Expanding Evidence-Based Practice to Service Planning in Child Welfare

Child Maltreatment 2015, Vol. 20(1) 20-22 ª The Author(s) 2015 Reprints and permission: DOI: 10.1177/1077559514566299

Benjamin E. Saunders1 Keywords evidence-based practice, child welfare services, child welfare

The report by the American Professional Society on the Abuse of Children. (APSAC) Task Force on Evidence-Based Service Planning (EBSP) Guidelines in Child Welfare (2015) represents a major step forward for the child maltreatment field. Although many organizations have promulgated guidelines concerning different aspects of child welfare practice (Child Welfare League of America, 2014; National Association of Social Workers, 2013), this report expands the reach of the core principles of evidence-based practice (EBP) by applying them to child welfare service planning. If implemented, the principles described in the report will have a major impact on how child welfare does its work.

Key Points in the Report EBSP Is More Than Simply Including a List of EvidenceBased Interventions (EBIs) EBSP involves using the principles of EBP (American Psychological Association, 2005; Institute of Medicine, 2001) in service planning. This means conducting sound assessments; identifying specific, measurable intervention goals directly related to the difficulties experienced by the family; using critical thinking to select the most effective interventions and trained service providers to meet these goals; problemsolving obstacles to child and family engaging in and completing the interventions; ongoing monitoring of progress toward the goals; altering the treatment plan if needed in response to progress (or lack thereof); and carefully assessing whether or not positive outcomes have been achieved. These advanced practice skills go far beyond compiling a list of services.

Safety, Permanence, and Well-Being Are Intertwined Goals That Affect One Another The Child Welfare System (CWS) traditionally has been most attentive to the goals of safety and permanence, with wellbeing sometimes treated as a secondary goal. As described in the report, well-being is necessary for safety and permanence as well as the converse. Reframing achieving better well-being as a primary approach to achieving long-term

safety and permanence would be an important shift in focus for many child welfare agencies.

Triage, Parsimony, and Efficiency as Guiding Principles of Evidence-Based Service Plans When it comes to children and families engaging in services, more is rarely better (Saunders, 2012). However, for true parsimony and efficiency in services to be achieved, these principles must cut across all involved agencies and providers. If service planning by individual providers occurs without an understanding of the total service experience of the family, parsimony and efficiency are unlikely. Collaboration among all professionals involved in a case, awareness of each other’s plans, and sensitivity to the full burden being placed on families is required.

Focus on Outcomes Rather Than Participation in Services Goals and monitoring activities in child welfare frequently are directed to client participation in services rather than functional outcomes. Participation goals are problematic since they frequently are met, but do not result in any meaningful change in the real problems that are a concern for child welfare. The shift from participatory to outcome goals proposed in the guidelines would be an extraordinarily meaningful change for child welfare service plans.


National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA Corresponding Author: Benjamin E. Saunders, National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861 Charleston, SC 29425, USA. Email: [email protected]

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Child Welfare Has an Ethical Duty to Ensure That Mandated Services Are Likely to be Effective Child welfare workers make determinations that client families need particular services, and often select the service providers and mandate participation. Most importantly, the CWS takes action based upon the outcomes of services. The actions taken can be extremely serious for the family, such as reunification of children with their parents, mandating further services, or even termination of parental rights. Therefore, developing an effective and feasible service plan is not only good practice, it is an ethical duty. Referring families to services with unknown or even questionable efficacy is at best a waste of time and an unnecessary burden on families. More concerning, these services can do great harm. When serious decisions are made based on poor outcomes due to ineffectual services, harm is much more likely. Equally problematic is the strong likelihood that many children and families will become ‘‘inoculated’’ against participating in any future services by being forced to go to poor ones. Families may be more reluctant to engage in highly effective services because their prior experiences have been so unhelpful. Therefore, doing an unknown or ineffective something is not necessarily better than doing nothing when it comes to service planning (Saunders, 2012). Child welfare workers traditionally have relied on the expertise of the service providers to make decisions about what interventions should be considered for families, believing it was not their role to ‘‘tell the therapist what to do.’’ EBSP implies that workers should have the requisite knowledge and skills to work with providers collaboratively, to question providers about the interventions they provide, and to ensure that their client families are receiving the most appropriate and effective interventions.

