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

jgilgun@umn.eduhttp://ssw.che.umn.edu

June 26, 2003G-MAP Conference, Bolton, Lancashire, United

Kingdom

Topics Assessment 101 The CASPARS The 4-D Case Studies Customizing Tools

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

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

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

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

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.

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.

Protective Factorsassets individuals actively use to cope with adapt to, or overcome vulnerability-inducing

conditions, or risks

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

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

CASPARS

Emotional expressiveness Family Relationships Peer Relationships Family Embeddedness Sexuality

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

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

The 4-D

Belonging Mastery Independence Generosity

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

Scoring the 4-D 1=mixed 2=low strength or low risk 3=medium strength or medium

risk 4=high strength or high risk

Relationship of Assets & RisksOver the Course of Intervention

40

30

20

10

0T1 T2 T3

Assets Risks

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

Types of Assessments

Unsystematic Systematic but idiosyncratic

Systematic and shared

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

Each Case is Unique

General, Agency-Wide Assessment

Individualized goals, outcomes, and interventions

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

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

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

Stetson School Assessment Responsibility Honesty Motivation for treatment Remorse

Developed by Phil Rich, Barre, MA, USA 1/978/355-4541

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.

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?

Field Tests CASPARS

25 professionals 1 state N=146

4-D 25 professionals 4 states N=118

The CASPARS Content Validity Item-Total Analysis Coefficient Alpha Inter-Rater Reliabilities Construct Validities

Item-Total AnalysisMeans

Emo Peer Fam Rel Fam Emb Sex.76 .63 .80 .78 .67

Note: none below .50

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

Construct ValiditiesR

Emo -.56 Peer -.80 FamRel -.81 Embed -.82 Sex .46

The 4-D Content Validity Item-Total Analysis Coefficient Alpha Interviewing

Results of Item-Total Analysis

Instrument # of Items # Below .5Belonging 12 1Mastery 18 2Independence 9 1Generosity 9 0

Results: Coefficient Alphas

Initial Eliminate Final

Belonging .87 Q8 .89Knowing .93 Q2 & 2 .93Independence.87Q4 .91Generosity.910 .91

Results: Standard Errors of Measurement

Expected Actual

Belonging 5.5 5.62Mastery 9.5 7.16Independence 4.0 8.84Generosity 4.5 4.87Total 11.94 11.75

Interviews with Users Usefulness the most important

criteria for the worth of practice tools

Find out instruments’ usefulness through discussions with users

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

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

ReferencesBrendtro, Larry K., Martin Brokenleg, & Steven Van Bockern (1990). Reclaiming youth at risk: Our hope for the future. Bloomington, IN: National Educational ServiceGilgun, 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.htmGilgun, 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.