maria hernandez, m.s.w., omayra sellas-lamberty, m.a.,

46
Maria Hernandez, M.S.W., Omayra Sellas-Lamberty, M.A., Stephanie H. Scott, Ph.D., A.C.S.W., M.S.S.W.,

Upload: adolph

Post on 22-Feb-2016

69 views

Category:

Documents


0 download

DESCRIPTION

Maria Hernandez, M.S.W., Omayra Sellas-Lamberty, M.A., Stephanie H. Scott, Ph.D., A.C.S.W., M.S.S.W., . What is Cherish The Family (CTF) ?. The goal of CTF is :. - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Maria Hernandez, M.S.W., Omayra Sellas-Lamberty, M.A., Stephanie H. Scott, Ph.D., A.C.S.W., M.S.S.W.,

Page 2: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

What is Cherish The Family (CTF) ?

Page 3: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

The goal of CTF is:– to prevent the abandonment of children under age three who

are in the dependency system and who have been affected by substance abuse and/or HIV/AIDS.

– Targets mothers with children (0-3) engaged in the child welfare system

– Mothers confronting substance abuse and/or HIV/AIDs

– Complex needs with limited access to resources and supports that can help them

– Provide services to strengthen a parent’s ability to care for their children, specifically promoting family reunification and stability,

Page 4: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

What are the theories behind CTF?

Page 5: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Theoretical FrameworksAttachment Theory:

• Kelly and Zucherman, 2003 stated “children GROW AND THRIVE in the context of close and dependable relationships that provide love and nurturance, security, responsive interaction and encouragement for explorations. Without at least one such relationship, development is disrupted, and the consequences can be severe and long lasting. …Focusing on the caregiver-child relationship is essential, not only because caregivers’ interactions with their children are developmentally critical, but also because qualities of these relationships need on going support.”

Page 6: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Theoretical frameworks continued…

• strengthening emotional bonds, maximizing children’s chances for optimal psychosocial development, and interrupting the transmission of maladaptive parenting practices across generations.

• Systems Approach– Viewing the whole structure of systems and the

interrelationships across systems

• Trans disciplinary Approach – Sharing roles against discipline boundaries

Page 7: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Staffing• 1 Program Director (Part-time)• 1 Program Manager• 4 Master Levels Counselors • 1 Data Entry/Administrative

Assistant

Training• Master Level professionals with at

least two years of experience with at risk families –HIV, mental Health issues, Substance Abuse.

• Experience with children 0-5• Counselors will be trained in

implementation of Mahoney, PSI, and NCAST.

• Trained in promoting first relationships curriculum.

• Solution-Focused Therapy techniques through Reflective Supervision

Page 8: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Services we offer …

• Therapeutic parenting by utilizing a solution focused approach with the Promoting First Relationships Curriculum

• Social emotional support• Increasing their awareness of SA issues,

and mental health issues• Multidisciplinary meetings• Court Testimony

Page 9: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

CTF’s Approach• Collaboration with multiple

community providers– This allows for additional types of

visits such as extended visits, sibling visits, and visits at locations in the community

• Links families with – substance abuse to treatment– mental health services– job training and support

Page 10: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Partners

• ChildNet• Broward regional Health Planning Council• Spectrum• Smith Community Mental Health• Broward Addiction Recovery Centers (BARC)• Healthy Start Coalition of Broward County• Workforce one• The Ounce Prevention of Florida

Page 12: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Logic Model

Activities Short Term Outcomes Long Term Outcomes Measures

Cherish the Family:• Case Mgmt• Assessment• Family

Advocacy• Mental

Health Supportive Svcs

• Promoting First Relationships

• Teaching the Tough Skills

• Childcare• Circle of

Parents• Referral and

Follow-up

90% of participants (26 sessions) will report parenting behavior consistent with decreased risk of child abuse and neglect

Safety Outcome 1: Children are, first, and foremost protected from abuse and neglect

Children not reported in the DCF Abuse Registry (info provided every 6 mths by ChildNet)

85% of families (26 sessions) will reduce abuse, neglect, abandonment recidivism rates

