Marriage & Family Health Services has conducted
Efficacy Studies on the service programs we provide:
Marriage & Family Health Services and the Mikan programs have recently completed the annual efficacy study. This year we also completed a more in-depth demographic analysis of the children referred to us.
Forty-five students participated in the study to include; 22 males and 23 females. Their average age was 14.4 years. One of the key areas which we wanted to analyze was their trauma experiences. Of the 45 students, only two indicated that they had not experienced trauma and/or not had trauma documented in their histories. While another study has indicated that 87% of children referred to services such as Mikan have had trauma in their background, our numbers not only support that, but also exceed that very high percentage. For our study we had the children complete a self evaluation related to trauma and compared that with the trauma data gathered via the referral sources and their prior treatment records. Much of this data was similar between the children’s self report and the documented data we had. Twenty-three of the 45 children reported that they were physically abused with 22 of those cases having been documented. In the area of sexual abuse, 20 children reported sexual abuse with 15 of those cases being previously documented. As such, a significant number of children came forward with their sexual abuse during the course of their treatment with us. From the self evaluation data, 10 of the 20 children who had experienced sexual abuse defined that abuse as being severe (intercourse or oral sex). The level of emotional abuse reported through our staff and prior treatment agencies is very consistent with what the children reported. Twenty-nine of the 45 children reported experiencing significant emotional abuse in their home with the data from our staff and previous agencies indicating that 28 of those same students had experienced significant emotional abuse.
One area which is certainly traumatic in nature and has not been reviewed in the literature to the level of the prior types of trauma experiences is the issue of abandonment and neglect. Of our 45 children, 24 of them portrayed their childhood as being raised in a neglectful home. We believe that this is important data if children believe that they have been neglected, we need to assist them in the process of identifying what needs are not being met and how to better meet them through engaging the parents in an in-home family therapy experience and/or in-office family experience. The children and parents both need methodologies to express caring and nurturance. Of our 45 children, 26 had one or both parents disappear from their lives in a significant manner.
In these cases, the parent or parents showed no interest in their children through either being placed in prison, leaving the area, being deceased, or simply showing no interest.
The school data gathered specific to the childrens’ current educational services indicated that of the 45 students, 17 were taking mainstream classes; 17 were involved in ED courses, with 10 participating in some LD offerings. Two of our students were home schooled and one was expelled. Some children received more than one type of educational experience.
In terms of the alcohol and drug involvement, we were pleasantly surprised. Of our 45 students, four were involved in significant alcohol use patterns with three being involved in significant drug use which at this point was exclusively marijuana. Eight students identified themselves as being addicted to cigarettes. Although these numbers were less than we anticipated, Mikan will continue to have alcohol and drug treatment and prevention as an essential part of our therapeutic programming.
In the area of self-harm, we were impressed with the significantly higher rates of self-harm behaviors that our students were engaged in. Ten students had either engaged in suicidal behavior or had significant suicidal ideation. Two students reported that they engaged in self-mutilation. Thirteen students acknowledged that they had engaged in cutting behavior. Five students indicated that they had a significant eating disorder. Many students who are referred to our program have engaged in some sort of self-harm behavior and have the potential to be dangerous to themselves.
Summary
We trust that this data will be as important and valuable to our readers as it is to us here at Mikan. We continue to use this and prior data to help us focus our treatment interventions. It is readily apparent that the children that we serve have significant mental health and abuse histories to go along with their behavioral manifestations. Our children are not simply behaviorally acting out clients. Each client has his or her own specific history which in the vast majority of cases involves some form of abuse, abandonment, and/or neglect. Through the use of IRRT and other cognitive therapeutic interventions, our children are able to therapeutically address their individual histories so that they can move forward in their lives.
We need to move beyond the view that these children are simply behavioral or even “bad kids.” The children we serve are much more likely to be good kids who have had bad things happen to them. The profound level of trauma in the areas of emotional, physical, sexual abuse and abandonment are obviously very significant and should form a cornerstone of any therapeutic treatment programming. Simply relegating our efforts to the behavioral manifestations of significant trauma does not provide the kind of intervention strategies necessary to help these children make the transition from abuse victim to healthy adolescent and adult. Limiting therapy to behavioral interventions and psychoeducational experiences offered by paraprofessionals should be treatment approaches of the past. This data clearly indicates that children referred to day treatment have significant treatment needs in the areas of healing from trauma, affect regulation, schema changes as well as social functioning.
