Joint Social Work Education and Research Conference

1
Joint Social Work Education and Research
Conference

• Swansea, Wales, UK
• July 11, 2007
• Cultural Adaptation of an Evidence Based
• Social Work Model Political Refugees
• Lynn McDonald, MSW, PhD
• University of Wisconsin-Madison and
• Brunel University, Social Work

2
Goals of Presentation

• Planning, adapting and implementing an evidence
  based, multi-family group with the elders of a
  community of political refugees
• Present a small quantitative research study
• Wait list randomized controlled trial
• Standardized instruments
• Describe principles of cultural adaptation of an
  evidence-based social work model
• Discuss implications for social work education

3
Multi-Family Groups have Child Mental Health
Outcomes

• Community based, school based, and family based
• A strength based, systemic prevention process
• Train collaborative teams to do outreach to
  parents
• 8 weekly multi-family groups sessions led by a
  team
• 5-25-100 whole families can attend
• Activities led by parents with coaching by team
  no didactics experiential learning teams
  facilitate
• 2 years of monthly multi-family groups led by
  families
• 10-150 whole families attend
• Parent led activities

4
Theoretical Bases for FAST

• Hills Family Stress Theory
• Minuchins Family Systems Theory
• Hawkins and Catalanos focus on protective
  factors vs. risk factors
• Bronfenbrenners social ecological theory of
  child development
• Colemans theory of social capital

5
Research Based MFG Positive Family Activities

• Each activity applies mental health theory
  research
• MFG group implementations are evaluated with
  process evaluations and quantitative data
• Pre and post questionnaires to show impact
• Completed by teacher and by parent
• Summarized in a site report with statistics
• Four randomized controlled trials of the
  multi-family groups with low-income, socially
  marginalized families have shown some positive
  results of FAST vs. comparison or control
  condition, using federal funds ACYF, NIDA, OERI,
  OSERS, NICHD (USA)

6
Experiential Learning vs. Lectures to Retain
Information
?
20
30
50
70
90
7
Learn through Repeating Positive Family
Experiences

• Children practice
• respectful behaviors towards their parents
• taking turns in their family, waiting for a turn
• talking about their drawings, their feelings, and
  their positive play activities with their own
  parents
• Parents practice
• taking charge, making requests of their children
• listening to their childs voice
• playing with their child responsively
• asking for social support from other parents

8
Bonding Bridging
Family Dyad Peers Dyad Family Community
9
Relationship Based vs. Curriculum Based Program

• Each child needs a caring parent, a long-term
  relationship, to learn, love and be resilient
• Parents need support from adults to parent
• A community needs trusting, respectful,
  reciprocal relationships social capital ties
• FAST offers a structure with opportunities to
  build relationships with respect, laughter, time,
  and interaction, through repetitive, weekly,
  participatory, fun, activities

10
Evaluation of FAST Adapted with Political
Refugees in USA

• United Refugee Center
• Several elders from Hmong community
• Trained elders on an implementation team
• Cultural adaptations of the evidence based
  multi-family group social work model were
  co-created by the team with the trainer, while
  also monitoring integrity of implementation

11
Experimental Design

• Universal recruitment and all are served
• Home visits to recruit parents into study
• Standardized instruments with established
  validity and reliability CBCL,SSRS, FACES
• Pre-test by parents
• Randomized matched pairs to FAST-now or
  FAST-later a wait list control design
• Evaluation of all after 8 weeks
• Evaluation of all after 4 Months

12
Results Retention Rates

• 80 of Political Refugee families graduated
  across two MFG cycles in this study
• Of those who attended one MFG session
• Attended six of eight MFG sessions
• Consider context FASTs 20 drop out rate vs.
  40-60 for outpatient mental health clinics
  (Kazdin, 2001)

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
Results

• 80 of political refugee families who came once
  completed the 8 week MFG to graduate
• Statistically significant improvements in parent
  report of child social skills and anxiety
• Statistically significant improvements in family
  functioning as reported by refugee parents
• Focus groups of service users shared growth of
  parent-child relationships and reduced stress and
  social isolation of the families

17
School
Agency
Church
FRCs
Community
Collaboration Cultural Representation Shared
Governance
Parents
FASTWORKS
Evaluation - Data
Program improvement Research studies
Parent leadership
Trainer
18
Cultural Adaptation of a Social Work Model

• Cultural representation on team
• Service-User involvement representation
• Shared governance planning and process
• Relationship based process not instructional
• Program manual and social work trainer to consult
• Room for 60 adaptation at the local level
• Monitor program fidelity by a trainer/person
• Need to have room to make mistakes

19
Cultural Representation

• Value Nothing about us, without us
• Consider the local issues of social power, social
  marginalization, and the ethnicity, language,
  culture of the families you wish to serve in the
  MFG
• Create a team of planners which proportionately
  represents the family cultures and service users
• Each partner on the team has an equal voice in
  creating the local adaptations of the group model

20
Relationship Based Process

• Relationship based vs. curriculum based
• Trainer assigned to each site-personal
• Time for team building-personal
• Home visits to recruit parents-personal
• Multi-family groups structured to build
  relationships dyads, small groups,
• Geographically dense, centers or schools
• Monthly MFGs sustain relationships

21
Shared Governance

• Team is created with a parent, youth, and
  grandparent, and several professionals
• Each team partner has a voice and a vote
• The team co-creates local adaptations
• Initial weekly MFG sessions---8 weeks----the team
  facilitates MFG transfers its leadership and
  power to the graduates of the program
• Consumer-facilitated monthly MFG--2 years

22
Encouraging Local Adaptations (60)

• 15 years of replications has increased our
  commitment to focus on local adaptations
• Review of program outcomes shows 60 can be
  locally adapted with no loss of impact
• Social worker encourage teams to adapt process
  which promote local ownership
• Trainers review local adaptations for possible
  drift away from core values of the process

23
Monitoring Fidelity (40)

• Quality assurance (QA) systems in place
• Certified social workers make 5 site visits
• Direct observation of MFG implementation
• Program integrity checklists w/ team review
• Pre and post evaluation of every MFG cycle
• Consumers provide feedback to team
• Team provides feedback to social worker

24
Principles of Program Integrity

• Limit access to the training materials
• Social workers are instructed to inquire about
  anticipated family ethnic make-up and require
  service users to be on the team
• If the team does not look like the families being
  served, and if there is no service user parent
  and or youth, this must be addressed
• If not resolved at the time, the Trainer is
  required to leave with the FAST manuals

25
Evidence Based Values Based Social Work Model

• Evidence based means experimental studies
  demonstrate outcomes with 1 year outcomes
• Values based means cultural representation
• Nothing about us, without us!
• Preliminary data suggest 80 retention rates
  with cultural representation on teams
• Cultural adaptation of an evidence based model
  through a local process of negotiation

26
www.fastprogram.org

• 800 replication sites in 48 states and
• 5 countries outside US by social workers
• Predictable retention rates of 80
• Predictable drop out rates of 20
• Manuals, training for social work trainers,
  program evaluation, and technical assistance
  purchased through FAST International, a
  non-profit organization, Madison, WI. USA

27
Integration into Social Work Education and
Practice?