Northern Kentucky University (NKU)-Children, Adolescent ...

Northern Kentucky University (NKU)- Children, Adolescent and

Transitional-Age (CAT)Project: A Mixed Methods Project

Evaluation of Competency and Community Impact

Vanessa Hunn, MSW, Ph.D.

Amy Trostle, MSW

Dana Harley,MSW

James Canfield, MSW, Ph.D.

Megan Lindsey, MSW, Ph.D. ABD

Amanda Brown, MSSW, Ph.D.

Innovative Methods That Improve Access to Care

• Themes:

• Describe how Photovoice is an innovative and cultural competent method of evaluation within the context of underserved/underrepresented populations

• Identify barriers to behavioral health care access in underserved/underrepresented populations

Project – Children, Adolescent and Transitional-Age (CAT) Youth Program

• Presentation Objectives:

• Be able to identify successful curriculum components of the NKU-CAT Project

• Identify basic components of Behavioral Health Workforce Education and Training (BHWET) grant funded project

• Identify significance of collaborative community relationships in project success

• Identify how participatory research method, Photovoice, was utilized for project evaluation

• Understand the use of Photovoice qualitative research for program analysis within the context of cultural competent program evaluation

• Understand advantages and challenges of mixed methods approach to project evaluation

Collaborative

•NKU-CAT Project is a collaboration between university and community agencies.

• Family Nurturing Center of Northern Kentucky

• Lighthouse Youth Services of Cincinnati

NKU – CAT Project Objectives

• Provide stipends to support Master of Social Work (MSW) students for field placement

• Recruit qualified students for the program

• Develop and implement interprofessional training

• Develop and implement field placements with a focus on service for children, adolescents, and transitional-age youth

• Evaluate program and disseminate findings

Background

• Growing concern because of sharp increases in substance abuse, such as heroin among adolescents and young adults – consequently, there is a growing need for mental and behavioral services for children and transitional-age youth.

• Local mental health service agencies have been challenged with providing needed services due to a limited number of available and qualified mental health professionals – many waiting lists for services surpassed a one-year wait time.

Background (cont’d)

• Heroin use has become especially problematic in the Greater/Cincinnati Northern Kentucky region

• In 2011, three Northern Kentucky counties, Boone, Kenton, and Campbell, accounted for 60 percent of all heroin prosecutions in the state of Kentucky (Kentucky Office of Drug Control Policy, 2012).

• In Greater Cincinnati, child-welfare experts estimate thatcaseloads involving heroin has doubled over the last year.

• In a recent study examining barriers to high school graduation among at-risk students in three Northern Kentucky high schools, heroin and other substances were identified as impediments to graduation.

Cultural Competent Practice

• NKU-CAT Program addresses the mental and behavioral health needs of children, adolescents, and transitional-age youth in the region by:

• Recruiting and retaining a diverse and highly qualified pool of students

• Providing financial support to those students while training

• Implementing interprofessional specialized curriculum with primary care professionals that fit the needs of the population (rural population and urban at-risk youth)

• Partnering with agencies that offer a variety of services for children, adolescents, and transitional-age youth.

Program Evaluation

• As part of the Project objectives of evaluation and dissemination of findings, we conducted a mixed methods evaluation Year one of the project.

• Also included is a discussion on the Photovoice evaluation during Years Two and Three.

METHODOLOGY - Quantitative

• A 26-item survey based on SAMHSA’s Trauma Informed Care (TIC) in Behavioral Health Services competencies was developed to assess students’ competency in trauma-informed care.

• Two foci - Trauma Awareness (TAQ; 8 items) and Counseling Skills (CSQ; 11 items)

Data Collection

• Year One: Pre-test and Post-test survey to CAT project students (N=33)

Analyses - Quantitative

• Calculations of post-test and pre-test difference for each student. Then re-coded to new variable

• Paired-samples t-test conducted to examine mean differences in scores

Findings

Demographics of MSW program participants (diversity by ethnicity was purposeful as a way to increase culturally competent practice with underserved/underrepresented populations in Northern Kentucky and Cincinnati, Ohio region)

• 93.9% female

• 75.8% Caucasian

• 21.2% African American

• 3% Hispanic/Latino

• Average age: 30.5 years (SD=9.546)

• Age range: 22 to 55

Findings (page 2)

In each measure, students had statistically significant higher scores from pre- to post-test.

• TAQ7 (demonstrating knowledge on impact of trauma with diverse cultures) had the highest increase, with over three-quarters (76.7%) reporting an increase.

