Journal of Children's Services

Gregory A. Aarons; Elizabeth A. Miller; Amy E. Green; Jennifer A. Perrott; Richard Bradway

2012 Journal of Children's Services

doi: 10.1108/17466661211286463

Purpose – Evidence‐based practices (EBPs) are increasingly being implemented in real‐world settings. While intervention effectiveness is dependent on fidelity, interventions are often adapted to service settings according to the needs of stakeholders at multiple levels. This study aims to examine the naturalistic implementation of The Incredible Years (IY) parenting programme in a residential substance abuse treatment programme for pregnant and parenting women. Design/methodology/approach – The study took place in a residential substance abuse treatment programme serving pregnant and parenting women and their children. Participants included 120 female clients. The primary IY facilitator was a master's level counselling psychologist. In person observations of IY sessions were completed by a trained bachelor's level anthropologist. Ethnographic field notes were collected and then coded in keeping with a priori themes and to identify emergent themes. The Parent Group Leader Checklist was used to evaluate quality and integrity of the IY basic parent programme. Findings – Quantitative analyses indicate that fidelity varied by type of checklist activity. Specifically, adherence to the IY programme was highest in beginning topic activities, setup, and home activity review, and lowest in role play, vignettes, and wrap‐up activities. Qualitative analyses revealed a number of adaptations in implementation of IY. Adaptations fit into two broad categories: modification of programme delivery and modification of programme content. Within each of these categories modifications included organisation‐driven adaptations, provider‐driven adaptations, and consumer‐driven adaptations. Practical implications – Changes to evidence‐based practice generally take two forms – adaptations consistent with model intent and theoretical approach and changes that represent drift from core elements of the EBP. The challenge for implementation science is to develop frameworks in which models can be adapted enough to make them viable for the service context (or the service context adapted to fit the model), yet avoid drift and maintain fidelity. Attending to the complexities of adaptation prior to and during implementation in a planned way is likely to help organisations better utilise EBPs to meet their unique needs while maintaining fidelity. Originality/value – The paper shows that identification of types of intervention adaptations and drift allows for consideration of systematic approaches, frameworks, and processes to increase adherence during EBP implementation in community mental health and substance abuse treatment settings.

Lisa M. Chauveron; Amanda C. Thompkins; Ofer Harel

2012 Journal of Children's Services

doi: 10.1108/17466661211286472

Purpose – The aim of this paper is to evaluate the effectiveness of The Leadership Program's Violence Prevention Project (VPP) – a 12‐session programme consisting of explicit curriculum‐based classroom instruction designed for adolescents to promote a range of communication skills associated with violence prevention and alter classroom norms about aggression and violence. Design/methodology/approach – A multi‐site, quasi‐experimental effectiveness trial examined pre‐ and post‐implementation surveys that assessed violence‐related behaviours and attitudes from 3,264 6th‐8th grade students in 24 urban public schools across four consecutive academic years (2005‐2009). Findings – Multilevel modelling showed VPP buffered negative beliefs and behaviour in a wide range of violence‐related outcomes including peer support and tolerance for aggression. VPP also promoted positive conflict resolution skills by reducing the use of verbally and physically aggressive resolution strategies over time in programme participants. Programme quality was maintained through a five point practitioner‐created fidelity system amenable to real‐world conditions. Originality/value – Findings indicate semester‐long violence prevention programmes promoting communication skills are effective with urban early adolescents.

Ayalew Gebre

2012 Journal of Children's Services

doi: 10.1108/17466661211286481

Purpose – This study attempts to identify the rural‐urban migration patterns of children, young girls in particular, exposed to commercial sexual exploitation in urban and semi‐urban environments of Ethiopia. The study also concerns itself with gaining a more accurate understanding and insight into the socioeconomic forces behind the migration process, and young people's experiences in urban communities. In addition, central to the study was its aim to inform programme interventions on curbing the uncontrolled influx of children from the rural areas to urban centres and reducing their exposure to commercial sexual exploitation. Design/methodology/approach – The necessary body of field data was generated through the use of a triangulation of methods that comprised a survey of children aged 13‐18 exposed to commercial sexual exploitation, in‐depth interviews of 400 children across the three zone capitals and three sub‐cities of Addis Ababa, in addition to semi‐structured interviews with key people such as local government officials and religious and community leaders. Focus group discussions and case studies were also utilised. Findings – Migrants were most commonly uneducated girls between the ages of 16 and 20 who had been married before leaving their rural communities. Reasons for migration were escaping the oppression of the marital home, seeking independence and a better education, or leaving for fear of being forced into child wedlock. Six key “push” factors were famine and war, environmental and demographic factors, living conditions, the practice of early marriage, family discord and breakdown, and early school leaving. The main “pull” factor was the possibility of escaping poverty. In towns and cities, the realities of low wages, the difficulty of gaining paid employment and the failure of some employers to pay for work all contributed to the movement of migrating children into commercial sexual exploitation. Recommendations include the improvement of rural living conditions through greater health and education provision, the introduction of family planning services, opportunities for off‐farm activities for women and girls, the abolition of child marriage, the provision of child‐focused rehabilitation services and greater collaboration between government and NGO rehabilitation interventions and community based organisations. Originality/value – Information regarding the migration patterns of children can help governmental agencies and NGOs to target key areas. Identifying the “push” and “pull” factors behind child migration is the first step in its prevention, as vulnerable children migrating alone to large towns and cities are targets for commercial sexual exploitation. Useful recommendations relating to the prevention of child migration through the improvement of rural conditions and the need for rehabilitation services for sexually exploited children are made.

