FAMILYINTERACTIONPROGRAM-Scholarshipin家庭互动计划奖学金.doc

The Family Interaction Program 69Table of ContentsSection I Service Profile4Section IIA Program Logic10Section IIB Program Logic Spreadsheet13Parent-Child Interaction Therapy13The STEP Program17Section IIIA Program Specifics21Parent-Child Interaction Therapy (PCIT)21Target Group and Description of Program Clients21Description of Program Clients21Service for Indigenous clients22Quality Systems and Quality Service Delivery23Referral Procedures between FIP and Department of Families23Match between Referrals and PCIT Service25Challenges to Service and Learnings26Client Outcomes31Current Client Outcomes31Caregiver Training Services36Potential For Effectiveness of Service, Long-Term Outcomes and Sustainability38Potential Client Outcomes38Longitudinal Follow-Up38Staffing Quality and Training, Access to Expertise39Transportability of PCIT40Section IIIB Program Specifics41The STEP Program41Background41Target Group and Description of Program Clients42Description of Program Clients42Service For Indigenous Clients44Quality Systems and Quality Service Delivery45Referral Procedures between FIP and Department of Families45Match between Referrals and The STEP Program46Challenges to Service and Learnings46Client Outcomes49Current Client Outcomes49Potential For Effectiveness of Service, Long-Term Outcomes and Sustainability49Section IV Action Learning Team51AppendicesAppendix A53Evaluation Tools Designed or Modified for the Trial53Qualitative Completion Interview53Completion Questionnaires54Appendix B58Standardised Measures Used In PCIT And The Step ProgramAssessments58Appendix C60School Liaison Protocol PCIT60Appendix D65Foster Caregiver Training Evaluation PCIT65Appendix E67The STEP ProgramPromise Of Effectiveness Based On Data From Other Sites67List of TablesTable 1Description of Families in PCIT22Table 2Department of Families Referral Outcomes for PCIT25Table 3Complex Psychological Characteristics of Caregivers and Children29Table 4Total Number of Adjunctive Psychological Sessions For Current Clients30Table 5Progression of Families Through PCIT32Table 6Changes In Child Behaviour Within the Home34Table 7Child Behaviour Within the School35Table 8Changes in Observed parent-Child Interactions36Table 9Changes in Caregiver Reported Stress37Table 10Results From Evaluation of Foster Caregiver Training, March 200337Table 11Average Change In Parenting Stress Index Scores From Pre-Assessment to Treatment Completion38Table 12Average Change In Child Behaviour From Pre-Assessment toTreatment Completion39Table 13Description of Families Assessed For STEP43Table 14Department of Families Referral Outcomes for STEP45Table 15Complex Psychological Characteristics of Caregivers and Children.48Table E1Percentage of child types manifesting clinically significant decreases (and clinically significant increases) in scores on theChild Sexual Behavior Inventory-3 after 16 weeks of treatment.68Table E2Mean CBCL Externalizing T-scores for five types of childrenwith sexual behaviour problems across time.69SECTION I SERVICE PROFILEAgency 14: Griffith University, Family Interaction ProjectBackground The Griffith University-Gold Coast, School of Applied Psychology initiated the Family Interaction Program in 2002 to provide and evaluate therapeutic interventions for families at risk of or engaged in child physical maltreatment through voluntary services of post-graduate students and staff at Griffith University. The Family Interaction Program includes:- Parent-Child Interaction Therapy (PCIT), a 12 to 20 week therapeutic intervention for families with children from 3 to 7 years, devised and empirically evaluated in the U.S. and implemented for the first time in Australia; and - The STEP Program for children from 8 to 12 years who have experienced abuse or neglect and their caregivers. The program was created and empirically validated through a grant from the U.S. National Center on Child Abuse and Neglect, is being implemented in DoFs Sexual Abuse Counselling Service (SACS) in Queensland and in two other sexual assault services and a child and youth mental health service in Victoria. Both programs have strong theoretical bases:- PCIT, which is founded on attachment theory and social learning models of behaviour, aims to restructure the parent-child relationship through directly coaching parents in skills that foster positive, nurturing interaction patterns. - STEP incorporates Relapse Prevention to identify risk factors associated with the experience of trauma and distress, increase protective behaviours, and acquire and employ coping strategies to reduce the impact of distressing events that cannot be avoided. MultiSystemic Therapy is used to address the multiple factors affecting the familys life. The development of Safety Teams is a critical component of The STEP Program. PCIT improves parent-child relationships in families with children exhibiting behaviours such as opposition, defiance, aggression and tantrums, and in families engaged in physical maltreatment. The program contains an intensive positive interaction component incorporating both the parent and child in treatment sessions. The Family Interaction Program provides strong industry and academic links to service families in the Gold Coast region who are experiencing difficulties parenting their children. Environment The number of notifications of child harm increased by 45% from 1997 to 2000 on the Gold Coast. There is limited availability of support services for parents. Waiting lists for crisis service extend to many months and prioritise severe, treatable psychological disorders. Few services on the