there
  is a good possibility of change within the
  childs timeframe
• a reasonable degree of responsibility being
  taken, reasonable flexibility of relationships
• a reasonable balance of family strength and
  difficulties
• a potential for individual change with facilities
  and resources available
• not too highly negative attitudes to
  professionals who have to intervene in family life

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The Prognosis for Change

• A doubtful outlook category is applied
• when it is uncertain whether change can be
  achieved or not within the time frame of the
  child
• uncertainty about the degree of responsibility
  taken
• uncertainty about the potential for collaborative
  work

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The Prognosis for Change

• There is a poor outlook for achieving change
  when
• a child has been subject to serious abuse
• there is failure to take responsibility,
  considerable family difficulties with few
  strengths
• severe parental pathology, personality disorder,
  or a level of addiction which implies changes
  cannot be achieved within the childs timeframe
• If resources are not available to intervene given
  the severity of the situation