Elizabeth Tovey; Juan Perez‐Olaizola; Paul Annecke; Jovanka Tolmac; Matthew Hodes

2012 Journal of Children's Services

doi: 10.1108/17466661211286490

Purpose – The purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of the service using standardised outcome measures. Design/methodology/approach – The data was collected on adolescents aged 13‐17 years in two London boroughs, attending the day service over a period of one year. Outcome measures were HoNOSCA, CGAS, SDQ and qualitative data from feedback forms from adolescents and parents. Findings – The adolescents ( n =22) had varied disorders, but mainly depression, ( n =9) and psychosis ( n =4). HoNOSCA score on admission was mean 18.14 (SD 3.78) but by discharge it had reduced to mean 15.39 (SD 7.31) ( p =0.07), and CGAS reduced from initial mean score of 43.83 (SD 9.90) to 53.17 (SD 12.04) ( p =0.003). Attendance for 19 (86 per cent) adolescents was for less than six months. Following discharge 14 (64 per cent) returned to education or employment. Adolescents and their carers reported high levels of satisfaction. The findings indicate substantial improvement and satisfaction with the service. The size of the improvement in outcome scores and the consistency across the HoNOSCA and CGAS associated with high service satisfaction also suggest that the data is reliable. Research limitations/implications – The small size of the sample and loss of data made it difficult to extrapolate from the results to other groups of impaired adolescents. There was no control group in the study and therefore it was not possible to demonstrate whether the improvement was due to spontaneous changes over time, Tier 3 CAMHS input or the attendance at the day service. It is difficult to demonstrate what proportion of adolescents who were admitted to the day service would have required a Tier 4 in patient admission had the service not been available. A larger study using a more robust design involving randomisation to the day‐service or in‐patient service would provide important comparative data regarding the service benefits. Originality/value – Currently there is little provision for severely psychiatrically impaired adolescents who require a day treatment programme. Day patient programmes appear to offer a useful and accessible treatment method. The service is much cheaper than an in‐patient service, and may also reduce the demands for or duration of inpatient admission. Unfortunately the service did not obtain continuation funding in view of NHS funding cuts, rather than dissatisfaction by local commissioners, and so needed to close. The data presented here can hopefully be used to support the case for child and adolescent psychiatric day programmes.

Milena Stateva; Jacqueline Minton; Celia Beckett; Moira Doolan; Tamsin Ford; Angeliki Kallitsoglou; Stephen Scott

2012 Journal of Children's Services

doi: 10.1108/17466661211286508

Purpose – The Helping Children Achieve study is a randomised controlled trial designed to test the effectiveness of parenting interventions for children at risk of anti‐social behaviour. The paper aims to examine the challenges in recruitment to the HCA trial. Design/methodology/approach – The study is on‐going and is being conducted at two sites: an inner city London borough and a city in the South West of England. In total, 395 participants consented to participate in the trial; 325 were assessed at baseline and 215 met the criteria and agreed to take part. Recruitment used population screens and referrals. Findings – The screening procedure was more labour intensive but attracted greater numbers, including many parents who might not otherwise have sought help and included many families from disadvantaged backgrounds. The referrals included those with more serious problems and a higher proportion engaged with the service. Recruitment rates were lower in the London site due to ineligibility and greater difficulty in accessing schools. Retention in the two areas was similar. Originality/value – The study provides data on recruitment challenges and lessons learned that could help formulate future policy regarding service delivery. Also of value is the finding that it is possible to conduct population screens in very deprived, multi‐ethnic areas and to get high rates of return.