• TAQ4 (understanding how protective factors effect trauma impact) 56.7% increase

• TAQ5 (understating importance of not engaging in negative behaviors) 56% increase

Findings (page 3)

• CSQ9 (demonstrate knowledge and skill in general trauma-informed counseling strategies) – 73.3% of students had statistically higher post test scores

• CSQ2 (willingness to work within a mutually empowering power structure) 50% increase

• CSQ3 (maintaining clarity of roles) 50% increase

Table 1: Student Demographics

Student Demographics (N=33)

Gender Number of Students

Percent

Female 31 93.9

Male 2 6.1

Race/Ethnicity Number of Students

Percent

Black/African-American

7 21.3

Hispanic/Latino 1 3

White/Caucasian 25 75.8

Table 1: Student Demographics (con’t)

Age

Minimum Maximum Mean (SD)

22 55 30.55 (9.546)

Table 2: Undergraduate Degree

Undergraduate University N %

Northern Kentucky University 20 60.6

University of Cincinnati 4 12.1

Ohio State University 2 6.1

Eastern Kentucky University 2 6.1

College of Mount St. Joseph 1 3

University of Kentucky 1 3

Western Kentucky University 1 3

Wittenberg University 1 3

Xavier University 1 3

Undergraduate Education (N=33)

Table 2: Undergraduate Degree (page 2)

Undergraduate Degree N %

Bachelors of Social Work 17 51.5



Bachelors of Arts

African American Studies 1 3

Criminal Justice 1 3

Criminal Justice with certificate in Addictions 1 3

Criminology 1 3

Elementary Education 1 3

Journalism 1 3

Organizational Leadership 1 3

Public Health Education 1 3



Bachelors of Science

Computer Science 1 3

Mental Health/Human Services 1 3

Psychology 6 18.2

Table 3: Field Placement Demographics

Age of Clients # of Students Percent

Birth-4 years old 1 3

5-10 years old 8 24.2

11-18 years old 18 54.5

18-26 years old 1 3

5-10 & 11-18 years old 4 12.1

All age groups 1 3

Field Placement Demographics (N=33)

Table 3: Field Placement

Field Placement Location N %

A Home Within 1 3

Beech Acres Parenting Center 1 3

Bethesda North Hospital 1 3

Blanchester Inter and Mid School 1 3

Burlington Baptist Church 1 3

Camelot Community Care 2 6.1

CCHMC-PPC 1 3

Christ Hospital 1 3

Table 3: Field Placement (page 2)


Cincinnati Children's Hospital 1 3

Cincinnati Police Department 1 3

DCCH Center 1 3

Envisions 1 3

Family Nurturing Center 1 3

GCB 1 3

Holly Hill Residential Program 1 3

Table 3: Field Placements (page 3)


KVC 1 3

Mobile Crisis Team at UCMC 1 3

Necco Therapeutic Foster Care 3 9.1

NKADD 1 3

NKU/Newport High School 1 3

NKY Medical Clinic 1 3

NKY Mental Health Court 1 3

Norse Violence Prevention Center 2 6.1



Summit Behavioral Healthcare 1 3

The Life Learning Center 1 3

UC Medical Center BMT Dept. 1 3

UC Medical Center Emergency Room 1 3

United Ministries 1 3

VA Healthcare System of Ohio 1 3

Integrated Care Meetings

Min Max Mean (SD)

0 20 3.67 (5.248)



KVC 1 3

Mobile Crisis Team at UCMC 1 3

Necco Therapeutic Foster Care 3 9.1

NKADD 1 3

NKU/Newport High School 1 3

NKY Medical Clinic 1 3

NKY Mental Health Court 1 3

Norse Violence Prevention Center 2 6.1

Summit Behavioral Healthcare 1 3

Table 4: Competency Score Changes

Competencies Increased, Decreased, or Stayed the Same (N=33)

TAQ1 N Raw % Valid %*

Stayed the Same 11 33.3 36.7

Increase 19 57.6 63.3

TAQ2


Increase 19 57.6 65.5

Table 4: Competency Score Changes (page 2)

TAQ3 % Raw % Valid %*

Decrease 1 3 3.4


Increase 17 51.5 58.6

TAQ4

Decrease 1 3 3.3

Stayed the Same 12 36.4 40

Increase 17 51.5 56.7


Table 4: Competency Score Changes (page 3)


Decrease 1 3 3.3


Increase 17 51.5 56.7

TAQ6


Increase 19 57.6 63.3

Table 4 Competency Score Changes (Page 4)


