Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698059463422.pdf (Liberia)
ESTER A way to work in a more effective and evidence based way in assessments and follow-ups of youths.

Henrik Andershed, professor Center for Criminological and Psychosocial Research CAPS To focus on risk and protective factors in work with youths (see e.g., Farrington & Welsh, 2007) o Why relevant and important?
o Many problems of adulthood originates from childhood and adolescence o Adult problems are often associated with risk and protective factors that are evident much earlier in life, in some already in the preschool years o The actual practical use of the research based knowledge concerning risk and protection has thus far been very limited, in general o Important that this knowledge IS used because it can make interventions more effective!
2014‐09‐26 1 Why relevant and important to focus risk and protective factors?

(cont.)

(see e.g., Farrington & Welsh, 2007) o In health care, this kind of knowledge about risk and protective factors IS used o For example: high blood pressure, high cholesterol, etc.
o A concrete way to work in a more evidence-based way o To use best available knowledge concerning risk and protective factors in assessments and interventions Risk- and protective factors exist on all different levels 2014‐09‐26 2 2014‐09‐26 Single factors are generally weak but have cumulative effects (see e.g., Eriksson et al., 2012; Farrington, 2003) o Single risk and protective factors in youths are generally quite weak o i.e., most children exhibiting only one individual risk factor will have a very good chance of not developing psychosocial problems in the future o Both risk and protective factors tend to have cumulative effects o i.e., the more risk factors the higher the risk and the more protective factors the stronger the protection Cumulative effects of risk factors (Farrington, 2003) % Convicted in adulthood 90 80 70 60 50 40 30 20 10 0 0 1 4 Number of risk factors in youth 2 3 5 ‐ 6.
3 How use risk and protective factors in practice?

”Risk-focused prevention” (Farrington & Welsh, 2007) o1.

o Identify and grade risk factors o Identify and grade protective factors o2.
o Plan and implement interventions that: o Reduce the risk factors o Strengthen protective factors Three Useful Guiding Principles in Assessments and the Tailoring of Suitable Interventions (see Andrews & Bonta, 2010) o The Risk Principle o Interventions more effective if intensive interventions are focused on children at high risk o The Need Principle o Interventions more effective if they are tailored to focus on the specific childs’ most relevant needs – the changeable risk factors explaining/maintaining the problem/s of the particular child at hand o The Responsivity Principle o Interventions more effective if tailored after the specific childs’ and the families’ abilities and motivation 2014‐09‐26 4 2014‐09‐26 More effective in helping when these principles are followed!
(see Andrews & Bonta, 2010) Much knowledge exist concerning risk and protective factors This knowledge is not used systematically in practice How can this be implemented?

Education/training?

Experience?

5 2014‐09‐26 One in five million = 0,00% 6 Appr.


3-17% leads to complications or death Not unusual that preventable errors are the causes (WHO, 2005) 2014‐09‐26 Complications decreased with 36 % Deaths decreased with 47 % (see Haynes et al, 2007) 7 2014‐09‐26 8 2014‐09‐26 9 2014‐09‐26 10 2014‐09‐26 11 2014‐09‐26 12 Can You, without help from an instrument, do a correct assessment?

Are A and B Equally Long?

 Without an instrument:  Three alternatives:  Equally long.

 Not equally long.

 Don’t know.


 With an instrument:  They are not equally long  Assessment becomes both reliable and valid A 0 B 0 2014‐09‐26 13 2014‐09‐26 -”It´s boring” -”Me?

I don´t need it” -”It takes time away from the patient/client” If you were having surgery – Would you like the checklist to be used?
93% said YES 15 knots side wind 14 2014‐09‐26 Education/training Experience Checklists/Instruments ESTER: A risk-need assessment instrument for youth with or at risk for conduct problems ESTER 15 What is ESTER?

o ESTER is an assessment system that includes o (1) a screening system (ESTER-screening) o (2) a structured research-based professional risk-need instrument (ESTER-assessment).

o An easy-to-use computerized system that helps visualize and interpret assessments.
o Aims to facilitate assessment and follow-up assessments of risk and protective factors for conduct problems among youths (0-18 years) with or at risk for conduct problems.
o Thus, for use in both preventive and treating settings Developed by researchers in collaboration with practice o Developed by the researchers Henrik Andershed & Anna-Karin Andershed o Comments and suggestions from o Practitioners in various youth-related organizations o Professors in the field o Has been formed together with practice via practical testing o Pilot version (October 2007) – Practical testing - revisions o Version 1 (April 2008) – Practical testing - revisions o Version 2 (October 2008) -> Practical and scientific testing o Now widely spread in Sweden 2014‐09‐26 16 Can be used by all professions and organizations and to improve collaboration  ESTER can be used by professionals working with assessment and interventions of youths with or at risk for conduct problems.
 E.g., intake assessment and follow-ups  Can be used by all organizations that work with youths  E.g., preschool, school, social service, child and adolescent psychiatry, juvenile justice institutions, etc  The computerized system is designed to facilitate collaboration Risk factors assessed in ESTER-assessment Youth risk factors Family risk factors 10.

