Inter-professional Education and Training
A template for implementing interprofessional education in child advocacy
Journal of Social Work Education
Garcia, A.R., Watts, C., Carlough, S.L., Christian, C.W., Finck, K.R., Jaffee, S., Greeson, J.K., & Connolly, C. (In Press).
While there is an urgency to offer graduate students’ inter-professional education (IPE) in child advocacy and welfare, there are no templates for educators to rely upon. Participants (n=34), inclusive of students, alumni, community stakeholders, and faculty representatives from Social Work, Law, Medicine, Nursing, and Psychology from a private, northeastern university, participated in a focus group to shed light on what IPE should entail. Grounded theory was used to distill the data, which revealed themes related to what participants would value and expect from an IPE program or certificate, perceived barriers to implementing IPE, and recommendations for the design and implementation of IPE. We next developed a template for implementing an IPE curriculum. Some participants agreed that online learning might be beneficial; however, in-person collaborative pedagogical approaches were more desired. Participants also expressed a need for educators to simulate “real-life” exposure to IPE. Community stakeholders noted that students need to refine reflective practice skills to grapple with systemic oppression, and students expressed a need for higher education to incorporate inter-professional student cohorts. Future research is needed to examine whether the proposed template promotes professional collaboration and improved child well-being.
Tear down those walls: The future of graduate education in child and family advocacy
Christian, C.W., Finck, K.R., Connolly, C., Jaffee, S., Greeson, J.K., Garcia, A.R., Carlough, S.L., & Watts, C. (2020).
The future of graduate education in child welfare requires specialized advanced degrees that are defined by interprofessional training and education. Disrupting the current silos in graduate education will result in a workforce able to integrate knowledge across disciplines with the ultimate goals of ending child abuse and neglect and improving outcomes for families. Although there are numerous challenges to implementing interprofessional education (IPE) in this context, research and existing programs highlight the potential for comprehensive reform of current practice and education. The authors describe a universitycommunity partnership model for a master’s degree program in child and family advocacy that exemplifies the opportunities and value of IPE. In so doing, they articulate an approach for addressing historical barriers from academia and professional disciplines to disrupt traditional structures and move towards a 21st century model of workforce development that best serves the needs of vulnerable, high-risk families.
Crossover Youth Project
Do mental health services influence child welfare involvement among juvenile justice system involved youth?
Garcia, A.R., Kim, M., & Barnhart, S. (2021).
There is limited understanding of mental health service utilization among youth in the juvenile justice system (JJS). Using administrative data, the current study examined service system trajectories of two cohorts of youth who initially entered the JJS in 2003 (N = 10,170) and 2012 (N = 5,787). We tracked mental health (MH) service utilization and dosage and child welfare system (CWS) involvement for 3 years and found that utilization and dosage of MH services increased between both cohorts. Notably, MH service use positively associated with CWS involvement and concurrent (dual) involvement in the CWS and JJS associated with decreased MH dosage if youth remained at home versus being placed in out-of-home care. Lastly, African American children received less services than their Caucasian peers. Future efforts should focus on preparing MH providers to detect youth who are dually involved and tailor services to enhance collaboration and information sharing across systems.
Changes in mental health service use over a decade: Evidence from two cohorts of youth involved in the child welfare system
Kim, M., Barnhart, S., Garcia, A. R., Jung, N., & Wu, C. (2021).
Recent policies have the potential to address the gaps between need for and access to mental health (MH) services among youth involved in the child welfare system (CWS). Yet, little is known about whether changes in the pattern of MH service use have occurred. This study sought to uncover whether the rates and predictors of MH service use among CWS-involved youth have changed over the past decade. This study relied on administrative data of CWS-involved youth in a large midAtlantic city of the United States. The sample consisted of two cohorts of youth who entered the CWS in 2003 and 2012, respectively. Logistic and negative binomial regression models were conducted to examine utilization and dosage of MH services in relation to individual (e.g., cohort, gender, age, and race/ethnicity) and case characteristics (e.g., placement type/ instability, and juvenile justice system involvement). Both utilization and dosage of MH services were found to have increased between cohorts, even after controlling for individual and case characteristics. There were also promising trends toward more equitable access and utilization of MH services along age and racial lines. However, disparities by gender and placement type were still prevailing problems. Potential positive effects of the recent policies are likely reflected in our findings of increased MH service use between the two cohorts. Given disparate MH service utilization based on gender and placement type, however, additional efforts to adhere to recent mandates to enhance child well-being are warranted.
Dual system youth: Subsequent system re-entry after receiving mental health services
Children and Youth Services Review, 127, 106104
Kim, M., Garcia, A. R., & Lee, L. H. (2021).