Safety Outcome 2: Children are safely maintained in the home

N.C. Family Assessment Scale

Mahoney

Children are not removed from the home

80% of children will be placed in a stable, safe home at the completion of the program

Perm Outcome 1: Children have perm and stability in their living situations

Children are in home at 12 months

75% of parents will meet at least 75% of their IFSP goals

Perm Outcome 2: Continuity of family relationships and connections80% of participants will access support

services in the community

80% of parents will report healthy levels of engagement and self sufficiency

Wellbeing Outcome 1: Families have enhanced capacity

PSI

Page 13: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Logic Model Continued

Activities Short Term Outcomes Long Term Outcomes

Measures

Job Readiness Training

Technical Assistance for teachers at the

Child Care Centers

Community/System

80% of unemployed participants will participate in job readiness training

95% of teachers will apply knowledge of child development, parental attachment, and child needs in selecting activities for targeted children

To be determined

Wellbeing Outcome 1: Families have enhanced capacity

Participant attendance and certification

Wellbeing Outcome 2: Children receive appropriate services to meet their educational needs

Mahoney Behavioral Scale

To be determined Online Survey

Page 14: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Instruments

• Parenting Stress Index-Short Form

• North Carolina Family Assessment Scale-Reunification

• Mahoney Behavioral Scale

Page 15: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Parenting Stress Index-Short Form

• This measure is a brief version of the Parenting Stress Index

• Underlying Assumptions

– Could identify and diagnose individual parent-child systems under stress

• Child Characteristics– Parent’s perception of impact of child’s behavior on parent

• “At Risk Screening Tool”– Parent-child relationship could be a predictor of child’s later adjustment

Page 16: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Scales• Total Stress Score

– Primary score in guiding professional judgments as to whether professional intervention might be appropriate

• Parental Distress– Reflects a parent’s perception

of child-rearing competence, conflict with spouse, social support, and stressors associated with restrictions placed on other life roles

Page 17: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Scales

• Difficult Child– Surveys the parent’s view of the child’s

temperament, defiance, noncompliance, and demandingness

• Parent-Child Dysfunctional Interaction– Assesses a parent’s perception that the child

does not meet expectations and that interactions with the child are not reinforcing

Page 18: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

North Caroline Family Assessment Scale- Reunification (NCFAS-R)

• Introducing the NCFAS-R– Assessment and measurement of

family functioning in family based child abuse and neglect prevention/intervention programs.

– A worker administered rating scale– Provides pre and post measurement of

families that are served by family-based services providers

Page 19: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Scoring• Each subscale is rated using a 6-point Likert-type

scoring strategy• Each item is scored as follows:

– +2 = Clear Strength– +1 = Mild Strength– 0 = Baseline/Adequate– -1 = Mild Problem– -2 = Moderate Problem– -3 = Serious Problem

Page 20: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Mahoney Maternal Behavior Rating Scale (MBRS)

• An observational instrument designed to assess the quality of observed parent-child interactions

• Evaluates the quality of maternal interactive behaviors

• Consists of a 10-minute video tape interaction between the parent and child

Page 21: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

MBRS– 12 items utilize a 5-point Likert Scale which differ for

each domain– 4 domains

• Responsiveness• Affect• Achievement• Directiveness

Page 22: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Subscales

• Responsiveness– Sensitivity to child’s interests: Parent seems

aware and understands the child’s activity or play interests

– Responsivity: Appropriateness and consistency of the parent’s responses to the child-facial expression and signs of discomfort.

– Effectiveness: Ability to engage child in play interaction

Page 23: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Subscales• Affect

– Acceptance: Approval of child and child’s behavior

– Enjoyment: Parent’s enjoyment interacting with the child

– Expressiveness: Tendency of caregiver to react emotionally toward the child

– Inventiveness: Range of stimulation parent provides to his or her child

– Warmth: Holding, caresses, kisses, hugs, tone of voice, and verbal endearments

Page 24: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Subscales• Achievement Orientation

– Achievement: Encouragement of sensorimotor and cognitive achievement

– Praise: Amount of verbal praises

• Directive– Directiveness: Frequency and intensity of

parent’s requests, commands, or attempts to direct child’s immediate behavior

– Pace: Parent’s rate of behavior, regardless of child’s rate

Page 26: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Demographic Findings

• 76 CTF Participants• 69 in comparison group

Page 27: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

CTF Participant ages

Page 28: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Comparison Group Ages

Page 29: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Education• There are a variety of

education levels in both groups

• CTF participants have higher levels of education.