Collaboration and Coordination The lack of attention given in the report to the critical role of interagency and provider collaboration in achieving service plan goals is somewhat surprising. Collaboration is alluded to in the report, but in a curiously one-sided manner when strategies are suggested such as the CWS using its contracting and purchasing power to promote EBIs in communities, the CWS educating caseworkers about EBIs and the caseworkers monitoring services to ensure they are adhering to EBI models. However, the notion of building and conducting a service plan through meaningful collaboration and coordination with other community professionals involved in a case does not seem to be a primary focus of the stated principles of EBSP. This is a serious omission. Evidence-based service plans rely on communities having adequate capacity to deliver EBIs skillfully. Intervention success is dependent upon family engagement and service providers’ abilities to provide the EBI with adherence to the intervention model and with technical competence. In addition, success is more likely when there is a high degree of ongoing

coordination and collaboration between those referring families to services and those providing them (Bai, Wells, & Hillemeier, 2009). The principles and steps of EBSP described by the task force report would benefit from a greater emphasis on the benefits of multidisciplinary collaboration in the service planning process and the implementation of service plans. Community agencies frequently work in their own service silos. They focus on their own mandates, services, and procedures with little understanding or consideration of the work of other agencies or the total experience a family has with all the involved service agencies and professionals. Emphasizing collaboration in the guidelines would promote a more comprehensive view of the CWS, a sense of shared community responsibility for the well-being of children and families, better engagement in evidence-based services, and better outcomes.

Implications of EBSP for the Child Welfare Workforce To meet the practice responsibilities of EBSP, child welfare workers will need specific knowledge and skills. For example, they will need to be skilled at screening and assessment of common problems, case formulation, and developing measurable intervention goals. They will need to be knowledgeable of common standards for judging intervention effectiveness, know how to use tools that can help them identify appropriate EBIs, have sufficient knowledge of EBIs relevant to their case population, and be able to identify trained providers in their community in order to make proper referrals. They will need collaborative skills to interact with providers and families. They will need to understand how to monitor progress and outcomes, as well as a host of other skills necessary to implement EBSP and related practice activities. To do these functions, the CWS will require a highly trained workforce with skills beyond those currently required by most agencies today. At minimum, specialized training, effective supervision, and strong administrative support will be needed to successfully implement EBSP. An important question is whether the CWS is prepared and has the resources to provide the capacity to implement the task force guidelines. What are the needed steps to develop the knowledge and skills in the CWS workforce to implement EBSP? Fully implementing EBSP likely would require new resources for the CWS. For example, additional training on the knowledge and practice skills described and implied in the report would be needed. Additional training takes time and has real costs. Most significantly, doing EBSP and the associated practice activities is likely to take more time than using approaches that require less assessment, less critical thinking, less consultation, and less collaboration with providers and families. To accommodate the extra time, caseloads would need to be smaller, which mean the CWS would need additional caseworkers to serve the same number families. Increasing the workforce has obvious budget consequences. Are States willing to provide the additional resources needed to have the skilled workforce necessary to implement

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Child Maltreatment 20(1)

EBSP and other standards of best practice in child welfare? Too often, past calls for new resources have not been heeded (e.g., Sadler, 1999), so why should a new one be any different? One difference is that the field now has much more scientific evidence concerning the strengths of EBP and the efficacy of EBIs that can be used to support a claim of service improvement. Past calls have highlighted the serious problem of child maltreatment, but evidence of the professional community’s ability to intervene effectively was slim. Today, the intervention research literature is much more robust, and a great deal is known about effective methods of implementation. With stronger evidence for interventions that are effective and with increasing knowledge on how to disseminate them effectively, a sound and convincing rationale for the allocation of new resources to implement these Task Force Guidelines can be made. This is hopeful news for improving the lives of maltreated children and their families in the CWS. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

References American Psychological Association. (2005). Report of the 2005 presidential task force on evidence-based practice. Retrieved December 3, 2014, from Bai, Y., Wells, R., & Hillemeier, M. M. (2009). Coordination between child welfare agencies and mental health service providers, children’s service use, and outcomes. Child Abuse & Neglect, 33, 372–381. Child Welfare League of America. (2014). Standards of excellence for child welfare services. Retrieved December 3, 2014, from Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. National Association of Social Workers. (2013). NASW standards for social work practice in child welfare. Retrieved December 3, 2014, from Child_Welfare.asp Sadler, B. (1999). The vision: Why a national call to action. Child Abuse & Neglect, 23, 955–956. Saunders, B. E. (2012). Determining the best practice for treating sexually victimized children. In P. Goodyear-Brown (Ed.), Handbook of child sexual abuse (pp. 173–197). Hoboken, NJ: John Wiley.

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