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

2. What we’ll 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, Barnardo’s, 2006

3. 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, Barnardo’s, 2006)

4. 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, Barnardo’s, 2006)

5. Tohelp staff understand the needs of service users To illustrate ‘what works’ To make the reasons for decisions about services transparent. To inform service users and carers of what the research says To help decide which interventions or services to support Toprovide staff with new and innovative practice ideas How can research be used? See: Macdonald (2001)

6. 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

7. 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

8. 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

9. 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

10. Example of using a literature for the Peer Quality Case Review

11. Factors, Characteristics, and Practices Related to Former Foster Youth and Independent Living Programs: A Literature Review

12. 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

13. 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) Background on Emancipating Foster Youth

14. 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)

15. 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

16. 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) 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

17. 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 Independent Living Programs

18. 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) Benefits of ILPs

19. 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

20. 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)

21. 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 youth’s 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

22. 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

23. 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 worker’s expectations for achievement Connections between child welfare agencies and schools (Naccarato & DeLorenzo, 2008) Future Focuses for ILPs

24. 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 inemployment • Collaborations between child welfare agencies and employers can promote long-term, stable employment opportunities for former foster youth (Naccarato & DeLorenzo, 2008) • California’s Regional Occupational Program offers variety of educational/job training services throughout local school districts with more than 100 occupational areas

25. 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)

26. 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

27. 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?

28. 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?

29. 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?

30. 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

31. 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!