Dual system youth, referring to those involved in the child welfare (CW) and juvenile justice (JJ) systems, require attention as they are particularly vulnerable to mental health (MH) problems. Although many of them receive MH services during their time in the CW and JJ systems, little is known about what happens to them afterward, in terms of system re-entry. Using administrative data on two cohorts of dual system youth in 2003 and 2012, we explored the proportion of dual system youth who re-enter the CW and/or JJ systems after receiving MH services, and the association between individual and case characteristics and the likelihood of system re-entry. We found that 85% of the dual system youth who received MH services became re-involved with the CW and/or JJ systems. Results from multinomial logistic regression showed that youth in the second cohort and females were less likely to become re-involved with the systems. However, youth who were older, experienced out-of-home placement and were diagnosed with disruptive behavior and anxiety disorders experienced greater odds of subsequent system re-entry.
Rates and predictors of mental health service use among dual system youth
Children and Youth Services Review, 105024
Kim, M., Garcia, A. R., Jung, N., & Barnhart, S. (2020).
Decades of research has indicated that a significant proportion of youth involved in the child welfare system are at risk of crossing over to the juvenile justice system. These youth, commonly referred to as ‘dual system youth’, experience elevated needs for mental health (MH) services. However, little is known about the pattern of MH service use by dual system youth. This study investigated the rates and predictors of MH service use among dual system youth, using administrative data on two cohorts of youth who experienced dual involvement in 2003 and 2012, respectively. Results show that about 75% of dual system youth received MH services, and there was an increase in MH service use over time. However, older youth, males, and those remaining at home were less likely to utilize MH services. Furthermore, among youth who received MH services, older youth, youth of color, and those remaining at home received fewer services, controlling for need for MH services. The findings suggest that while the use of MH services by dual system youth is likely to increase, these trends are conferred to a particular subset of individuals and case characteristics. Implications for practice and research are discussed.
Do implementation contexts for the Positive Parenting Program improve child and parental well-being?: Findings from the PEP-2 child welfare study.
Journal of Social Work, 21(6), 1512-1532
Garcia, A.R., Kim, M., Myers, C., & Trinh, X. (2020).
Summary: While previous studies have offered insight into evidence-based practices that are effective in promoting safety and well-being, the underlying contextual implementation conditions that influence these outcomes in child welfare agencies are less understood. To address this gap, this study relied on organizational survey data collected from child welfare workers and supervisors during the process of implementing an evidence-based practice—the Positive Parenting Program—and merged those data with data gathered by the Parents’ Assessment of Protective Factors survey.
Findings: Results showed a significant increase between baseline and termination of services in social connections and overall protective factors index scores. Parents who received services from organizations inclusive of supportive leadership experienced greater increases in social connections. Lower protective factors index scores were associated with workers’ perception that evidence-based practices were required; however, scores increased as supportive leadership increased. Parents who identified as African American experienced lower protective factors index scores compared to parents in other racial categories. Parents who were engaged with workers who felt evidence-based practices were appealing were likely to experience greater increases in protective factors index scores.
Applications: Intended client outcomes are more likely to be achieved when agency leaders (1) provide workers support to learn and use evidence-based practices and (2) rely on methods to increase evidence-based practice appeal rather than mandate implementation. Future research is needed to (1) understand why the implementation contexts or Positive Parenting Program itself are not as effective for African Americans as they are for other racial/ethnic groups and (2) validate findings in other agency contexts and with other evidence-based practices.
“It starts from the top": Caseworkers, leaders, and TripleP providers’ perceptions of implementation processes and contexts.
Human Service Organizations: Management, Leadership, & Governance, 44(3), 266-293
Garcia, A.R., Myers, C., Morones, S., Ohene, S., & Kim, M. (2020).
Although child welfare leaders recognize the impetus to implement evidence-based practices (EBPs), like the Positive Parenting Program (TripleP), to achieve intended outcomes, they lack knowledge on how to effectively engage in the implementation process. Child welfare workers, supervisors, and clinicians participated in semi-structured interviews during the early stages of implementing TripleP in a large Mid-Atlantic city to illuminate (1) how implementation processes are theoretically linked, and (2) whether they agree upon these relationships. Findings revealed that agency leaders may observe a shift in practice by mobilizing teams to disseminate research about EBP efficacy and illustrate the referral process.
Factors that predict child welfare caseworker referrals to an evidence-based parenting program
Children and Youth Services Review, 109, 104750
Myers, C., Garcia, A.R., Beidas, R., & Yang, Z. (2020).
Background and purpose: Despite the increasing number of evidence-based practices (EBPs) for children and families in child welfare, child welfare agencies continue to encounter barriers to implementation, including a lack of utilization that may be caused by a lack of caseworker referrals to EBPs. However, further research is needed to determine additional factors that impact caseworker referrals.