Decrease 2 6.1 6.7


Increase 23 69.7 76.7

TAQ8

Decrease 2 6.1 7.1


Increase 21 63.6 75

Note: *Valid Percent is the percent of cases without missing data

Table 5 Competency Score Changes (page 5)


CSQ1 N Raw % Valid %*

Decrease 3 9.1 10.3


Increase 16 48.5 55.2

CSQ2

Decrease 2 6.1 6.7


Increase 15 45.5 50


CSQ3

Decrease 2 6.1 6.7


Increase 15 45.5 50

CSQ4

Decrease 4 12.1 13.3


Increase 19 57.6 63.3



CSQ7


Increase 19 57.6 65.5

CSQ8


Increase 16 48.5 55.2


Table 5: Competency Score Changes (page 8)Competencies Increased, Decreased, or Stayed the Same (N=33)

CSQ9 N Raw % Valid %

Decrease 1 3 3.3


Increase 22 66.7 73.3

CSQ10


Increase 20 60.6 66.7

CSQ11

Decrease 2 6.1 6.7


Increase 19 57.6 63.3Note: *Valid Percent is the percent of cases without missing data

Table 6: Item Means (N=30)Mean Standard Deviation

Pair 1 TA Q1 Post 4.67 .479

Pair 1 TA Q1 Pre 3.93 .583


Pair 2 TA Q2 Pre 4.03 .626


Pair 3 TA Q3 Pre 3.97 .626


Pair 4 TA Q4 Pre 4.03 .615


Pair 5 TA Q5 Pre 3.9 .845

Table 6: Item Means (N=30) (page 2)

Mean Standard Deviation


Pair 6 TA Q6 Pre 3.8 .664


Pair 7 TA Q7 Pre 3.37 .809


Pair 8 TA Q8 Pre 3.93 .663


Pair 9 TA Q1 Pre 3.83 .848


Pair 10 TA Q2 Pre 4.2 .714

Table 6: Item Means (N=30) (Page 3)Mean Standard Deviation

Pair 11 TA Q3 Post 4.73 .521

Pair 11 TA Q3 Pre 4.3 .596

Pair 12 TA Q4 Post 4.27 .785

Pair 12 TA Q4 Pre 3.5 1.009

Pair 13 TA Q5 Post 4.17 .834

Pair 13 TA Q5 Pre 3.3 .952


Pair 14 TA Q6 Pre 4.3 .651

Pair 15 TA Q7 Post 4.48 .688

Pair 15 TA Q7 Pre 3.69 .85

Table 6: Item Means (N=30) (Page 4)

Mean Standard Deviation

Pair 16TA Q8 Post 4.62 .561

Pair 16 TA Q8 Pre 3.97 .626

Pair 17TA Q9 Post 4.3 .794

Pair 17TA Q9 Pre 3.13 .819

Pair 18TA Q10 Post 4.47 .629

Pair 18TA Q10 Pre 3.3 .988

Pair 19TA Q11 Post 4.67 .547

Pair 19TA Q11 Pre 3.73 .98

Table 7: Mean Differences (N=30)

Mean Difference

SD SE95% CI

Lower

95% CI

Uppert df

P-value

TAQ1 .733 .640 .117 .494 .972 6.279 29 .000

TAQ2 .759 .636 .118 .517 1.000 6.428 28 .000

TAQ3 .655 .721 .134 .381 .929 4.894 28 .000

TAQ4 .567 .626 .114 .333 .800 4.958 29 .000

TAQ5 .767 .898 .164 .431 1.102 4.678 29 .000

TAQ6 .900 .803 .147 .600 1.200 6.139 29 .000

TAQ7 1.067 .944 .172 .714 1.419 6.186 29 .000

TAQ8 .821 .772 .146 .522 1.121 5.628 27 .000

Table 7: Mean Differences (N=30) (Page 2)

Mean Difference

SD SE95% CI

Lower

95% CI

Lowert df

P-value

CSQ1 .552 .948 .176 .191 .912 3.134 28 -

CSQ2 .500 .731 .133 .227 .773 3.746 29 .001

CSQ3 .433 .626 .114 .200 .667 3.791 29 .001

CSQ4 .767 1.073 .196 .366 1.167 3.915 29 .001

CSQ5 .867 .900 .164 .531 1.203 5.277 29 .000

CSQ6 .467 .730 .133 .194 .739 3.500 29 .002

Table 7: Mean Differences (N=30) (Page 3)

Mean Difference

SD SE95% CI

Lower

95% CI

Lowert df

P-value

CSQ7 .793 .675 .125 .536 1.050 6.327 28 .000

CSQ8 .655 .670 .124 .400 .910 5.270 28 .000

CSQ9 1.167 .986 .180 .799 1.535 6.484 29 .000

CSQ10 1.167 1.053 .192 .773 1.560 6.067 29 .000

CSQ11 .9331.04

8.191 .542 1.325 4.877 29 .000

Photovoice – Description of Qualitative Methodology

• Photovoice methodology is a cutting edge and innovative community-based participatory action research method seldom utilized in social work teaching, practice, research, and training

• Northern Kentucky University Social Work program faculty provided NKU-CAT students a unique approach to active student learning culturally competent training. NKU-CAT students assisted in giving vulnerable children, adolescents and their families a voice.

