OVC Provider Forum Transcript

Integrating Evidence-Based Practices Into Victim Services
Ben Saunders, Phelan Wyrick  -  2011/7/20
How can these evidence-based practices be adapted to align with our culturally and linguistically practices, specifically, our Latina and Spanish speaking clients?
1.  Rebecca K. Odor
 Dr. Saunders- I am interested in some citations for your statement that 'relatively little adaptation is needed beyond language. The consequences of criminal victimization appear to be rather universal and interventions often work equally well with different cultural and ethnic groups.' This is a persistant issue for practitioners and policymakers and I would like to be able to share this viewpoint with others. Thank you.
2.  curious
 Really? Our experience was leading us to conclude that there were deep cultural and ethnic nuances in help seeking behavior after a victimization.
3.  Host: Ben
 We are often asked about adapting evidence-based practices to different cultural and ethnic groups and for resources in languages other than English. The good news is that this issue has been examined for many practices. Often relatively little adaptation is needed beyond language. The consequences of criminal victimization appear to be rather universal and interventions often work equally well with different cultural and ethnic groups. A primary difference appears to be access and trust among some groups. For child victims, the National Child Traumatic Stress network has many resources available for a variety of groups. Check out this webpage http://nctsn.org/resources/topics/culture-and-trauma/resources.
We have just started a new program in Arizona for young children birth to five who have victims of crime, do you have any recommendations that may be helpful when starting a new victim services program, specific to young children and their families?
1.  Host: Ben
 The biggest challenge in starting a new program such as this is making sure you are doing with a reasonable degree of fidelity to the model. Translating an EBP to the field can be difficult. I recommend seeking consultation from other areas that have done it or the developers to help identify solutions to the obstacles that may arise.
How are programs selected for review for the crimesolutions.gov Web site?
1.  GH - Phelan
 For the launch of CrimeSolutions.gov we wanted to make sure to cover the spectrum of topics that the Office of Justice Programs addresses. That includes criminal justice, juvenile justice, and victim services. Within that scope, we looked to programs that have been subjected to sufficiently rigorous program evaluation research. You can find more information about our program review and rating system at http://www.crimesolutions.gov/about_starttofinish.aspx .
Are there any specific EBPs that have been shown to be effective in addressing the behavior of perpetrators of DV? Or are the Batterer intervention programs it?
1.  Host: Ben
 Unfortunately, the long-term outcome data for perpetrators of intimate partner violence is less promising than we would hope. Some studies have found positive effects for certain programs. However, replicating the positive effects found in some studies has been difficult. And the impact of these programs in the long term is also somewhat disappointing. It should be noted that perpetrators of IPV are a diverse group. Some have long histories of violence towards many people and other crimes, while others have single incident of IPV. Intervening with these groups likely requires quite different approaches.
2.  GH - Phelan
 On www.crimesolutions.gov there is a search box in the upper right hand corner. If you enter domestic violence (including the quotes) it provides a list of programs that address the issue. Not all are focused on the perpetrators. But this should give you a sense for what is out there.
There is a lot of research out there. How do we determine which research we should focus on when implementing new practices or changing our current practice? I guess my question is ... if it's evidence-based, does it always mean correct?
1.  Host: Ben
 Great question. The term evidence-based has varying definitions. But, essentially it means that a particular program or intervention has met a specific threshold of research support for its efficacy, usually at least 2 randomized controlled trials. This means that the intervention is likely to work with its intended population and target problems. However, no intervention works with everyone. And, interventions may be less effective with populations outside the ones tested or with problems it was not intended to treat. So, when choose a program or intervention, one must be sure you are clear on who it is for and what it is supposed to do. And, even then, it will not work with everyone. It likely will work with most, but not everyone.
2.  GH - Phelan
 Think of research as falling into several buckets. Some tells you about the nature, extent, and dynamics of a problem. That kind of research can be very helpful in designing programs, targeting resources, etc. Another kind of program evaluation research tells you what works. When we say evidence-based we are usually talking about the what works research. But both buckets of research can be really important. There are some fairly universal conventions about judging quality program evaluation research. But even here, it is often best to consult with an expert or work through a resource that synthesizes existing research applying a high standard - CrimeSolutions.gov is one example of such a resource.
What are the best resources to find tools for EBP? Where should I start my search?
1.  nwesley
 thank you - this was a helpful start.
2.  GH: Ben
 For child victims probably the best source is the California Evidence-Based Clearinghouse for Child Welfare. This website details many interventions and programs and ranks them according to their empirical support. The website is http://www.cebc4cw.org. You can also download a report we developed for OVC that does much the same thing. Go to our website at http://academicdepartments.musc.edu/ncvc/resources_prof/reports_prof.htm and download the Child Physical and Sexual Abuse: Guidelines for Treatment.
3.  GH - Phelan
 There is no single source that is complete and definitive. But the Office of Justice Programs created CrimeSolutions.gov just for this purpose. We continue to build our database and it will be important to check back periodically.
I am trying to locate the materials on Integrating evidence-based practices into victim services.
1.  GH - Phelan
 In addition to the www.CrimeSolutions.gov website that includes evidence-based programs in victim services, you might also want to take a look at assistance available through the Office for Victims of Crime Training and Technical Assistance Center https://www.ovcttac.gov.
Can you please comment on the use of home visitation as an evidence-based strategy to helping children (and their families) deal with exposure to violence and trauma? Thanks!
1.  GH - Phelan
 Hi John. Home visitation (AKA Nurse Family Partnerships) is an evidence based program, but it may not address all outcomes of interest. My read of the evaluation outcomes is that home visitation helps reduce the exposure to violence, but I am not clear on whether it necessarily helps with coping with violence and trauma that has already occurred. There is a lot of information out there on this program. CrimeSolutions.gov covers it at this link http://www.crimesolutions.gov/ProgramDetails.aspx?ID=187. The main website for Nurse Family Partnerships also includes more information on research findings http:www.nursefamilypartnership.org .