2007 Efficacy Data
It is always rewarding to be able to take some time to assess the impact of the Mikan programs. We believe this is a critical part of any treatment program. We must know what is working and also must analyze those areas that we need to improve.
As our readers know, we gather data from the client directly, their family, and school. We find that the combination of the three sets of data gives us a better picture of whether or not that child is not only making efforts, but is also actualizing treatment gains. Due to the amount of data gathered, we will limit this newsletter to the school-based information and a bit of therapeutic data. Our Winter newsletter will present additional efficacy data.
The data gathered from the schools specific to the 45 children previously mentioned, indicated the following changes. The data was derived from the respective schools that we serve. In terms of unexcused absences, our students realized a 49% decrease. The students demonstrated a 43% decrease in excused absences and a 69% decrease in tardy behavior. The data compared behavior during the semester prior to coming to Mikan with the data gathered at the conclusion of this spring semester. The behavioral changes are signi-ficant and indicate that children are showing up to school on time, and making significant strides in being responsible to the school and to themselves. This information supports keeping children in school while providing professionalinterventions as the methodology of choice.
In terms of depression and emotional regulation skills, particularly in the area of anger, our students demonstrated a 20% decrease in depression symptoms and a 22% decrease in anger management issues. While we are pleased with these numbers, we know that we can continue to improve upon these areas. However, we also recognize that very often children who are working with licensed therapists experience some increase in their levels of depression and/or anger as they address their abuse history.
The last bit of efficacy data that we’ll share in this newsletter will be specific to the clients own self-evaluation in terms of the effort that they are putting forth to meaningfully change their lives. Because of how much data we’ve had to present, we will save the family evaluation data for our next issue.
The children were asked to analyze their behavior prior to coming to Mikan in ten specific areas and compare that data with how they feel their current efforts have been. It should be noted that there was no secondary gain for the student to portray themselves in any other way than how they have actually been feeling.
This study looked at the areas of school performance, alcohol and drug use, home behavior, anger management skills, communication skills, family functioning, taking personal responsibility for actions and decisions, overall behavior, and the development of empathy skills. This data clearly indicates that the students believe that they are making significant changes in their lives. The following data certainly indicates their efforts. To gather this data, each child rated their behavior on a 0 to 10 Likert scale both pre program and post program. The 45 students on average indicated that they have improved their effort at school by 207%. That they had increased their efforts to mitigate alcohol and drug involvement to include cigarettes by 156%. It indicated that their efforts to improve their behavior in their home increased by 252%. Their efforts at emotional regulation, particularly in the area of anger management improved by 295%. The students also indicate that their communication skills improved 268%. In terms of interpersonal functioning in the family they believe they’ve improved by 219% and in terms of taking personal responsibility for their actions and decisions, they believe they have improved their capability here by 285%. In the area of their behavior in the community, they indicate an improvement of 269% and lastly in the area of empathy building skills, they believe they have improved by 230%.
This data is truly impressive from the context that our students are acknowledging that they are making efforts to improve their lives in each of the ten areas specified in this study. Furthermore, their efforts are being acknowledged by their schools. This data will also be corroborated in the family results to be discussed in our next issue.
The data derived from this study clearly supports our efforts to integrate research-based intervention methodologies addressing emotional and cognitive stabilization needs (DBT); individual schema needs in regard to trauma (IRRT) with Mikan’s own unique and therapeutically effective programming. It is apparent that when children with significant therapeutic needs are given the opportunity to work with licensed/certified professionals in a evidence-based program, they will make statistically relevant treatment gains. Children should be given every opportunity to address their treatment needs.