Gold Coast provide assistance to parents and children together. Critical Features Of The ModelBusiness relationships Griffith University-Gold Coast, School of Applied Psychology is trailing the two programs using clinic facilities at the School of Applied Psychology Clinic in Southport.The staffing model The project team has 3 full-time funded positions: - Program Coordinator- 2 Service Providers12 therapists undertaking post-graduate programs (masters or PhD from Griffith University School of Applied Psychology) who have been trained in PCIT and/or The STEP Program All Family Interaction Program staff members have received and continue to undertake other training in working with adults, children and families in distress. PC credentialsFunding/ Costing Model The funding of $181 025 is allocated to the following: - Salaries (including supervision) 91%- Operational expenses 9% Office and clinic space are provided as in-kind support by Griffith University. Postgraduate students provide supervised volunteer support services. Linkages The Family Interaction Program has provided in-services to Queensland Health offices including Gold Coast Child and Youth Mental Health (CYMHS: Burleigh, Southport), Central Zone CYMHS, and to Queensland Health psychologists within the Gold Coast districts (Community Health and Child Health). Collaborative activities occur through case management conferences and case planning activities with agencies integral to an individual clients well-being such as DoF Family Services Officers, Adult Mental Health workers and CYMH practitioners Links, inservices and referrals have also been established with Education Queensland and Queensland Health Child Health services. Referrals for the program have been sought from Queensland agencies (both government and nongovernment) that work with at-risk families including sexual abuse counselling services (e.g., SACS and Bravehearts), family support centres (e.g., Lifeline), and domestic violence services. Relationship with the Department and other agencies The Family Interaction Program has established a referral system and protocol with the Department of Families by providing several in-services to staff and management of the Gold Coast Area Office and the Beenleigh Intake Office. The system enables supervisors to consider cases with respect to the Family Interaction Program criteria and DoF staff members are encouraged to contact with any inquiries. Staff members of the program maintain weekly contact with Department of Families Area Offices. Systems, structures The School of Applied Psychology sits within the Griffith University structure and as such is required to report to many levels of administration (Head of School, Dean, Pro-vice Chancellor). Accounting services are centralised within the Financial Business Services (FBS) unit. All payments are made through FBS and an authorised financial manager must sign off all payments. PCIT is conducted within strict quality guidelines and connections with US-based program originators are maintained. The STEP Program is supervised by the originators of the program (Kristy Pinter, Alison Gray, William Pithers). The Program Coordinator reports to the Co-Directors (Melanie Zimmer-Gembeck, William Pithers). The Co-Directors report to the Head of the School of Applied Psychology (Ian Glendon).The Service ItselfPrinciples of practice, policies The Family Interaction Program is required to adhere to national ethical and quality standards of the University system. The Family Interaction Program has developed internal policy guidelines.Who are the clients? Clients are:- Families with young children, within the Gold Coast and surrounding regions, who are experiencing family difficulties and those whose children are at risk of entering into the statutory system or are currently statutory clients. Foster carers and children are also clients.- 80% referred by government departments with the majority referred by the Department of Families. PCIT provides individualised services to children aged 3 to 7 years and their caregivers. STEP provides group-based services to children aged 8 to 12 who are experiencing symptoms of trauma and their parents. At risk families include those where: - caregivers are very young (under 21 years)- caregivers are having relationship difficulties- caregivers lack basic parenting skills- income is below the poverty line- families and foster carers are caring for children with challenging behaviours- children have been assessed by the DoFs as having protective needs- caregivers have a mental illness or intellectual disability- caregivers have a drug, alcohol or substance addiction/ dependence- Families have experienced violence or other forms of trauma- Families lack support from extended family or others- Families who do not access or are not engaged with support services- Families who require additional parenting skills prior to reconnection or after alternative care of children. Needs of target groups include:- children to have their protective needs met- families to gain effective communication strategies- caregivers to adopt skills to engage in positive and supportive interactions and relationships with their children- caregivers to adopt effective discipline strategies- caregivers to gain information about risk factors for behaviour problems- caregivers to gain information about protective factors to decrease likelihood of future trauma and behavioural problems- caregivers to develop coping and parenting strategies to prevent further abuse- caregivers and children to gain support networks. Service delivery to clients The Family Interaction Program