2.  Host: Ben
 For example, approximately 40 of the treatment delivered in my clinic is done in the home or school because of these obstacles. We have had to adapt our service delivery model to our client population. Some have suggested that some services are actually more effective when delivered in the home. For example, training in parenting skills may be more effective when delivered in the actual home setting than in an office. However, the evidence is still unclear on this point. But, it is clear that for interventions to be effective, people have to actually receive them. This may mean delivering them in the home setting.
3.  Host: Ben
 Home visitation is a modality of intervention, not an intervention itself. Many families have genuine obstacles that prevent them from engaging in traditional office-based services. Lack of transportation, job demands, distance from services, and a host of other challenges often make it very difficult for many families to get to an office for a service. Some organizations have adapted their services for home delivery with success.
Dr. Saunders - What are some of the outcomes of these evidence-based practices? Which outcomes are best for us to measure at the local service provider level?
1.  follow up
 This is where we sometimes struggle - objective outcomes are sometimes hard to come by when dealing with domestic violence - is the outcome that they aren't victimized again?? That they leave the relationship? Sometimes that makes them at greater risk, so how do you define an objective outcome when it can be so subjective at times when it comes to victimization? Any tips for us?
2.  GH - Phelan
 In general, local service providers should work to measure outcomes that are most closely associated with the goals of your program. Strive to measure behavioral outcomes (e.g., future victimization, future offending, reduction in symptoms of trauma) in addition to outcomes related to satisfaction and completion of treatment. Put yourself in the role of a skeptic and consider what outcome data that person would most want to see to be convinced that your services are worthwhile.
3.  Host: Ben
 Another great question. Programs and interventions will have different goals, outcomes, and target populations. For example, a mental health intervention may target PTSD, but not drug and alcohol abuse. Using an evidence-based program or intervention for a problem for which it was not intended may not result in optimal results. What outcomes you measure will be dependent on the types of problems the victims you work with have. This implies that a good assessment is needed. After a good assessment determines the most serious problems experienced by a victim, selection of the intervention should follow that lead. Most important, continuing to assess the outcomes over time is critical to insuring that the victim gets what they need.
Our community has no evidence based services for DV, and no evidence based services for Parents in the child welfare system who engage in DV. Do they exist? How effective are they for child welfare population? Where can we find the research? what do you recommend if there are no available EBPs?
1.  Host: Ben
 Evidence-based interventions for children exposed to IPV do exist and are quite effective. Trauma-Focused Cognitive-Behavioral Therapy is the most well-supported. Similarly, interventions for spouse victims with IPV-related PTSD are available, specifically Cognitive Processing Therapy and Prolonged Exposure.
How do you integrate EBP when there is a limited evidence base for your population?
1.  rosie
 Thank you--very helpful.
2.  GH - Phelan
 You are right that the evidence base is very limited in many areas of practice. As a practitioner, you should be looking to build from the existing evidence base and have a high level of awareness for the ways in which you may be stepping into untested territory. If at all possible, document and test results when you adapt or modify an existing evidence based practice. It will help others to know your results.
Are there any screening tools that can recommend one EBP over another that would take into account the unique circumstances of individual victims, crimes and or offenders.
1.  Host: Ben
 I am unaware of a single screening tools that can do this. There are some resources available that will allow you enter a population or a problem and see descriptions of evidence-based interventions for that group or problem. for example CEBC at http://www.cebc4cw.org does this.
What exactly is best evidence practices in dealing with financial abuse of the elderly?
1.  GH - Phelan
 I am not sure that there are evidence based programs (i.e., those that have demonstrated their effectiveness in rigorous program evaluations) for this issue. However, I know that the National Institute of Justice has completed research in this area and has some resources and information online at http://www.nij.gov/topics/crime/elder-abuse/financial-exploitation.htm . I hope this is helpful.
Are there any EBP specific to victim interactions with courts, the judiciary or courtroom procedures?
1.  Lisa
 Maybe, evidence-based solutions would work.Proper casework, archiving information; yet protecting it; could help with not making a victim, more of a victim; then they already are!!!
2.  GH - Phelan
 I don't know the answer for certain. There is a little information on www.CrimeSolutions.gov about Victim Impact Panels, but it is related to the outcomes for the offenders.
3.  Host: Ben
 I am unaware of a specific program or intervention tested for this specific issue. However, anxiety management strategies are commonly employed with this group and are evidence-based.
There seems to be quite a few resources and tools for working with children and families - what about adult victims? Any EBP that would be beneficial to adults who may have experience crime as a child or adult?
1.  GH - Phelan
 You are right. The research is uneven and more work is out there on children. We need to continue to carry out evaluations for some of these topics that get less attention.
2.  Host: Ben
 EBP for adult crime victims do exist. A good source for descriptions of interventions treating PTSD in adults is the National Center on PTSD at http://www.ptsd.va.gov. They provide descriptions of interventions such as Cognitive Processing Therapy, Prolonged Exposure Therapy and EMDR. Another good source is the International Society for Traumatic Stress Studies at www.istss.org.
Much of our work is short term. How does one measure success in short term and crisis intervention strategies?
1.  Host: Ben
 There are some measures that have very short windows of assessment, such as the past week. For example, the SCL-90-R asks about a broad range of symptoms over the past week.
2.  GH - Phelan
 Even though the work is short term or crisis related, the intended effects of your work may be long term. Immediate support after a traumatic event can help prevent or reduce the impact of that trauma in the long term. Unfortunately, it is more difficult to track longer term outcomes. But that is very likely what you need to consider.
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