Parents own difficulties.

Definition: Parents have economical problems or are sad, depressed.
Parent/s often consumes a lot of alcohol or have a criminal behavior.

11.

Difficulties in parent‐youth relations.

Definitions: Parents are in conflict with or are not engage in the youth.

They have difficulties to show love and affection or have difficult to accept and emotional attach to the youth.

12.

Parents difficulties with parenting strategies.

Definition: Parents doesn’t strongly condemn non‐desired behavior or have little knowledge about the youth’s behaviors and activities.
They have difficulties being consequent in their reactions to the youth’s behavior or use harsh discipline towards the youth.

1.

Defiant behavior, anger or fearlessness.

Definition: Defies parents and others wishes and demands – are disobedient‐ or easily becomes very angry and irritated.

Seems fearless or doing risky and dangerous things.

2.

Overactivity, impulsiveness or concentration difficulties.

Definition: Is very physically active and restless.
Is impulsive and has difficulties to wait for his/her turn and to think before he/she does something.

Has difficulties to retain attention and to concentrate for longer times.

3.

Difficulties with empathy, feelings of guilt or regret.

Definition: Has difficulties with empathy or doesn´t care about others or what they feel and think.

Doesn´t seem to feel guilt and regret when he/she has done something wrong or hurt someone.

4.

Insufficient verbal abilities or school performance.
Definition: Has difficulties with speech, reading‐ or writing abilities.

Insufficient school performances.

5.

Negative problem solving, interpretations or attitudes.

Definition: Uses negative/destructive behaviors/problem solving strategies to solve different situations or has a negative way to interpreting others behavior and purposes.

Express negative antisocial and status focused and materialistic attitudes and values.

6.

Depressive mood or self harming behavior.


Definition: Is sad, depressed or has a self harming behavior.

7.

Conduct problems.

Definition: Brakes norms, rules or laws in an aggressive or non‐aggressive way.

8.

Alcohol‐ or drug abuse.

Definition: Uses alcohol for intoxicated purposes or uses other drugs.

9.

Problematic peer relations.

Definition: Has difficulties to keep, or is not interested in relations with prosocial peers.
Spends time with peers with conduct problem behavior or attitudes, or who uses alcohol or other drugs.

2014‐09‐26 17 Protective factors assessed in ESTER-assessment Youth protective factors Family protective factors 13.

Positive school attachment and performance.

Definition: Has a positive attachment to school and the school work and enjoys school work and as well as school‐peers and teachers.

Performs at least on an average level in all subjects.

14.

Positive attitudes and problem solving strategies.


Definition: Is happy, helpful, polite or has positive and constructive ways of solving problems and stressful/pressed situations.

15.

Positive relations and activities.

Definition: Has positive and prosocial peer relations and supports.

Participate regularly in structured activities or spend a lot of his/her spare time on positive and non‐ normbreaking activities.

16.

The youth’s awareness and motivation.


Definition: Is aware of his/her own problematic behavior or is motivated to change.

17.

Parents energy, engagement and support.

Definition: Parents have a lot of time and energy to engage in the youth’s life or are generally interested and engage in the youth’s life.

They have support from other people or have the ability to use the support the society offers.

18.

Parents positive attitudes and parenting strategies.
Definition: Parents are clear with the youth in their attitudes against conduct problem behavior and drugs, and encourage positive activities.

They are very consistent in their reactions to the youth’s behaviors or know much about the youth’s life and activities.

19.

Parents awareness and motivation.

Definition: Parents know and seem aware of the youth’s problems and possibly their own problems, which can affect the youth’s behavior.

Parents are motivated to change.


