Degrees of freedom and degrees of certainty: a developmental model for the establishment of evidence-based youth care

Working With the Encounter: A Descriptive Account and Case Analysis of School-Based Collaborative Mental Health Care for Refugee Children in Leuven, Belgium

Scholars increasingly point toward schools as meaningful contexts in which to provide psychosocial care for refugee children. Collaborative mental health care in school forms a particular practice of school-based mental health care provision. Developed in Canada and inspired by systemic intervention approaches, collaborative mental health care in schools involves the formation of an interdisciplinary care network, in which mental health care providers and school partners collaborate with each other and the refugee family in a joint assessment of child development and mental health, as well as joint intervention planning and provision. It aims to move away from an individual perspective on refugee children's development, toward an engagement with refugee families' perspectives on their migration histories, cultural background and social condition in shaping assessment and intervention, as such fostering refugee empowerment, equality, and participation in the host society. Relating to the first stage of van Yperen's four-stage model for establishing evidence-based youth care, this article aims to engage in an initial exploration of the effectiveness of a developing school-based collaborative mental health care practice in Leuven, Belgium. First, we propose a detailed description, co-developed through reflection on case documents, written process reflections, intervision, an initial identification of intervention themes, and articulating interconnections with scholarly literature on transcultural and systemic refugee trauma care. Second, we engage in an in-depth exploration of processes and working mechanisms, obtained through co-constructed clinical case analysis of case work collected through our practice in schools in Leuven, Belgium. Our descriptive analysis indicates the role of central processes that may operate as working mechanisms in school-based collaborative mental health care and points to how collaborative mental health care may mobilize the school and the family-school interaction as a vehicle of restoring safety and stability in the aftermath of cumulative traumatization. Our analysis furthermore forms an important starting point for reflections on future research opportunities, and central clinical dynamics touching upon power disparities and low-threshold access to mental health care for refugee families.

The Effects of TIME-IN on Emotion Regulation, Externalizing, and Internalizing Problems in Promoting School Readiness

Children's readiness for school is often threatened by the occurrence of both externalizing and internalizing problems. Previous research has shown that Positive Behavioral Interventions and Supports (PBIS) is particularly effective for fostering children's behavioral skills and reducing externalizing problems. However, whether PBIS can enhance children's emotional skills and reduce internalizing problems is less clear. Therefore, TIME-IN was developed, which extends PBIS by also including emotional support systems. It was tested whether TIME-IN was effective for (a) improving emotion regulation and (b) reducing depressive symptoms. Furthermore, it was tentatively explored whether TIME-IN is accompanied by more than natural fluctuations in both children's externalizing and internalizing problems. The effectiveness of TIME-IN was evaluated in a non-randomized study, in which an intervention group was compared with a matched control group. Both research questions were addressed in a sample consisting of 81 children between 8 and 12 years of age with special educational needs. Questionnaires for teachers (i.e., TRF), children (i.e., FEEL-KJ and CDI), and their parents (i.e., CBCL) were administered at the beginning (T0) and the end of the school year (T1) using multi-informant assessment. Only indicative evidence was found for the hypothesis that TIME-IN improved children's emotion regulation. Practical implications, strengths, and limitations were discussed. Clinical Trial Registration: This work was retrospectively registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry ISRCTN54456609 (Weymeis, 2017). Registered 28 March 2017.

[Establishing evidence-based prevention and health promotion: criteria for evidence-based interventions and necessary organizational requirements and capacities]

Für die Umsetzung des Präventionsgesetzes in einem sich entwickelnden System Prävention und Gesundheitsförderung (PGF) ist die Anforderung der Evidenzbasierung formuliert. Vor diesem Hintergrund stellt sich die Frage, welche Schritte, Prozesse und Vorgehensweisen in diesem System benötigt werden, um der Anforderung zunehmend gerecht zu werden. Dieser Übersichtsartikel diskutiert für Deutschland, wie evidenzbasierte Maßnahmen in der Praxis operationalisiert werden können und welche organisationalen Rahmenbedingungen und Kapazitäten für ein evidenzbasiertes Handeln von AkteurInnen notwendig sind.

