Child, Adolescent & Family

Executive Summary

Volume V: Training Strategies for Serving Children with Serious Emotional Disturbance and Their Families in a System of Care

Introduction

How can people best be trained to practice in systems of care? The monograph, Promising Practices: Training Strategies for Serving Children with Serious Emotional Disturbances and Their Families in a System of Care, seeks to answer that question by identifying and describing the following: a) the essential elements of practice that are consistent with system-of-care philosophy, provide quality care to children with emotional disturbances and their families, and lead to positive outcomes; b) the core competencies to be incorporated into training; and c) the essential processes needed to sustain training over sufficient time to result in a change in practice. The focus of the document is to articulate a common base of knowledge, skills, values, and attitudes that cuts across all professions and roles, and that ideally should be part of the training for all individuals working in a system of care, no matter the group with which they identify, or the role they occupy. Promising examples of training curricula and strategies at both the preservice and inservice levels are provided.

Methodology

The information that forms the basis of this work was gathered from several sources that included the following: a thorough review of the literature; a work group consisting of state and local children’s mental health administrators, family advocates, and university-based faculty who served as an expert advisory panel; surveys by the Division of Children, Youth, and Families of the National Association of State Mental Health Program Directors, and the Comprehensive Community Mental Health Services Program for Children and Their Families to identify promising practices; telephone interviews and review of written materials from selected sites; and an interdisciplinary work group on Innovative Training Approaches for Psychologists Working in the Public Sector, organized by the American Psychological Association’s (APA) Committee for Children, Youth and Families, and APA’s Division of Children, Youth and Family Services.

Framework

The comprehensive perspective on training presented in the report is based on an ecological and developmental framework that encompasses the principles and values of systems of care. Three important themes served as a foundation for this framework:

The purpose of training is to influence practice, yet training is only one of many elements that lead to effective practice; therefore, it cannot be viewed in isolation. The ability to transfer the learning that occurs in training is dependent on many factors in the environment in which a person works, such as supervisory support, opportunity to use the training, and organizational goals and commitment.
Training is a set of interacting events that affect what a person learns, knows, and can do. One has to consider all aspects of this system in developing an approach to training, including the characteristics of the person being trained, the training itself, the environmental or organizational context in which the person works, and standard-setting or credentialing that confirms that competence has been attained or maintained.
Effective training is a lifelong process, not a series of one-time events.

Changes in Service Systems Challenge Traditional Training Approaches

The report provides the context for a discussion of training practices by reviewing the changing nature of treatment approaches and service delivery systems over the past 15 years. There is increasing concern that training, especially at the preservice level, bears little relation to these changing trends in service delivery, the demands of the actual work, and even less relation to the needs of the children and families served. Many programs have not sufficiently altered their approaches to education and training, continuing to focus on traditional forms of practice in traditional settings. There are few examples of training programs that incorporate the values, aptitudes, and skills reflecting current practice, such as the involvement of parents and consumers, interdisciplinary collaboration, strengths-based assessment and intervention, wraparound services, cultural competence, and the use of natural informal supports and resources.

Conclusions of a 1992 survey of key stakeholders in 12 southern states, and a more recent review by three organizations—the Child, Adolescent, and Family Panel of the Mental Health Managed Care and Workforce Training Project convened by the federal Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Center for Mental Health Policy and Services Research at the University of Pennsylvania—suggest that the competencies related to best practice are not being adequately incorporated into higher education training and are not reflected in professional practice (Goldman & Irvine, 1997). The challenges are to reform training systems so that the content is relevant to practice, and to assure that what is taught in training is transferred into practice in the workplace.

Core Competencies of Practice in a System of Care

Competence involves a person’s knowledge, skills, and attitudes. Put most simply, competence is the ability to do the right thing, at the right time, for the right reasons (Knapp et. al., 1993, p. 143). Two examples of sets of recommended core competencies—both cited by the Child, Adolescent and Family Panel as exemplary for practitioners working with children with emotional and behavioral problems in systems of care settings—are those developed by the Program in Community Mental Health at Trinity College in Vermont, and Pennsylvania’s Child and Adolescent Service System Program (CASSP) Training and Technical Assistance Institute affiliated with Pennsylvania State University. In addition, cutting across all specific skills and knowledge, four areas of competence central to working in systems of care are cultural competence, family-professional relationships, systems thinking, and interprofessional education and training.