Page 30: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,
Page 31: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,
Page 32: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

North Carolina Family Assessment Scale-Reunification

• Child wellbeing was found to be statistically significant at both time 1 and time 2 – treatment group having significantly better

scores than the control group. • Both groups made positive gains between

the three data points– most notable gains were family safety, child

wellbeing, and readiness for reunification

Page 33: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

North Carline Family Assessment Scale-Reunification

– 1= clear strength– 2= mild strength– 3= baseline/adequate– 4= mild problem– 5= moderate problem– 6= serious problem– 7= not applicable– 8= unknown

Domain Treatment (Time 1)

Control (Time 1)   Treatment (Time 2)

Control (Time 2)

  Treatment (Time 3)

Control (Time 3)

Environment 3.76 3.79 3.20 3.00 2.85 5.54

Parental Capabilities 4.48 4.13 3.45 2.95 2.51 2.58

Family Interaction 3.74 3.93 3.17 3.12 2.55 2.71

Family Safety *3.38 4.02 2.52 3.00 2.58 2.39

Child Wellbeing *3.92 4.21 *3.08 3.68 2.30 3.28

Caregiver/Child Ambivalence 3.84 3.81 3.25 3.06 2.67 2.56

Readiness for Reunification 4.69 4.75 3.58 3.17 3.02 2.52

Page 34: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Parenting Stress Index-Short Form

• Scale– 1=low stress (1-15 percentile)– 2=normal (16-60 percentile)– 3= Borderline stress (81-84 percentile)– 4= Clinically Significant (85 and above)

• It is noteworthy that the scores below decreased indicating that parents demonstrated improvements in the areas of feeling healthier and a reduction in overall stress.

Page 35: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Defensive Responding

Page 36: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Total Stress

Page 37: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Parental Distress

Page 38: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Dysfunctional Interaction

Page 39: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Difficult Child

Category 1 Category 2 Category 30

5

10

15

20

25

30

Clinically SignificantNot Clinically Significant

Page 40: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Maternal Behavior Rating Scale• Rating Example

– 1=highly inexpressive– 2=low overt expressiveness– 3=moderate overt

expressiveness– 4=overtly expressive– 5=highly expressive

Domain Time 1 (Intake)

Time 2 (6-Months)

Responsiveness/ChildOriented

2.67* 3.29*

Affect/Animation 2.77 2.96

Achievement Orientation 1.93 2.04

Directive 2.82 2.64

Page 41: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Maternal Behavior Rating Scale

Page 42: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Qualitative look at CTF

• Maternal behavior– Before and after

Page 43: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

Strengths

• Small case loads- 12 families which provide an opportunity to work closely with family (engagement- support- and all the therapeutic services).

• Promotes fair opportunities for parents to be reunified with their children through referrals and one on one support.

• Systemic approach to problem solve issues the parent and family faces.

• A solution focused approach that allows the family to strengthen and build their strengths.

• Ensures effective coordination of services to support the family (providers-foster placement and child advocate).

Page 44: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

• Families feel they are learning, and the support received has helped them to increase awareness, communication, and achieve their goals (remain engage in case plan.)

• The program has provided financial support to families that have reunified.

• The program has facilitated payment for services such as psychological evaluations, and individual therapy.

Page 45: Maria Hernandez, M.S.W.,  Omayra Sellas-Lamberty, M.A.,

In my words ….• “It’s nice to have someone support

me and look at me in a positive light. The court looks at me like I’m a bad person so it’s nice to have at least one person on my side.” (Cherish the Family Participant)

• “If I was by myself, I wouldn’t think I would get my children back. Because I have someone helping me through this, I’m hopeful that I will get my kids back. Now I look at things more positive. Before, I was very negative and felt alone.” (Cherish the Family Participant)

• “I feel like I have someone on my side, helping me through this process.” (Cherish the Family Participant)