Aufbauend auf internationalen wissenschaftlichen Erkenntnissen und dem Memorandum Evidenzbasierte Prävention und Gesundheitsförderung der Bundeszentrale für gesundheitliche Aufklärung (BZgA) wird zunächst das Verständnis von evidenzbasierten Maßnahmen erläutert und im Weiteren werden Elemente zur Umsetzung von mehr Evidenzbasierung skizziert.

Neben der transparenten und einheitlichen Darstellung in Datenbanken und Empfehlungen ist es notwendig, bei EntscheidungsträgerInnen in Praxis und Politik ein gemeinsames Verständnis von evidenzbasierten Interventionen und von Anforderungen für eine Evaluation, die Evidenzbasierung sichert, zu schaffen. Darüber hinaus kann evidenzbasiertes Handeln von EntscheidungsträgerInnen gefördert werden durch Wertschätzung gegenüber Evidenzbasierung in ihren Organisationen, durch Gewährleistung eines regelhaften Zugangs zu Evidenzdatenbanken, durch verbesserte Kompetenzen in Bezug auf Interpretation von Evidenz und durch eine systematische Zusammenarbeit mit der Wissenschaft.

Mehr Evidenzbasierung ist eine Voraussetzung für die nachhaltige Verankerung von PGF als fünfte Säule des Gesundheitssystems.

[Development of intervention databases to promote evidence-based prevention and health promotion-methodological considerations]

Municipal actors do not experience sufficient scientific support in the development and selection of preventive and health promoting interventions. Intervention databases can remedy this by presenting scientifically validated and well-documented interventions. This allows local decisions to be informed by scientific evidence on the effectiveness of interventions. The databases can also be used to promote quality development of interventions.This paper explains methodological and conceptual considerations on how preventive and health-promoting interventions can be identified for databases and how they can be classified in terms of their effectiveness and prepared in a way that is appropriate for the target group. It is based on findings from the public health literature and the project "Ageing in Balance" ("Älter werden in Balance") of the Bundeszentrale für gesundheitliche Aufklärung (BZgA).Systematic reviews are of limited use in the search for suitable interventions for the database, partly because the types of interventions listed in them are limited and information relevant to implementation is often incompletely presented. However, it seems promising to include interventions from practice in the database if they are additionally classified with regard to their effectiveness or if consequences for further development and evaluation are formulated. In addition, as much information as possible should be provided on the practical implementation of interventions. A first suggestion shows what a description of the measures could look like. In addition, manuals for the implementation of measures should be available.

Understanding and evaluating the impact of integrated problem-oriented research programmes: Concepts and considerations

Researchers and research organizations are under increasing pressure to demonstrate that their work contributes to positive change and helps solve pressing societal challenges. There is a simultaneous trend towards more engaged transdisciplinary research that is complexity-aware and appreciates that change happens through systems transformation, not only through technological innovation. Appropriate evaluation approaches are needed to evidence research impact and generate learning for continual improvement. This is challenging in any research field, but especially for research that crosses disciplinary boundaries and intervenes in complex systems. Moreover, evaluation challenges at the project scale are compounded at the programme scale. The Forest, Trees and Agroforestry (FTA) research programme serves as an example of this evolution in research approach and the resulting evaluation challenges. FTA research is responding to the demand for greater impact with more engaged research following multiple pathways. However, research impact assessment in the CGIAR (Consultative Group on International Agricultural Research) was developed in a technology-centric context where counterfactual approaches of causal inference (experimental and quasi-experimental) predominate. Relying solely on such approaches is inappropriate for evaluating research contributions that target policy and institutional change and systems transformation. Instead, we propose a multifaceted, multi-scale, theory-based evaluation approach. This includes nested project- and programme-scale theories of change (ToCs); research quality assessment; theory-based outcome evaluations to empirically test ToCs and assess policy, institutional, and practice influence; experimental and quasi-experimental impact of FTA-informed ‘large n’ innovations; ex ante impact assessment to estimate potential impacts at scale; and logically and plausibly linking programme-level outcomes to secondary data on development and conservation status.