Efficacy Studies over 10 Years of Excellence
Introduction
1. The majority of children/teens referred to day treatment have experienced some form of trauma or neglect. Therapeutic day treatment is the treatment of choice for children/teens who have experienced single episode or complex trauma or neglect. It is a disservice to those children to simply work with their behavior. By having licensed/certified staff working with the clients throughout their treatment day, you can achieve the type of behavioral and emotional gains documented in our efficacy studies. The research on brain development and trauma in children clearly supports our results and the need to work with higher brain functioning.
2. Children/teens with emotional needs are best met through therapeutic day treatment services. When a child/teen has been diagnosed with a mental health diagnosis (e.g., bipolar, depression, PTSD, ODD, attachment disorder, Asperger’s disease, etc.) these clients’ need much more than the behavior modification offered by unlicensed/certified staff. Children/teens who have experienced complex trauma and those who have a mental health diagnosis without trauma deserve an opportunity to experience therapeutic day treatment. Their needs are not met through behavioral day treatment services.
3. The following efficacy data was gathered through a Likert scaled self-evaluation tool, a parent completed Likert scale evaluation form, testing data, information gathered through the school district, as well as data derived from interviewing the parent/foster parent. We trust that you will find this information to be helpful. We were able to gather information on 40 children/teens who were given the opportunity to participate in our program.
4. Partial therapeutic day treatment programming such as the Mikan program provides the client with the opportunity to make changes behaviorally, but also to make strides in their own decision-making, affect regulation, self-concept, attachment, with substance abuse and in healing from past trauma or neglect. The following data is much more credible in the sense that it is measuring changes that our clients make within their home, community, and school. This data does not reflect changes made within a program isolated from the challenges and distractions that are inherent when our clients are in their schools. These changes are valid. We trust that you will find this data helpful in evaluating the success of the clients who have had the opportunity to participate in a therapeutically driven program. We also hope more children/teens are given the opportunity to work therapeutically before they are removed from their school completely. Children/teens are much more likely to make treatment gains when they receive professional, individualized assessments and treatment planning/interventions.
Client Self Evaluation Summary
The client’s self-perception of the effort that they have put into themselves during their time in Mikan is valuable. In this data, the children/teens compare the effort that they were putting into themselves at the beginning of their treatment with the efforts that they are now providing at the end of their program. The data was organized into ten specific areas of their lives.
The following changes in effort remain quite impressive in each of the ten areas in which the children/teens were asked to evaluate themselves. We know that the clients own insight into their efforts is extremely valuable and worthwhile in measuring the success or lack of success that they have demonstrated in their program. The first column is the average score on a Likert type self-evaluation tool. The second score was taken during the last week of program. The last column reflects the amount of change they saw in themselves during their therapeutic work with us.
|
|
Beginning of Program |
End of Program |
% Change |
|
School Effort |
2.95 |
6.875 |
133% increased effort |
|
AODA |
3.15 |
6.00 |
191% increased effort |
|
Home Effort |
3.95 |
6.79 |
172% increased effort |
|
Anger Management |
2.92 |
6.03 |
206% increased effort |
|
Communication |
3.05 |
6.00 |
197% increased effort |
|
Family Relations |
4.00 |
6.70 |
168% increased effort |
|
Personal Responsibility |
3.53 |
6.95 |
197% increased effort |
|
Behavior |
3.41 |
7.27 |
213% increased effort |
|
Empathy |
4.05 |
7.00 |
173% increased effort |
We are very impressed with our children/teens efforts in each of these areas. It should be noted that this year’s evaluation in the area of alcohol and drug abuse has had the highest level of self-perceived improvement (that being lowered use and/or complete abstinence) than any other time in the ten-year history of Marriage & Family Health Services. We have also noted significant differences in the areas of changing behavior in the home, anger management, taking personal responsibility for their actions and decisions that are being made, efforts at improving family relations and lastly in the area of being able to be empathetic toward the needs of others. These areas of change reflect dramatic improvements in the area of higher brain functioning. They are not simple behavior alterations in response to structure. The children are owning their efforts.
