Mother’s Day

In the 25 years of National Family Preservation Network’s (NFPN) existence, there has never been a News Notes about Mother’ Day.  Let’s remedy that now!

I vividly recall Mother’s Day 2013.  At 5:30 a.m. that morning, my sister called.  When you have elderly parents, the phone calls always come between midnight and 6:00 a.m. and they are never good.  She said my mom was on the way to the hospital in an ambulance.  By the time I arrived, my mom was regaining consciousness and was able to give a big smile to her two daughters, perhaps thinking she would be able to spend Mother’s Day with most of her family which turned out to be the case.

The attending doctor was less cheerful and said there were so many things wrong with my mom that he gave her only a 50-50 chance of surviving the day.  After he left the room, we pondered that for a while and then my sister said, “I don’t know—Mom’s color is good now—I think she’ll be okay.”  Since my sister had known my mom for a lot longer time than the doctor, I decided to go with her prognosis.  And she was right!  But that was the beginning of a 17-day hospital odyssey.

During those 17 days I learned every nook and cranny in the hospital, the personalities of all the nursing staff, and the healthy choices menu in the cafeteria.  I had 5 meals of fish in a row!  I also learned the names of every disease that you can get during a hospital stay.  For a while, they thought my mom had “C-diff” and everyone had to wear a gown, mask, and gloves.  Fortunately, that only lasted for a day until the test came back negative…or I would have suffocated wearing the mask!  I had a horrible sore throat the first couple of days but a quick trip to quick care ruled out anything serious or contagious, again sparing me from the mask.

The main thing I noticed during that long period of time was that time stops as soon as you enter the hospital doors.  Sometimes I would be there for 4 hours and it would seem like 15 minutes…or the reverse!  Listening to the machines that my mom was hooked up to gurgle, buzz, and shriek was the only way to gauge the passing of time.  Eventually, the nurses would come and turn off the shrieking and say they didn’t know why the alarm went off.   Mostly you wait. You wait for the blood test to be taken because they can’t find a vein, you wait for the test results, you wait for the doctor to come and make another prognosis, and you wait to find out when your mom can leave.

Meanwhile, your mom is enjoying all the attention and constant care.  Other than the blood-drawing, it was quite pleasant for her.  My mom loved the Care Channel on TV that has an infinite loop of nature scenes accompanied by soft music although she sometimes asked who was in bed with her due to the audio coming through her remote.   She was well-rested by the end of the 17 days while I was completely exhausted.

Then, suddenly, all the waiting and prognoses aligned and my mom was dismissed to enter a nursing home, a four-month odyssey with a sad ending and a story for another time.

My mom loved cats, dogs, small children, pizza, God, family, and nature programs.  If she were here on this Mother’s Day, would I be willing to repeat the 2013 odyssey?  In a heartbeat!  But, I would want to have a more extensive healthy choices menu.

Happy Mother’s Day to all moms everywhere.  We’ll never forget you.

Posted by Priscilla Martens, NFPN Executive Director

 

Evidence-Based Practice

When the National Family Preservation Network (NFPN) was founded 25 years ago, there were no standards for Evidence-Based Practice.  However, since its inception NFPN has supported evidence-based practice including one of the first child welfare programs demonstrating effectiveness through research: Intensive Family Preservation Services.

What is the definition of Evidence-Based Practice? The gold standard comes from the field of medicine with the Institute of Medicine defining it as:

  • Best Research Evidence
  • Best Clinical Experience
  • Consistent with Family/Client Values

Today all fields, including social work, have adopted standards for Evidence-Based Practice (EBP). More narrowly, the field of child welfare has a searchable registry of EBP available through the California Evidence-Based Clearinghouse for Child Welfare. The Clearinghouse uses a scientific rating scale of 1-5 to determine the level of research evidence and the following is a description of each level:

  • Well-supported by research evidence: Two rigorous randomized controlled trials (RCT), with sustained effect for at least one year post-treatment, and published in peer-reviewed literature
  • Supported by research evidence: One RCT, with sustained effect for at least six months post-treatment, and published in peer-reviewed literature
  • Promising research evidence: One study using a control group and published in peer-reviewed literature
  • Evidence fails to demonstrate effect: Two RCT studies have found the practice has not resulted in improved outcomes and published in peer-reviewed literature
  • Concerning practice: Multiple outcome studies suggest the intervention has a negative effect and/or risk of harm
  • Not able to be rated: Does not meet criteria for any other level and is generally accepted in clinical practice as appropriate and there is no known risk of harm

All ratings also require a written description of the components of the practice protocol and how to administer it, and the program must be replicable. The list of descriptions have been abbreviated; to view the complete descriptions visit http://www.cebc4cw.org/ratings/scientific-rating-scale/

The CEBC was launched in 2006 and has over 40 topic areas with over 300 programs plus a special section for measurement tools.  The complete list of topics is available here: http://www.cebc4cw.org/search/by-topic-area/.  Suppose that  you wish to find evidence-based programs for Trauma Treatment for Children and Adolescents.  Programs, beginning with the top level rating, are listed on one web page to allow a quick review: http://www.cebc4cw.org/topic/trauma-treatment-client-level-interventions-child-adolescent/.  You can then select a specific program to obtain a detailed report.

For a webinar overview of the CEBC, visit: http://www.cebc4cw.org/cebc-webinars/cebc-sponsored-webinars/looking-beyond-the-numbers/.The CEBC is not an exhaustive resource and it is not recommended for use as the sole source of evidence-based practice.

There are other evidence-based clearinghouses such as the National Registry of Evidence-Based Programs and Practices with more than 350 mental health and substance use interventions.  Programs listed must have a random control trial or control/comparison group study published in peer-reviewed literature. Programs are not rated effective or ineffective but are rated on the quality of research. Evidence ratings are based on outcomes. An outcome rating instrument is used to review each program with four levels of outcome ratings: effective, promising, ineffective, and inconclusive.  For example, entering “trauma” into “Find an Intervention” lists all of the reviewed programs and a color-coded rating for each outcome that was tested.

For more information on this registry visit http://www.nrepp.samhsa.gov/landing.aspx.

NFPN recommends checking EBP registries when EBPs are required by government contracts or when considering design and implementation of a new program.  If there is a program listed that could meet the need, it will save you a tremendous amount of time and resources.

Posted by Priscilla Martens

NFPN Executive Director

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