Social robots to support children's well-being under medical treatment: A systematic state-of-the-art review

Hospitalization is a stressful experience for children. Socially assistive robots (SARs), designed to interact with humans, might be a means to mitigate a child's stress and support its well-being. A systematic state-of-the-art review was performed to inventorize the use of SARs in hospital to support children's well-being and what the effects are. We searched five databases (Cinahl, Medline, Embase, PsycInfo, IEEE), combining terms for 'distress', 'relaxation' and 'well-being' with terms for social robot and child, and did an additional hand search. Ten publications (on eight studies) out of 563 unique titles were considered relevant. Six different robots were used (one humanoid, five pet-like) for distraction during medical procedure, emotional support for dealing with a disease or support of well-being during hospital stay. Positive effects on the children were noted, such as experiencing distraction and engagement, and less stress or pain, more relaxation, smiling and openness or better communication. On a psychiatric ward some youngsters felt unsafe with the robot. The outcomes suggest that SARs may have a potentially positive influence on a child's well-being. Further research is needed to determine the effect of using SARs and how to integrate the use in the working routines of health personnel.

Make a Move: A Comprehensive Effect Evaluation of a Sexual Harassment Prevention Program in Dutch Residential Youth Care

Sexual harassment-unwanted sexual comments, advances, or behaviors-and sexual violence are still prevalent worldwide, leading to a variety of physical, cognitive, and emotional problems among those being harassed. In particular, youth in care are at risk of becoming perpetrators (and victims) of sexual harassment. However, in general, there are very few interventions targeting this at-risk group, and no such programs exist in the Netherlands. To this end, a group intervention program-Make a Move-targeting determinants of sexual harassment was developed. This program was implemented and evaluated among boys ( N = 177) in Dutch residential youth care (20 institutions). A pre-test, post-test, and 6-month follow-up design including an intervention and a waiting list control group with randomized assignment of institutions (cluster randomized trial) was used to measure the effects of the intervention on determinants of sexual harassment. Multilevel (mixed) regression analysis with Bonferroni correction for multiple testing (α = .005) showed no significant effects of Make a Move on determinants of sexual harassment ( ps > .03, Cohen's ds < .44). Results are discussed in light of a three-way explanatory model focusing on intervention content, evaluation, and implementation as potential explanations for not finding any measurable intervention effects.

Interventions to improve functioning, participation, and quality of life in children with visual impairment: a systematic review

Visual impairment in childhood often has life-long implications. To aim for the highest levels of functioning, participation, and quality of life and to ensure children's well-being, children should be entitled to the most effective rehabilitation programs. We review evidence for the effectiveness of rehabilitation interventions for children with visual impairment to improve skills and behavior, thereby improving participation and quality of life as an ultimate goal. Of the 441 potentially relevant articles identified, 66 studies met our inclusion criteria (i.e., 28 randomized controlled trials, 18 nonrandomized controlled trials, and 20 before-after comparisons). The results suggest that sports camps, prescription and training in the use of low vision devices, and oral hygiene programs might be effective in improving functioning and elements of participation and quality of life in children with visual impairment. Other interventions showed mixed or negative results. The results should be interpreted with caution because of moderate to high risk of bias and suboptimal reporting. Heterogeneity of results and the use of over 50 different outcome measures prevented a meta-analysis. Future studies should focus on promising interventions for which effectiveness is still unclear (e.g., mobility, social skills), with adequately designed methodology.

