applying research on risk & resilience to assessment of children with sexual behaviour problems...
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Applying Research on Risk& Resilience to Assessmentof Children with Sexual Behaviour Problems
Jane F. Gilgun, Ph.D., LICSWProfessor, School of Social Work, University of
Minnesota, Twin Cities1404 Gortner AvenueSt Paul MN 55108 USA
[email protected]://ssw.che.umn.edu
June 26, 2003G-MAP Conference, Bolton, Lancashire, United
Kingdom
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Topics
Assessment 101 The CASPARS The 4-D Case Studies Customizing Tools
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Significance
Practice effectiveness Accountability Brief treatment Evidence-based practice
Best research evidence Clinical experience Client preferences, wants, cultures Practitioners’ personal experiences, values,
cultures Ethical codes
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Purposes of the Instruments direct attention to positives lead to helpful assessments help formulate treatment plans help estimate progress in treatment provide a check on countertransference provide measures of outcome provide data that demonstrates effects
of treatment
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Concepts of the Instruments Assets are Significant in Models of Risk Adding Assets to Risk Models Increases
Accuracy of Classification Assets Alone in Models of Risks May be as
Accurate as Risk Alone Models Assets, Risks, and Protective Factors
Reside Within Individuals, Families, Other Social Groups, Communities, Social Policies, and Cultural Themes and Practices.
Asset Models Require Shifts in Thinking
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Assets Assets are positive counterparts of risk
that can contribute to pro-social outcomes when individuals are exposed to risks.
Assets include factors such as high IQ, physical attractiveness, verbal facility, parents who care, safe neighborhoods, adequate family income, a pro-social sense of agency, optimism about a positive future
Not all persons with assets turn out well, nor do all persons from poor families and unsafe neighborhoods have maladaptive outcomes
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Risks Risks predict that a proportion of an at-risk
group will experience adverse outcomes. Persons with risks are vulnerable to an
associated outcome, but risks cannot predict that any one person in an at-risk group will experience that outcome
Risks include childhood maltreatment, unsafe neighborhoods, isolated families, exposure to persons who model violent behaviors, genetic risks such as those predisposing persons to particular types of physiological reactivity Individuals in an at-risk group, however, are vulnerable to that outcome.
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Risk Pile-Up
a series of risks that may overwhelm whatever resources
an individual can marshall
or in some cases persons appear to have the resources to cope.
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Protective Factors
assets individuals actively use to cope with adapt to, or overcome vulnerability-inducing
conditions, or risks
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Protective Factors Pro-social sense of agency Desire to emulate persons who are pro-
social Have avenues open to them where they
can attain a sense of self that includes self-efficacy and self-worth These avenues do not harm self or others
Emotional expressiveness Affirmative relationships Healthy sexuality Sense of belonging to a pro-social group Strong sense of positive future
Resources to attain future goals
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Resilience Definition: positive outcomes when
individuals have been exposed to risks
Resilience means a person has risk conditions and therefore has vulnerabilities
Persons can be Resilient at one point and not at others Resilient in some areas and not in others
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CASPARS
Emotional expressiveness Family Relationships Peer Relationships Family Embeddedness Sexuality
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Scoring the CASPARS Each instrument yields two scores: An
asset score and a risk score Scores for each instrument are attained
by summing each column Children can be classified by using
scores from single instruments Children can be classified using scores
resulting from the sums of scores of all the instruments for a global score
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Scoring the CASPARS
1=low strength or low risk 2=medium strength or medium
risk 3=high strength or high risk 0=not observed or unknown
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The 4-D
Belonging Mastery Independence Generosity
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Scoring the 4-D Each instrument yields two scores: An
asset score and a risk score Scores for each instrument are attained
by summing each column Children can be classified by using
scores from single instruments Children can be classified using scores
resulting from the sums of scores of all the instruments for a global score
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Scoring the 4-D
1=mixed 2=low strength or low risk 3=medium strength or medium
risk 4=high strength or high risk
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Relationship of Assets & RisksOver the Course of Intervention
40
30
20
10
0
T1 T2 T3
Assets Risks
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Clinical Assessment Tools Short, easy to use Useful to practice Provide scores Not the same as tools used in
psychological and educational testing
Provide practice guidelines When they are based on research &
practice experience
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Types of Assessments
Unsystematic
Systematic but idiosyncratic
Systematic and shared
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Systematic, Shared Asessments
Can coordinate practice across cases, within agencies, and across agencies
Provide practice guidelines
Help standardize practice
Provide clear identity for the agency
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Each Case is Unique
General, Agency-Wide Assessment
Individualized goals, outcomes, and interventions
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The CASPARS: Sources of Concepts
My reflections on the factors associated with resilience
Factors extracted from My long-term life history research
(primary) Integrated with
social work’s ecological perspectives
Research on risk and resilience
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Sources of Items: 4-D
Circle of Courage Related research and theory Experience of social work
professionals and one clinical psychologist
My life history research
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Sources of Items: CASPARS
Primary: My life history research Backed up with
Related research and theory Experience of two social work
professionals and two clinical psychologists
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Stetson School Assessment
Responsibility Honesty Motivation for treatment Remorse
Developed by Phil Rich, Barre, MA, USA 1/978/355-4541
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Capacities for Accountability What do the young people say about their
problematic sexual behaviours? Can they describe them? Take responsibility for them? Recognize harm done? Are they willing to apologize? Are they willing to work on managing these
behaviours?
