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Enhancing Youth Care: Common and Specific Factors Driving Effectiveness

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16 diapositives · 279 Views · Aug 20, 2014

This symposium presentation explores the key common and specific ingredients that influence the effectiveness of youth care. Focusing on evidence-based treatments and the validity of established frameworks, it emphasizes the importance of tailoring interventions to individual needs and the appropriateness of specific techniques. The findings suggest that better implementation of practices leads to improved outcomes. Presenters Tom van Yperen and Mariska van der Steege from the Netherlands Youth Institute highlight existing research and provide guidance for enhancing youth care delivery.

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  1. Common And Specific Ingredients Of Youth Care EUSARF 2010 Symposium Netherlands Youth Institute September 22. 2010 Tom van Yperen and Mariska van der Steege Netherlands Youth Institute

  2. Effects Of Youth Care 2.0 Very large effect | | .80 LargeAverage: .70 | (Most studies .40-.80) .50 Moderate | In practice .20 Small (newestimate: ± .40) | .00 No effect In practice | (acc. Weisz cs: ± .01) -.10 (Sourcea.o.: Kazdin, 1991, Kazdin & Weisz, 1998: Lipsey & Wilson, 1993, 1998; Shadish cs, 2000; Weisz cs, 1992, 1995; Van Yperen, 2005; Carr, 2009)

  3. Factors Accounting For Change Total effect youth care in practice: d= 0.40 *Source: Lambert (1992) 3

  4. How To Improve Youth Care? • Implement evidence-based treatments? • Focus on the common factors? In this session: • Is the Lambert scheme valid? • Implement specific evidence-based programs?

  5. Is The Lambert Scheme Valid? (1) • Not based on quantative, statistical analyis, but on impression of the literature • Outdated: published in 1992, based on Lambert, Shapiro & Bergin (1986) • Review based on data from adult psychotherapy (not youth care) • Studies show different definitions and results

  6. Is The Lambert Scheme Valid? (2) Studies show different definitions and results

  7. Confusion (1): The Fuzzy Concept Of ‘Common Factors’ • Fitting the treatment with the motivational stage • Fitting the treatment with the type and severity of the problem • Structuring the treatment • Working with treatment integrity • Supporting the practitioner (e.g. with good supervision) • Monitoring the treatment, providing feedback on results • The quality of therapist-client relationship (‘Alliance’) Confusing: Some call this placebo (e.g. Stevens et al., 2000), others focus on relationship factor only (e.g. Thomas, 2006)

  8. Confusion (2): Common Factors And Specific Techniques Are Very Different Entities (Or Not) Common factors and specific techniques are mentioned separately in Lambert’s scheme. But: Using specific techniques may contribute to • Quality of the relation (e.g. Stams e.a. 2005) • The structuring of the treatment (e.g. Wampold, 2001) Specific techniques are vehickels for bringing common factors into practice(Sprenkle & Blow, 2006; Carr, 2009)

  9. Do Specific Techniques Have A Unique Contribution? Yes • Meta analyses show: • In general, specific treatments do explain a (small) part of the variance in outcome (Carr, 2009; Hoagwood, 2005; Asay & Lambert, 1999; Karver e.a., 2006). • In case of severe problems, specific treatments may be more important than common factors (Stevens et al, 2000) 2. Better implementation leads to better outcome (o.a. Aos, 2002; Lowenkamp, 2004; Goggin & Gendreau 2006; Barnoski e.a., 2004).

  10. Do Specific Techniques Have A Unique Contribution? Yes Meta analyses show: In general, specific treatments do explain a (small) part of the variance in outcome (Carr, 2009; Hoagwood, 2005; Asay & Lambert, 1999; Karver e.a., 2006). In case of severe problems, specific treatments may be more important than common factors (Stevens et al, 2000) 2. Better implementation leads to better outcome (o.a. Aos, 2002; Lowenkamp, 2004; Goggin & Gendreau 2006; Barnoski e.a., 2004). 3. Specific treatments not only specify the do’s, but also the don’ts, to eliminate negative influences on the total outcome. 10

  11. Outome = Common x Specific Factors An illustration of how to improve youth care • IOG for multi problem families, with severe behaviour problems child • Data 1999-2005 • N of cases: 43 – 72 • Response rate 50-60% • Effect size based on • CBCL Total Problem scale • NOSI Total Parenting Stress Source: Leijsen (2008)

  12. Improving The Outcome Source: Leijsen (2008) 12

  13. Improving The Outcome Source: Leijsen (2008) 13

  14. Enhancing The Effects Of Youth Care Total effect youth care in practice: d = 0.40 d = 1.20?

  15. You are managing director of a youth care provider. How do you decide to improve your services? What is your conclusion? 15

  16. More information Yperen, T.A. van, M. van der Steege, A. Addink & L. Boendermaker (2010). Algemeen en specifiek werkzame factoren in de jeugdzorg. Stand van de discussie. Utrecht: Nederlands Jeugdinstituut. (download: www.nji.nl). Yperen, T.A. van (Red., 2010). 55 Vragen over effectiviteit. Antwoorden voor de jeugdzorg. Utrecht: Nederlands Jeugdinstituut. (Download: www.nji.nl). Yperen, T.A. van & Steege, M. van der (In Preparation): Common and specific factors in Youth Care. 16