Evidence-Based Practice in the social sciences? A scale of causality, interventions, and possibilities for scientific proof

This article discusses Evidence-Based Practice (EBP) in the social sciences. After a brief outline of the discussion, the work of William Herbert Dray (1921–2009) is examined. Dray, partly following Collingwood, worked on different forms of causality and methodology in historical explanation (in comparison to the social sciences), based on a distinction between causes and reasons. Dray’s ladder of rational understanding is also explored here. Taking his argumentation further and sometimes turning it upside-down, a scale of forms of causality is developed with accompanying types of interventions and possibilities for scientific proof of their effectivity. This scale makes it possible to weigh interventions regarding the degree to which “hard” scientific proof is possible for them. The article concludes with a brief discussion of how interventions in psychology and education should be chosen and can be justified, both those that do and those that don’t lend themselves to empirical research.

Evidence and Evidence-Based Practices: Are We There Yet?

The purpose of this article is to move the field of intellectual and closely related developmental disabilities (IDD) towards a better understanding of evidence and evidence-based practices. To that end, we discuss (a) different perspectives on and levels of evidence, (b) commonly used evidence-gathering strategies, (c) standards to evaluate evidence, (d) the distinction between internal and external validity, and (e) guidelines for establishing evidence-based practices. We also describe how the conceptualization and use of evidence and evidence-based practices are changing to accommodate recent trends in the field.

Evaluation of a Social Network Intervention for People with Mild to Borderline Intellectual Disabilities

BACKGROUND

Little is known about the effectiveness of interventions aimed at enhancing the social networks of people with intellectual disabilities. This study explores the results of such an intervention. How did the clients with mild to borderline intellectual disabilities and their support workers evaluate the intervention? What did they learn from it? Were there any changes in network characteristics, satisfaction and wishes in relation to networks, participation, loneliness, self-determination or self-esteem?

METHOD

The evaluation of the intervention was explored from several perspectives (i.e. five clients, their six support workers and three trainers), using mixed methods (i.e. interviews and questionnaires).

RESULTS

The intervention was positively evaluated by both clients and support workers. Moreover, the analysis revealed the vulnerability of clients and their networks but also the benefits experienced from the intervention, such as decreased loneliness, enhanced social networks, increased awareness, competence, autonomy and increased participation.

CONCLUSION

The indicative level of evidence for the effectiveness of this intervention justifies a larger series of case studies or a larger control trial study.

Monitoring and Evaluating Psychosocial Intervention Outcomes in Humanitarian Aid

Existing tools for evaluating psychosocial interventions (un-validated self-reporting questionnaires) are not ideal for use in non-Western conflict settings. We implement a generic method of treatment evaluation, using client and counsellor feedback, in 18 projects in non-Western humanitarian settings. We discuss our findings from the perspective of validity and suggestions for future research. A retrospective analysis is executed using data gathered from psychosocial projects. Clients (n = 7,058) complete two (complaints and functioning) rating scales each session and counsellors rate the client’s status at exit. The client-completed pre- and post-intervention rating scales show substantial changes. Counsellor evaluation of the clients’ status shows a similar trend in improvement. All three multivariable models for each separate scale have similar associations between the scales and the investigated variables despite different cultural settings. The validity is good. Limitations are: ratings give only a general impression and clinical risk factors are not measured. Potential ceiling effects may influence change of scales. The intra and inter-rater reliability of the counsellors’ rating is not assessed. The focus on client and counsellor perspectives to evaluate treatment outcome seems a strong alternative for evaluation instruments frequently used in psychosocial programming. The session client rated scales helps client and counsellor to set mutual treatment objectives and reduce drop-out risk. Further research should test the scales against a cross-cultural valid gold standard to obtain insight into their clinical relevance.

