Transcript Residential Advocacy Training

Research Insights from the Family Home Program:
An Adaptation of the Teaching-Family Model at Boys Town
Daniel L. Daly and Ronald W. Thompson
EUSARF 2014/ Copenhagen, Denmark
2013 Numbers Served
Rate of Runaway Occurrences per 100 Residential
Youth Served
100
Runaway Rate
80
60
40
20
0
73
85
97
09
4
74
86
98
10
75
87
99
11
76
88
00
12
77
89
01
13
YEAR
78
79
90
91
02
03
80
92
04
81
93
05
82
94
06
83
95
07
84
96
08
Teaching-Family Model (TFM)
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Developed at Achievement Place, University of Kansas
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Teaching Interaction
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Family style environment staffed by highly trained couples
Applied behavior analysis and social skill teaching
Scaled up in several states across the US
Practices developed in an applied research setting
Core practice for changing youth behavior and teaching social skills
Study results: Positively related to youth social skills and satisfaction and
negatively related to delinquency
Self government
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Youth lead regular family meetings
Study results: Youth can establish consequences for peer behaviors
TFM Model at Boys Town: Program Elements
Teaching Skills and Building Relationships
Supporting Religion and Faith
Creating a Positive Family Environment
Promoting Self-determination
Focus on Safety, Permanence, and Well-Being
National Program Replication and Implementation:
Core Components
Model fidelity
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Staff selection
Staff training
Supervision
Evaluation and
data support
• Facilitative
leadership
Positive
youth and
family
outcomes
Ongoing
quality
improvement
Research Evidence
• Four US models of residential care have been identified as having at
least promising research evidence by the California Evidence-based
Clearinghouse for Child Welfare (cebc4cw.org)
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Positive Peer Culture
Sanctuary Model
Stop Gap Model
Teaching Family Model
• Four decades of research on the Teaching-Family Model
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University of Kansas and other TFM sites
Boys Town National Research Institute
NIMH funded TFM study in North Carolina
Results of Numerous Outcome Studies
-Social Skills
-School Functioning
& Success
-Pro-social Behavior
-Positive Adult and
Peer Relationships
-Behavioral &
Emotional Problems
-Aggression
-Delinquency
(arrests)
-Intimate Partner
Violence
Diagnostic Interview Scale for Children: Mental
Health Symptom Improvement (During Care)
Admission
% of Youth Endorsing Disorder
100%
80%
The change from admission to
12-months was statistically
significant for all disorders
(p<.05).
70%
60%
40%
12-Months
39%
38%
34%
25%
20%
10%
28%
14%
8%
5%
4%
8%
0%
Any Disorder
Disruptive
Behavior
10
Mood
Anxiety
Substance
Other
Quasi-experimental Outcome Study: High School
Graduation Rates (4 Years Post Discharge)
100%
83%
69%
80%
60%
40%
20%
0%
Boys Town Group
Comparison Group
Research Insights with Practice Implications
• Moderators of outcomes
• Length of stay
• Gender
• Model fidelity
• Mediators of outcomes
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Therapeutic alliance
Positive teaching
Family involvement
Positive and negative peer contagion
Longitudinal Outcome Study: Intimate Partner
Violence (16 Years Post Discharge)
• As adults, former Boys Town youth
with a history of abuse or neglect
had lower levels of adult Intimate
Partner Violence (IPV) than
expected from research.
• Rates of IPV decreased with longer
lengths of stay.
Intimate Partner Violence Reports
40%
30%
20%
10%
0%
• IPV rates for youth who were in the
program for at least 18 months
were virtually identical to the
normal population.
Expected < 18 mo. ≥ 18 mo. NSFH*
Individuals with Histories of Maltreatment
*National Survey of Families and Household
Strengths and Difficulties Questionnaire (SDQ): Percent
in Clinical Range at Intake and Discharge by Gender
Male (n=377)
Female (n=256)
Percent of Youth in Clinical Range
60%
58%
56%***
50%
51%
44%
42%***
40%
36%***
36%**
37%**
30%
27%
27%
25%
25%***
22%
20%
15%
19%
16%
10%
0%
Intake
Discharge
Total
Difficulties
Intake
Discharge
Emotional
Symptoms
Intake
Discharge
Conduct
Problems
*p < .05, **p < .01, ***p < .001; indicates statistically significant change over time on scale scores
Note: sample consists of youth with SDQ caregiver-report forms at both intake and discharge
Intake
Discharge
Inattention/
Hyperactivity
Source: SDQ data collected in Home Campus
Family Home Program 10/4/10 – 7/18/14
Studies Show Evidence of Positive Peer Contagion
• In some environments children’s interactions with peers lead
to increases in aggression, delinquency, and drug use. It is
seen as a special concern in residential care settings.
• Studies specifically examining this in a BT/TFM setting
indicate that youth can experience positive instead of
negative peer contagion:
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All youth had significantly fewer problem behaviors over time; youth
with more serious problems showed greater improvement.
Youth in homes with fewer peers who currently demonstrate problem
behavior showed the greatest reduction in behavior problems.
Current Research and Goals for the Future
• Randomized trials of TFM adaptations to family intervention
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On the Way Home
Common Sense Parenting
In-Home Family Services
Well Managed Schools
• Community impact
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Parenting and family well being
Youth risk e.g., substance abuse, aggression, school dropout
• Neurobehavioral studies
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Emotion regulation and aggression
On the Way Home RCT: Post discharge
placement stability
Home/Community
100
Return to Care/Jail
4.9
7.7
90
23.1
12.2
25.6
30.8
80
70
60
50
100
92.3
40
100
95.1
76.9
87.8
74.4
69.2
30
20
10
0
Treatment Control
n=39
n=39
Quarter 1
Treatment Control
n=41
n=39
Quarter 2
Treatment Control
n=41
n=39
Quarter 3
Treatment Control
n=41
n=39
Quarter 4
Presenter Contact Information
• Daniel L. Daly, Ph.D.
• Boys Town Executive Vice President and Director of Youth Care
• [email protected]
• www.boystown.org
• Ronald W. Thompson, Ph.D.
• Senior Director, Boys Town National Research Institute for Child
and Family Studies
• [email protected]
• www.boystown.org/nri