Explicitly developed for repeated assessments o Made for repeated measures o Should facilitate repeated-measurement-thinking o Get more professionals in practice to do ”before-and-after- intervention” assessments.
o One can conduct an unlimited number of follow-up assessments with ESTER o Meaningful changes should be detected o ESTER-assessment uses a five-point response scale o The computerized system makes the changes of risk and protective factors over time easy to follow 2014‐09‐26 18 Involves structured documentation of planned and performed interventions o The professional can in a structured way document planned and performed interventions o E.g., what is being done, goals, which risk and protective factors are focused, who will be involved, etc.
Assessment of a risk factor in ESTER- assessment 2014‐09‐26 19 Rating of the risk factor’s frequency and problem-level ESTER-screening  Short screening questionnaire to screen for strengths and difficulties  Main focus on risk factors  Main purpose:  To screen for youths in need for more detailed assessment/interventions  4-pages (appr.
15 minutes)  Versions to:  Parent/guardian  Professional (e.g., teacher, treatment staff, etc)  The youth (when 10 years or older) 2014‐09‐26 20 ESTER - A computerized system o An easy-to-use system o Web-based o On secure server, with double-layered pass-word, encryptation, etc.
o Facilitates: o Understanding of the assessment o Visualizes the results in an easy-to-understand way o I.e., the reports that are produced can be used directly with the parents and the youth o Collaboration between colleagues and different organizations o Can share and move clients to other uses.
Risk-need profile All risk and protective factors ratings on one single page 2014‐09‐26 21 2014‐09‐26 Follow-up graphs for all risk and protective factors Summary graphs – Risk factors 22 Summary graphs - Protective factors Research testing ESTER 2014‐09‐26 23 ESTER 30 social workers using the ESTER- checklist 30 social workers NOT using a checklist Charles 14 years (Andershed & Andershed, in press) Number of risk factors identified by the social workers Number of risk factors identified 8 7 6 5 4 3 2 1 0 With ESTER- assessment (n=30) 37% 20% 30% 13% 0% 0% 0% 0% 0% Without ESTER- assessment (n=30) 0% 10% 20% 17% 23% 17% 3% 7% 3% Andershed & Andershed, in press 2014‐09‐26 24 Social work directors’ opinions about the assessments Overall a good/adequate assessment?
1.

Not at all adequate 2.

To some extent adequate 3.

Adequate 4.

Very adequate Missed things in the assessment?

1.

No 2.

Yes, some individual things 3.

Yes, several things Are the interventions that are suggested in the assessment relevant/correct?

1.

No, probably not 2.

Yes, partially 3.

Yes, probably With ESTER- assessment Without ESTER- assessment 2,68* 2,40 1,48*** 1,93 2,03+ 1,95 Andershed & Andershed, in press How about in real-life settings?
o We compared children who were assessed with ESTER- assessment in regular social work in Sweden with children who were not assessed with a structured instrument o 65 youths were included who were assessed by trained social workers with ESTER-assessment o 85% boys – Age: 1-17 years.

M = 10,29 (SD =3,96) o 30 youths who were not assessed with a structured instrument o 80% boys – Age: 1-18 years.

M = 10,25 (SD = 4,38) o They were all followed over one year.
o Parents rated their childrens´problem behavior at first assessment and at the 1-year follow-up Andershed & Andershed, in prep.

2014‐09‐26 25 2014‐09‐26 The social workers´ descriptions of the interventions delivered to these children ESTER at first assessment (n=65) No structured assessment at first assessment n=30 81% * 17% Interventions focused on changing evidence-based risk and protective factors Interventions adjusted to fit the individual needs of the child 67% 73% Andershed & Andershed, in prep.
ESTER-assessment related to more positive outcomes in children 1,5 High 1,45 Degree of problem behavior (rated by parents) 1,4 1,35 1,3 Low 1,25 First assessment 1-year follow-up ESTER at first assessment No structured assessment at first assessment Andershed & Andershed, in prep.
26 The process of assessment and interventions (see Andershed, Andershed, & Farrington, 2012) Structured assessment of risk- and protective factors, by trained professionals Observed factors Pronounced risk factors, e.g., Aggression Hyperactivity Poor parenting Rejection Weak protective factors, e.g., Warmth Safety Analysis by trained professional/s concerning Risk?

Need?

Responsivity?
Analysis to tailor a plan for intervention/s Available interventions Intervention A Intervention B Intervention C Intervention D Intervention E Follow up / re-assesment Summary and Conclusions o A large body of research on youths has identified a number of behaviors, traits, relationships and social structures that can involve risk and protection in the development of severe psychosocial problems o This knowledge, if used with care by trained professionals, can and should be used in practice to make interventions more effective o Risk focused prevention and treatment o The use of a structured instrument in assessing risk and protective factors is helpful in assisting practitioners to target these factors in assessments and interventions!
o ESTER is an example of such an instrument 2014‐09‐26 27 Contact.

Henrik Andershed, Phd Professor of psychology Associate Professor of criminology E-mail: henrik.andershed@oru.se info@ester-bedomning.se CAPS – center for Criminological And PsychoSocial research www.oru.se/jps/caps Örebro University, Sweden 2014‐09‐26 28