Bridging the gap: Using Veerman and Van Yperen's (2007) framework to conceptualise and develop evidence informed practice in an Irish youth work organisation

While there is considerable support among the policy, practice and academic communities for the idea that practice in youth work should be based on evidence, Veerman and Van Yperen (2007) highlight the fact that little practice in the area of youth care is actually evidence based due to the paucity of experimental studies in the field and the difficulties associated with evaluation of non-standardised interventions such as youth work. They propose a model consisting of levels of evidence, the aim of which is to 'bridge the gap between evidence based and evidence informed practice' (p. 218). In order to address the dearth of examples in the international literature of how organisations have dealt with these complexities in practice, this article provides a case study of how a large Irish youth organisation, Foróige, has endeavoured to adopt an inclusive approach to evidence, working towards both evidence based and evidence informed practice. Drawing on Veerman and Van Yperen's (2007) framework, the case study shows that Foróige committed itself to gathering different types of evidence, including logic models and theoretical understandings at the foundation level and experimental design studies of key programmes at the advanced level. The case study focuses in detail on the intermediate level, whereby practitioners were trained to evaluate aspects of their own work, with a view to embedding evaluation and reflection in day to day practice. The process is described and key lessons emerging are discussed.

An evidence-based approach to organization evaluation and change in human service organizations evaluation and program planning

The work described in this article focuses primarily on how human service organizations can use an evidence-based, self-assessment approach to organization evaluation to facilitate continuous quality improvement and organization change. Real-life examples are presented, strengths and challenges discussed, and future conceptual and measurement issues identified.

Analyzing the Hidden Curriculum

Values play an important part in the childrearing practices of parents, but are hardly a subject of debate in discussions about the youth care system. Also, a reliable research instrument for an investigation of values in this specific field is not readily available. In this article we will present our research design, which will make such an investigation possible. The framework we use is based on an existing theory and model of universal values ( Schwartz, 1992 ). Our adapted framework consists of 39 universal values and can be used for the content analysis of documents. It offers the opportunity for an objective, empirical analysis of values. Next to an elaborate description of this framework, a case study will be presented as an example of how this method can be used.

Implementation of Treatment Integrity Procedures

This systematic review evaluates the implementation of treatment integrity procedures in outcome studies of youth interventions targeting behavioral problems. The Implementation of Treatment Integrity Procedures Scale (ITIPS), developed by Perepletchikova, Treat, and Kazdin (2007) , was adapted (ITIPS-A) and used to evaluate 32 outcome studies of evidence-based interventions for youths with externalizing behavioral problems. Integrity measures were found to be still rare in these studies. Of the studies that took integrity into account, 80% approached adequacy in implementing procedures for treatment integrity. The ITIPS-A is recommended as an instrument to guide development of integrity instruments and the implementation of treatment integrity procedures in youth care.

Transforming prevention systems in the United States and the Netherlands using Communities That Care Promising prevention in the eyes of Josine Junger-Tas

Josine Junger-Tas introduced the Communities That Care (CTC) prevention system to the Netherlands as a promising approach to address the growing youth violence and delinquency. Using data from a randomized trial of CTC in the United States and a quasi-experimental study of CTC in the Netherlands, this article describes the results of a comparison of the implementation of CTC in 12 U.S. communities and 5 Dutch neighborhoods. CTC communities in both countries achieved higher stages of a science-based approach to prevention than control communities, but full implementation of CTC in the Netherlands was hampered by the very small list of prevention programs tested and found effective in the Dutch context.

Parent-child interaction therapy for preschool children with disruptive behaviour problems in the Netherlands

BACKGROUND

Persistent high levels of aggressive, oppositional and impulsive behaviours, in the early lives of children, are significant risk factors for adolescent and adult antisocial behaviour and criminal activity. If the disruptive behavioural problems of young children could be prevented or significantly reduced at an early age, the trajectory of these behavioural problems leading to adolescent delinquency and adult antisocial behaviour could be corrected. Parent-Child Interaction Therapy (PCIT) is a short-term, evidence-based, training intervention for parents dealing with preschool children, who exhibit behavioural problems. Recently, PCIT was implemented in a Dutch community mental health setting. This present study aims to examine the short-term effects of PCIT on reducing the frequency of disruptive behaviour in young children.

METHODS

This study is based on the data of 37 referred families. Whereby the results of which are derived from an analysis of parent reports of the Eyberg Child Behavior Inventory (ECBI), obtained during each therapeutic session. Furthermore, demographic information, extracted from client files, was also utilized. However, it must be noted that eleven families (27.5%) dropped out of treatment before the treatment protocol was completed. To investigate the development of disruptive behaviour, a non-clinical comparison group was recruited from primary schools (N = 59).

