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Page.Volume V: Training Strategies for Serving Children with Serious Emotional Disturbance and Their Families in a System of Care
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Changes in Service Systems Challenge Traditional Training Approaches Core Competencies of Practice in a System of Care Processes and Practices for Effective Education and Training Promising Approaches to Training |
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. | ||
| top | 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 for Children and Their Families
Program 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.
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| top | 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:
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| top | 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.
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| top | 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.
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| top | 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:
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.
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| top | 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 for Children
and Their Families Program. 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.
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| top | 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. |
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