includes two programs Parent-Child Interaction Therapy (PCIT) and The STEP Program. PCIT is provided to Gold Coast families at a specially equipped clinic at Southport Griffith University and at Marymount College in Burleigh Heads. Families attend sessions and use specialised equipment including one-way mirrors, earpieces and videotaping equipment. STEP can be provided at the 3 venues: the Griffith University, School of Applied Psychology Clinic, the Mermaid Beach office of the Department of Families and in Beenleigh. Assistance is given for transportation to the centre by Department of Families caseworkers, FIP staff and reimbursement of fares. The interventions The PCIT program runs for 12 to 20 weeks as determined by how quickly caregivers acquire the skills and when they feel competent. PCIT has 2 phases: the relationship enhancement phase and the discipline phase PCIT provides therapeutic interventions for caregivers and their children, where families have children with behavioural problems and are at risk of, or engaged in child maltreatment. In PCIT, the therapist observes structured interactions between parent and child from a room behind a one-way mirror and coaches the parent in positive and effective behaviour through earpieces. STEP is a 12-week intervention with groups of caregivers and children participating in separate, parallel groups. The children and caregivers come together each session to share information and build networks of supportive adults (Safety Teams) for adults and children. Program Overview The intended program outcome is that families will be able to facilitate nurturing caregiver-child relationships in a safe environment. For each family undertaking PCIT this outcome will be shown when the caregiver feels better able to manage the challenges of parenting and family life. the caregiver and child recognise the things they do well. the caregiver and child spend more enjoyable time together. the caregiver understands and effectively manages parent-child conflict and the childs behavioural problems. the caregiver manages parenting stress in a proactive and prosocial manner. In order to do this, PCIT develops caregivers abilities to (a) listen, observe, and use positive communication skills; (b) set consistent and predictable limits; and (c) implement time-out disciplinary strategies consistently and effectively Emotional skills are modelled and developed through PCIT so that caregivers (a) understand the impact of her/his affect on children; and (b) feel competent as a parent; To develop these skills, PCIT therapists coach parents in communicating and applying appropriate discipline strategies when interacting with their children in a positive way. For families undertaking STEP the outcome will be shown when families caregivers are aware of the impact of trauma in their children. caregivers and children demonstrate protective factors that will decrease the likelihood of future trauma. caregivers and children effectively manage behavioural and emotional problems resulting from trauma. caregivers identify and implement safety measures to protect children. families expand positive and supportive community networks. The STEP program intervention explains the impact of trauma to children and their caregivers, and teaches children and their caregivers ways of building supportive networks to avoid future trauma. In order to do this, The STEP Program develops caregivers abilities to (a) recognise cues that remind the child of abuse and cause subsequent distress; (b) effectively cope with problems; and (c) recruit community supports to assist with safety behaviours and access these team members when required. Emotional skills are modelled and developed through The STEP Program so that participants (a) understand the impact of trauma and acquire skills to cope more effectively with it; (b) feel more able to connect/collaborate with family, advocates or community about safety; (c) feel confident setting limits; (d) feel more able to use safety tools; and (e) feel more able to prevent harm.Service Delivery To The Community Inservice presentations on PCIT and The STEP Program skills are provided to service providers in the community to increase knowledge of the intervention. PCIT and The STEP Program are also offered to foster carers to increase their ability to manage challenging behaviours and reduce likelihood of placement breakdown. The Family Interaction Program provides strong industry and academic links in servicing those families in the Gold Coast region experiencing difficulties parenting their children. Action Learning The Action Learning Team commenced on 2 April. Membership includes FIP team, Gumurrii Centre, YMCA, Department of Families, Queensland Health, Lifeline The Family Interaction Program is undertaking rigorous evaluation procedures for both PCIT and The STEP Program. Assessment of child, parent and dyadic functioning occurs across situations (teachers/day care providers and parents are asked to complete assessments) and in assessment instruments (self-reports, teacher-reports and observational measures). The outcome of the trial will inform future service delivery components of the program.SECTION IIAPROGRAM LOGIC_Departmental Outcomes: Reduced Involvement in the statutory system Child Protection, Youth Justice._Program Outcomes:Parent-Child Interaction Therapy (PCIT)Families have nurturing parent-child relationships.The STEP ProgramFamilies and children use protective behaviours and safety skills to prevent harm and abuse.PCITFor each family undertaking PCIT this outcome will be shown when the caregiver feels better able to manage