A 'Common Elements' approach to children's services
Dr. Bilha Davidson-Arad
I have chosen to discuss the "common elements" and "common factors" approaches in relation to the area I study. My research centers on the decision to remove abused and neglected children from home to an alternative care, and their well being after the decision has been implemented.
I would like to start by sharing with you an association I had while I was reading the materials professor Barth has sent me on the concept of "common elements".
In the sixties, when I was a young child, the economic situation in Israel was not so good. We lived in a small blue-collar neighborhood and occasionally a dramatic event took place: One of the privileged families that had relatives in the U.S received a huge package from their "American uncle”. All the children were kindly invited to the ceremony of opening the package. Usually, the package contained some food and clothes which were quite helpful. Some of the clothes were amazing and made me very jealous. I still remember the desire to have a pair of jeans like the ones in the package. Other items looked quite awkward. They were not tailored for the Israeli weather or fashion.
I have the same feelings now. On the one hand, the common elements approach for intervening with abused and neglected children, at home or in out of home placements, looks so impressive and right. I even feel some of the same childish jealousy. On the other hand, I am not sure it will fit – after all it is a package of imported elements from abroad.
While the adoption of the common elements approach to the Israeli context seems to be unproblematic, the specific practice elements it builds upon may not transfer well to the Israeli context. However, in Israel we do not yet have a large enough body of evidence based manuals from which we can distill our local common elements.
We could have a long discussion on how come or why we don’t have enough evidence based practice in Israel. But such a discussion must to take place on another occasion and before we can implement Professor Barth's approach.
However, back to our discussion, I think that it is right and important to adopt empirically tested elements with child protection clients for more than one reason. As we all know, the decision on removal is very difficult, complex, and has crucial implications for the child and his or her family. Yet, the law provides only vague guidelines for the decision and there is not sufficient knowledge to predict which alternative will serve the best interest of the child.
It is an intrusive decision in which a social worker as an agent of the society makes a decision against the parents' wishes and tells parents that she knows better than they what is best for their child, and that she knows better than they how to provide for the child's needs. I believe that under these circumstances it is very important and ethically crucial that we use common practice elements that were found empirically effective for improving children's well being.
Another argument for the use of the common elements approach is that it could move us from the unresolved dilemma of which is the better place for maltreated children, at home or in an alternative care; a dilemma that currently absorbs so much of our attention. A more promising direction is the identification and implementation of evidence based programs or interventions, that can improve children’s welfare at home, as well as in out of home placements.
I believe that we are stuck in a split between the two alternatives - in home versus out of home - as a defense mechanism. Social workers defend themselves against the unpleasant feelings that arise from the gap they are facing between their legal responsibility for the safety, normal development, and the welfare of children at risk, and the limited existing knowledge about how to provide it. And this is true for both alternatives, home and out of home placements.
The “common elements” approach may help us to narrow the gap and allow us to direct our professional energies to the identification and implementation of the common elements that can improve the children’s well being at home or out of home
Still, there is the dilemma of using practice elements that were found to be effective overseas, in different cultures and in different contexts.
There are some significant differences between Israel and other countries in the context of child protection with relation to: type of out of home placements, children's characteristics in different placements, stability rates, frequency of visiting at home, and the organizational culture, context, law and regulations of the child protection system.
After acknowledging the differences, we have to ask ourselves whether practice elements that were developed and empirically tested abroad, will be effective for Israeli children. Does the common elements model, which allows flexibility and adaptations, enable us to be more confident about using elements from "imported" manuals?
The question is whether our clients, conditions and context are similar enough and, if so can we use the "imported" evidence based practice elements, or is there too big of a difference? More specifically, we should ask ourselves whether it is sufficient to have the same target problem in order to implement the same elements. Can we assume that because we use the same theories as professionals in other countries to explain, for example, emotional problems of maltreated children, the goals and the strategies to gain them will be the same? Or, should we assume that although the target problems are identical, the differences in the conditions and contexts are too big and therefore it is wrong to use imported practice elements? For example, the problem of neglect is explained by both theories we share in common and particular socio-cultural contexts.
Yet, even if we agree that it is necessary to develop our own common elements, could we suspend our evidence based practice until this endeavor is completed? Do we have the time and resources to develop our own manuals and common elements, tailored to the special characteristics of our children, our culture and our contexts?
Because there is no easy way to answer these questions, in the meantime we may want to adopt the imported common elements, while accompanying their use with an on-going assessment. Then we can add, revise and empirically test new contextualized elements.
In doing this, we need to take into account the resistance of practitioners to using empirically tested manuals. Practitioners, in Israel as elsewhere, are often not convinced that practice manuals are sensitive enough to the specific characteristics of their clients and their work contexts. They tend to question the generalizations of research knowledge to a specific child or family. I believe that they will be even more suspicious towards imported practice elements and it will be much harder to convince them to use them. We need to make sure that their experience in implementing this approach will be positive enough so they will continue to participate in the development and implementation of evidence based practices.
A strong argument in favor of using imported empirically tested common elements is Prof. Barth's emphasis on the involvement of clients - parents and children, in the effectiveness assessment. This notion is supported by 2 studies that I conducted. In this studies I found differences between parents' and children's assessments and social workers' assessments of children's well being, as well as of the contributions of professional intervention to children's well being.
The differences highlight the need for a timely dialogue on the outcomes of the interventions. Such dialogue will enable social workers to obtain parents' assessments of the impact of the interventions on their children. Like wise, social workers can share their assessments with the parents. Like professor Barth I think that this may help social workers to better meet the needs of the parents and their children and to enhance parents' cooperation with their social workers.Since we don’t know what works for our clients and since there might be a risk of a bias in social work intervention assessments we must listen to clients’ feedback.
I believe that involving child protection clients in the evaluation will improve our ability to match the common practice elements to the needs of the children and their families. I would like to emphasize that this is true also for parents of children who were removed from home. Though their children are out of home, they are still their parents. Involving them in the process of assessment might not only improve our intervention with the children but also increase their involvement in the child's life and the likelihood of reunification.
Thank you
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