Family Evaluation Summary
The most critical area for the client to demonstrate valid improvement is within their homes and families. Data gathered by the parents themselves is invaluable as they are the ones who witness changes in effort first hand. They also are in a position to note behavioral changes within the school and community as well as any improvements in mental health and behavioral functioning. They see how their children function outside of the structure and as such they witness opportunities to apply learning and growth.
|
|
Beginning of Program |
End of Program |
% Change |
|
School Effort |
2.10 |
5.95 |
283% increased effort |
|
AODA |
5.30 |
6.88 |
130% increased effort |
|
Home Effort |
2.95 |
6.44 |
218% increased effort |
|
Anger Management |
2.65 |
6.70 |
253% increased effort |
|
Communication |
2.86 |
5.93 |
207% increased effort |
|
Family Relations |
4.12 |
6.16 |
160% increased effort |
|
Personal Responsibility |
2.37 |
5.44 |
230% increased effort |
|
Behavior |
3.60 |
7.00 |
194% increased effort |
|
Empathy |
3.40 |
5.91 |
173% increased effort |
The parental results were extremely impressive and supportive of the child/teen’s efforts in our program. The increase in effort that they have seen in their particular child ranged in improvement from a low of 130% in the area of AODA (which is more than twice the observed effort noted in our study of 2003) to a high of 253% improvement in the area of anger management. The parents are seeing a difference in their child, not only in our program, but more importantly in their homes, in the schools, and in the community. They are witnessing much more than in-program change on a graph. These parents/care-givers are seeing therapeutic growth in each area of their child’s life.
School/Community Performance and Behavior
This information was gathered from hard data provided to us by the respective schools that our clients participate in as well as data from the client’s social worker and/or parent. Such data is valuable in that it gives an indication of what the client is actually demonstrating in critical areas of their lives. As such, we have been impressed with the positive changes which our students are demonstrating in their schools and communities.
|
Tardiness |
24% decrease |
|
Unexcused Absence |
65% decrease |
|
GPA |
1.18 improvement (on a 4-point scale) |
|
Excused Absences |
41% decrease |
The data in this section demonstrates consistency in terms of what the client is perceiving about their efforts with what the parents are witnessing in their homes, and what is being actualized within the school environment. It is impressive that the students are able to make these kinds of changes while they continue to be involved in their schools and communities. The students have not been removed from their peers, teachers, academic staff, nor schools. These are measures of valid change in the midst of numerous temptations and distractions and as such, it is powerful information. Statistics clearly indicate that children who are allowed to remain in their schools have a much greater chance to graduate from high school.
Lastly, we gathered community placement data attempting to see if our program is making an impact in terms of where the client lives. This data is valuable in the sense that it should demonstrate progression from restrictive environments to less-restrictive environments. This group of students demonstrated the following concerning their community placement:
At the beginning of our program we had seven students who came directly to us from an institutional placement and one student from a group home placement. We are pleased to share that at the conclusion of the program, there were no students placed in an institution or a group home.
At the beginning of the program we had six students who were in a foster home placement and twenty-six students who were residing in their home. At the conclusion of our program we still had six students in foster care, but we had thirty-four students living in their homes. This data supports a migration from more restrictive placements (e.g., institutional and group home) to foster home and most important, their own private homes.
Summary and Conclusion
It has been extremely rewarding to have had the opportunity to work with our children and to do so in cooperation with you. We wish to thank each of you for the data you have gathered or shared upon our request. It is through efficacy studies which measure not only internal, but external changes in a child while that child is allowed to function in a less restrictive therapeutic environment that makes all of the therapists, families, and community supporter’s efforts so much more valid. This study further demonstrates that partial therapeutic day treatment programming is the treatment methodology of choice. Students have demonstrated significant improvement in their behavior, affect regulation, problem-solving, effort in school, alcohol and drug behavior, improvement in family relationships, taking personal responsibility for their actions and decisions, their ability to communicate, as well as their ability to be able to empathize with the needs and feelings of other human beings. It is through involvement in a therapeutic day treatment program where the therapists are with their clients on a minute-by-minute basis and each child/teen receives professional, individualized assessments and treatment, that this type of improvement can occur. This data is indeed supportive of everyone’s efforts.
Please feel free to contact us should you have any questions or comments.