This is a strengths-based approached because such questions are asking the young people to tap into their competencies.
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Capacities for Accountability Appropriate vs. flat affect in talking about their
behaviours Take responsibility vs. blame others Remorse vs. “blowing off”
Signaled by I’m sorry I hurt others. I feel ashamed. Does the child appear to have these
responses but need help in articulating them?
How can practitioners do assessments that provide children with a sense of safety so that children can show their deep shame, embarrassment, guilt, and remorse, which we can assume is almost always there?
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Field Tests CASPARS
25 professionals 1 state N=146
4-D 25 professionals 4 states N=118
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The CASPARS
Content Validity Item-Total Analysis Coefficient Alpha Inter-Rater Reliabilities Construct Validities
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Item-Total Analysis
MeansEmo Peer Fam Rel Fam Emb
Sex.76 .63 .80 .78 .67
Note: none below .50
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Alphas & IRR# Items Alphas
IRR
Emo 14 .94 .92 Peer 16 .90 .93 FamRel 20 .97 .93 Embed 13 .96 .92 Sex 13 .90 .95
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Construct Validities
R Emo -.56 Peer -.80 FamRel -.81 Embed -.82 Sex .46
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The 4-D
Content Validity Item-Total Analysis Coefficient Alpha Interviewing
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Results of Item-Total Analysis
Instrument # of Items # Below .5
Belonging 12 1Mastery 18 2Independence 9 1Generosity 9 0
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Results: Coefficient Alphas
Initial Eliminate Final
Belonging .87 Q8 .89Knowing .93 Q2 & 2 .93Independence.87 Q4 .91Generosity .91 0 .91
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Results: Standard Errors of Measurement
Expected Actual
Belonging 5.5 5.62Mastery 9.5 7.16
Independence 4.0 8.84Generosity 4.5 4.87Total 11.94 11.75
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Interviews with Users
Usefulness the most important criteria for the worth of practice tools
Find out instruments’ usefulness through discussions with users
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Interviews with Users
Individually Phone Email In-person Group in-Person
Minnesota staff South Carolina staff
Informational interviews in person South Carolina social workers and care
providers
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Responses to the Field Test:Summary
Positive responses Helped me know youth in a new way Led to one of the best conversations
I’ve ever had Areas for improvement
Too long Too intrusive, such as the questions
on sexuality Don’t fit practice
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References
Brendtro, Larry K., Martin Brokenleg, & Steven Van Bockern (1990). Reclaiming youth at risk: Our hope for the future. Bloomington, IN: National Educational Service
Gilgun, Jane F. (2003). The 4-D: Strengths-based instruments for the assessment of youth who’ve experienced adversities. Submitted for publication.
Gilgun, Jane F. (2002a). Completing the Circle: American Indian Medicine Wheels and the promotion of resilience in children and youth in care. Journal of Human Behavior and the Social Environment, 6(2), 65-84.
Gilgun, Jane F. (1999b). CASPARS: New tools for assessing client risks and strengths. Families in Society, 80, 450-459. tools available at ssw.che.umn.edu/faculty/jgilgun.htm
Gilgun, Jane F., Susan Keskinen, Danette Jones Marti, & Kay Rice. (1999). Clinical applications of the CASPARS instruments: Boys who act out sexually. Families in Society, 80, 629-641.
Levitt, J. L., & Reid, W., J. (1981). Rapid-assessment instruments for practice. Social Work Research and Abstracts, 17, 13-19.
Schafer M. (1999) Nomothetic and idiographic methodology in psychiatry: A historical-philosophical analysis. Medicine, Health Care & Philosophy, 2(3):265-74.