Objective: This study examined whether caseworker demographic factors, attitudes towards EBPs and organizational factors predict caseworker referrals. Relying upon tenets of the Theory of Planned Behavior, this study also examined whether intention to refer predicts caseworker referrals to an EBP. Participants and setting: A convenience sample of 130 caseworkers and support staff was selected from two community-based agencies that provide child welfare services and were implementing an EBP, the Positive Parenting Program (Triple P).
Methods: Researchers used survey data from participants and caseworker referral data collected three to six months after survey completion. Binary logistic regression was used to measure the relationship between predictor variables and caseworker referrals.
Results: Results showed that agency of employment (OR = 3.31), age (OR = 0.12), race/ethnicity (OR = −4.303), and openness to EBPs (OR = 1.77) significantly (p < .05) predicted whether or not a caseworker made a referral to Triple P. Conclusions: Intention to refer did not predict referral behavior, possibly due to intervening events that took precedence over parenting needs. Providing support to caseworkers in navigating well-being needs amidst emergent crises may mitigate this barrier. Findings underscore the need to explore organizational differences that may facilitate caseworker referrals including the impact of locating Triple P providers the same location as caseworkers and of differing agency referral norms.
A theory of planned behavior exploration of child welfare caseworker referrals to an evidence-based parenting program
Journal of Social Service Research, DOI: 10.1080/01488376.2019.1705458
Myers, C., Garcia, A.R., Beidas, R., Trinh, X., & Yang, Z. (2019).
Despite the proliferation of evidence-based practices (EBPs) for children and families, the majority of children and families do not receive EBPs in the child welfare (CW) system, despite their growing availability. One major driver of this lack of access may be caseworker referrals to EBPs given that children and families access services through their caseworker. In this study, we applied the Theory of Planned Behavior (TPB) model and qualitative methods to understand caseworker decisions to refer to EBP. Twelve semi-structured interviews were conducted with child welfare caseworkers and support staff from two community-based CW agencies that were implementing an EBP, the Positive Parenting Program (Triple P). Directed content analysis was used and results supported a TPB model, in that 1) caseworkers’ beliefs about Triple P’s effectiveness; 2) agency expectations and culture around referring to Triple P; 3) conflicting court mandates and 4) multiple job demands influenced caseworker referral decisions. Recommendations include increasing communication and training for caseworkers and court officials around Triple P and increasing agency support for EBP implementation. Future research should explore whether constructs from the TPB predict actual caseworker referrals to EBPs.
Mitigating barriers to implementing evidence-based interventions: Lessons learned from scholars and agency directors.
Children and Youth Services Review, 100, 313-331.
Garcia, A.R., DeNard, C., Morones, S., & Eldeeb, N. (2019).
Decades of research shows that casework services as usual are ineffective in reducing risk factors associated with child welfare involvement. Although child welfare leaders recognize the impetus to implement evidence-based practice (EBP), they aren’t privy to how to optimize provider, organizational, and political contexts to promote implementation. Qualitative data collected from scholars and leaders in this study furthers the development of theories and guidance on how to promote EBPs that are effective, relevant, and responsive to racial and ethnic diversity. Findings reveal that future efforts should be devoted to cultivating an optimal implementation climate to increase efficacy and relevancy of cultural exchanges with colleagues.
“I am more than my past”: Parents’ attitudes and perceptions of the Positive Parenting Program in Child Welfare.
Children and Youth Services Review, 88, 286-297
Garcia, A.R., Ohene, S., DeNard, C., Morones, S., Connaughton, C. (2018).
Child welfare workers are challenged on a daily basis to achieve the goals of promoting child safety, permanency, and well-being. To achieve these goals, system leaders in two child welfare agencies in a large-Mid-Atlantic City received external funding to implement the Positive Parenting Program (TripleP), an evidence-supported parenting intervention (ESPI). While contextual and organizational barriers have been illuminated among clinicians and child welfare workers and leaders, less is known about the attitudes and perceptions of ESPIs among parents involved in the child welfare system. Thirty-five parents who graduated from or who were near completing Triple-P participated in one of four focus groups. Grounded Theory methods illuminated three core themes. Categories within the first theme “barriers of engagement” included lack of immediate acceptability, multiple demands, limited time and visitation privileges to practice new skills, and biased assessments by caseworkers. However, the parents overcame barriers (theme two) due to Triple-P providers’ ability to cultivate positive therapeutic alliances by praising and recognizing progress, adapting case studies for increasing applicability, and facilitating bonds between peers. Consequently, the parents illuminated the impacts of engagement (theme three), which included: confidence to engage in positive talk with children, increased insight of previous negative parenting practices, and recognition of positive and prosocial child behaviors. Findings underscore the salience of providing support and resources for clinicians and child welfare workers to effectively engage parents in ESPIs. Future research is needed to validate these findings in other agency contexts, and with attention to other ESPIs implemented in child welfare agencies