RESULTS

The results of this study indicate that PCIT significantly reduces disruptive behaviour in children. Large effect sizes were found for both fathers and mothers reported problems (d = 1.88, d = 1.99, respectively), which is similar to American outcome studies. At post treatment, no differences were found concerning the frequency of behavioural problems of children who completed treatment and those who participated in the non-clinical comparison group.

CONCLUSION

The findings of this study suggest that PCIT is potentially an effective intervention strategy for young children and their parents in the Dutch population. However, further research into the evaluation of PCIT using a randomised controlled trial is recommendable.

Evidence-based practices in the field of intellectual and developmental disabilities: an international consensus approach

As evidence-based practices become increasingly advocated for and used in the human services field it is important to integrate issues raised by three perspectives on evidence: empirical-analytical, phenomenological-existential, and post-structural. This article presents and discusses an evidence-based conceptual model and measurement framework that integrates these three perspectives and results in: multiple perspectives on evidence-based practices that involve the individual, the organization, and society; and multiple interpretation guidelines related to the quality, robustness, and relevance of the evidence. The article concludes with a discussion of five issues that need to be addressed in the future conceptualization, measurement and application of evidence-based practices. These five are the need to: expand the concepts of internal and external validity, approach evidence-based practices from a systems perspective, integrate the various perspectives regarding evidence-based practices, develop and evaluate evidence-based practices within the context of best practices, and develop a set of guidelines related to the translation of evidence into practice.

Practice-driven evaluation of a multi-layered psychosocial care package for children in areas of armed conflict

Psychosocial and mental health service delivery frameworks for children in low-income countries are scarce. This paper presents a practice-driven evaluation of a multi-layered community-based care package in Burundi, Indonesia, Sri Lanka and Sudan, through a set of indicators; (a) perceived treatment gains; (b) treatment satisfaction; (c) therapist burden; (d) access to care; (e) care package costs. Across four settings (n = 29,292 children), beneficiaries reported high levels of client satisfaction and moderate post-treatment problem reductions. Service providers reported significant levels of distress related to service delivery. Cost analyses demonstrated mean cost per service user to vary from 3.46 to 17.32 <euro> depending on country and specification of costs. The results suggest a multi-layered psychosocial care package appears feasible and satisfactory in reaching out to substantial populations of distressed children through different levels of care. Future replication should address therapist burden, cost reductions to increase sustainability and increase evidence for treatment efficacy.

Person-centered planning: analysis of research and effectiveness

Person-centered planning is a well known and widely used approach to individual program planning in the field of intellectual and developmental disabilities. Its purpose is to develop collaborative supports focused on community presence, community participation, positive relationships, respect, and competence. Because there is little research on its effectiveness, our purpose here was to (a) review the current status of effectiveness research; (b) describe its effectiveness in terms of outcomes or results; and (c) discuss the effectiveness of person-centered planning in relation to evidence-based practices. Analyzed studies suggest that, overall, this planning has a positive, but moderate, impact on personal outcomes for this population. The body of evidence provided in this review is weak with regard to criteria for evidence-based research.

The conceptualization and measurement of quality of life: implications for program planning and evaluation in the field of intellectual disabilities

The concept of quality of life (QOL) is increasingly being used in the field of intellectual disabilities as a conceptual and measurement framework for program planning and evaluation. This article describes the development of a QOL conceptual and measurement framework, and summarizes how this framework is currently being used both nationally and internationally to assess and report personal QOL-related outcomes, to guide quality improvement strategies, and to evaluate the effectiveness of those strategies. Implications of such use are discussed, including those related to understanding mental models, developing internal data systems, supporting organization change, and building on current public policies. The article concludes with reference to the evolving nature of the QOL concept and the impact of this on model development and transdisciplinary research.