Processes and Practices for Effective Education and Training

The report presents what is known about the process of training at both the preservice and inservice levels, and what training practices facilitate learning and are effective in changing practice over time.

Principles of adult learning provide a framework for thinking about the most effective way to design learning experiences for adults. Key characteristics of adults that have implications for how they best learn are:

Adults are autonomous, and wish to be responsible for their own lives and decisions,
Adults are self-directed and are ready to learn when they judge that they need to know something to help them meet their real life challenges,
Adults are goal-oriented and will learn in order to accomplish goals,
Adults are practical and want information that is relevant to making their lives easier or more productive;
Adults have accumulated life experiences and are interested in learning that builds on these experiences.

Although limited, the data do suggest that the most effective training approaches combine theory, modeling, practice, feedback, and coaching. Programs that incorporate only lecturing and reading for conveying information are less effective. They must be supplemented with more interactive activities such as the following: methods that focus on demonstration and practice; case discussions, role playing, and simulations; and systematic follow-up opportunities after training to support the transfer of training to daily practice through supervision, mentoring, and coaching.

Preservice Training

Examples of programs with innovative approaches to preservice professional training include the Community Mental Health Program at Trinity College in Vermont, the doctoral studies program in child and family policy at the University of South Florida, the Training for Interprofessional Collaboration Project developed at the University of Washington in Seattle, and the clinical child psychology internship program at the University of New Mexico Health Sciences Center.

Inservice Training

For inservice training to be effective, a full commitment reflected throughout the organization, and a close tie to program goals, objectives, and priorities, is essential. As summarized by the National Staff Development and Training Association (NSDTA), an affiliate of the American Public Human Services Association, the essentials for sound inservice training include the following (NSDTA 1993): administrative support; an organizational climate that permits looking at problems and the means to resolve them; management’s commitment to the value of cooperative planning and the development of ways to work together to meet program and staff needs; a realistic understanding by management of what one can expect from a sound staff development and training program; and reinforcement and follow-up of training programs by supervisory and managerial staff. Training commonly fails because of such elements as these: persistence of a classroom mentality; lack of management commitment to training; lack of performance-based evaluation; too much content being covered; inappropriate trainees selected for a particular training; or lack of follow-up after training.

Promising Approaches to Training

One example of a comprehensive approach to training at both the preservice and inservice levels is in the state of North Carolina, through its Pitt and Edgecombe-Nash Public Academic Liaison (PEN-PAL) Project. This project was funded by the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, Child and Family Services Section, through a grant from the Center for Mental Health Services’ Comprehensive Community Mental Health Services Program for Children and Their Families. In partnership with East Carolina University, PEN-PAL formed the East Carolina University Social Sciences Training Consortium to work with project staff and community stakeholders to develop state-of-the-art curricula, and provide training and consultation to service providers, family members, community representatives, and university graduate students. The Consortium helps prepare students in preservice professional training programs in child- and family-serving fields to work effectively in a collaborative, integrated system of care for children who have emotional/behavioral disabilities and their families. This purpose is achieved through: 1) infusion of system of care principles into existing course work; 2) supervised field placements for students in child-serving agencies who are delivering services through Individual Service Teams; 3) the development of a graduate course in collaborative theory and practice; and 4) national presentations, publications in professional journals, and dissemination of products. They have also developed the PEN-PAL Training and Technical Assistance Resource Center to provide intensive inservice training and technical assistance for and with service providers and families.

Other examples of innovative approaches to training for work in systems of care include work being done in Santa Barbara County in California and in the state of Vermont, a specific training curriculum approach for case managers in Hawaii’s Ohana Project, and a training for families, neighborhood residents and others in the principles and practice of family support through the People in Partnership Initiative in Houston, Texas.

Conclusion

There is a need for all those involved in training to develop a clear understanding of the necessary competencies based on a set of broad principles and knowledge of what works to improve outcomes, and what appear to be promising practices even if not yet entirely supported by empirical findings. There also is a need to develop training systems that incorporate effective training methods and assure that those in practice are competent in using the knowledge, skills, values and attitudes they possess. There is much that can be done by universities and colleges, community agencies, federal and state government administrators and policy makers, family organizations and professional organizations, and accrediting boards to work together to ensure that training leads to improved practice and ultimately results in better outcomes for children and their families.