• With NKU-CAT Photovoice Project, MSW students developed skills in engagement, research, cultural competency and advocacy on behalf of at-risk youth and their families

Photovoice (page 2)

• NKU-CAT students engaged vulnerable families in the Photovoice process and collected data from clients and their families. The NKU-CAT students and social work faculty conducted a data analysis of the photographs (participant- perceived meaning of his/her photos).

• This data analysis provided a significant method of formulating qualitative themes and recommendations for addressing families perceived barriers to seeking mental health services.

Photovoice (Page 3)

• A gallery showing at NKU was held for the purpose of:

• Displaying selected participant photographs to educate agency representatives, policy makers, educators, and the public on participant-identified barriers to seeking help.

• Presenting key research findings to stakeholders, and making policy recommendations to address barriers to seeking help (presentation made by MSW students).

• Promoting critical dialogue among key community leaders, policy makers and other stakeholders (particularly agency officials) responsible for policy and program development.

Photovoice (Page 4)

• Through participation in the NKU-CAT Photovoice project, families were

• given a voice and valuable input in prevention and treatment of behavioral challenges of children, adolescents, and transitional age youth;

• encouraged to address concerns regarding access to prevention and clinical intervention and treatment for those at risk for engaging in harmful behaviors, including violence; and

• given the opportunity to discuss concerns with behavioral health and primary care professionals

Photovoice–Year One– Sample Data

Photovoice-Year One-Sample Data(page 2)

Photovoice –Year One Results • THEMES – from Year One Photovoice data, the students

took photos that represented beneficial elements to the grant program. The following themes emerged:

• Faculty/Peer Support

• Field Placement

• Financial Support

• Personal Growth/Encouragement

• CAT Curriculum/Special Skills

• Trainings/Speakers

• Examples:

• Photo 1: “I was able to apply what I was learning in the field while learning in the classroom.”

• Photo 2: “These two books were very helpful in learning about trauma.”

Photovoice –Year Two – Sample Data

Photovoice –Year Two – Sample Data(page 2)

Photovoice –Year Two Results• THEMES– from Year Two Photovoice data, the following

themes emerged as barriers to mental health care access:

• Disorganization

• Financial Constraints

• Mental Health Stigma

• Parental Inadequacies

• Transportation

• Examples:

• Photo 1: “My clients face the trauma of community violence and it creates a barrier to healing.”

• Photo 2: “Broken families represent a barrier to my clients in seeking services and receiving support after services.”

Photovoice –Year Three– Sample Data

Photovoice –Year Three – Sample Data

Photovoice –Year Three Results

• THEMES– from Year Three Photovoice data, the following themes emerged as barriers to mental health care access:

• Financial Constraints

• Lack of Parental/Community Support

• System/Service Flaws

• Mental Health Stigma

• Transportation

• Examples:

• Photo 1: “The lack of a support system can cause clients to feel isolated and alone, making it difficult to seek help.”

• Photo 2: “Clients have to prioritize resources – sometimes a bus trip to therapy is not the highest priority.”

Benefits of Mixed Methods Analyses

• Quantitative (Year One) results illustrate significant increase in TIC knowledge, skills, and application

• Qualitative results in Year One helped identify valuable program elements (e.g., field placements, resource materials).

• Qualitative results in Years Two and Three helped identify barriers to mental health treatment access, created talking points between university, practitioners, and stakeholders for solutions

Photovoice and Culturally Competent Practice

• Students in the NKU CAT program were diverse in ethnicity, culture, life experience, and age. Their opportunity to use Photovoice to identify barriers allows for diversity in conceptualization of those barriers. Conceptualization and perception are heavily determined by culture, background, ethnicity, life experience, age, and gender. Photovoice data was rich and represented the diversity of student though and perception.

Contact Information

Vanessa Hunn, MSW, Ph.D.Associate ProfessorAssistant ChairProgram Director - CAT ProjectNorthern Kentucky [email protected]

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