Keisha Failure to Thrive evaluation

Due to using the computer based training , I better understand the following:

The appropriate sequence of activities when working a case

How to use my supervisor with working on a case

The dynamics of failure to thrive

How to work a failure to thrive case

State policy and procedures for working a case

Results of the Pilot Implementation of Keisha Ver 1.0

Demographics

In an effort to establish training outcomes, Keisha was pilot tested with 28 female and 6 male new trainees at the Dallas Training Academy during the Fall of 1994 and the Spring of 1995. Hardware during the training was limited and the hardware used could not display the pictures at the correct resolution. Consequently, pictures from a color DeskJet printer were passed around to trainees.

The average age of the trainees was 29 (range from 22 to 57). The educational degrees of the respondents were: 11 BA, 11 BS, 7 BSW, 1 Masters of Divinity, 1 MSW, 1 BAW, and 4 = unknown.

Questions concerning generic failure to thrive (FTT) knowledge and casework knowledge

Evaluation was conducted by determining how well trainee answers were in agreement with experts' answers before and after using Keisha. The items below required a yes/no response. The respondents were five experts (except 4 for the last question), and 36 trainees. The table contains the percent of experts, pretest trainee respondents, and posttest trainee respondents who replied yes A positive change on an item indicated more agreement with experts.

Overall, change in a positive direction after using Keisha = 335%, while change in a negative direction = 82%.

1. An interview with a mother who has a failure thrive baby should include questions about?

Item	Experts	Pretest %	Posttest %	Change %
Feeding patterns	100%	100%	100%	no change
Child's eating patterns	100%	94%	100%	+ 6%
The mother's feelings about the baby	100%	94%	94%	no change
The mother's marital status with the father	80%	39%	31%	- 8 %
The circumstances of the pregnancy and birth	100%	97%	94%	- 3%
The child's medical history	100%	94%	94%	no change

2. Failure to thrive is sometimes the result of which of the following?

Item	Experts	Pretest %	Posttest %	Change %
Disease	100%	75%	86%	+ 11%
The child's refusal to eat	20%	44%	44%	no change
The parent's lack of feeding knowledge	100%	89%	97%	+ 8%
Lack of bonding between mother and baby	100%	83%	94%	+ 11%
Deliberate starvation	80%	81%	90%	+ 9%

3. Determining the origin of failure to thrive requires which of the following?

Item	Experts	Pretest %	Posttest %	Change %
Careful examination of the child	100%	92%	97%	+ 5%
An in-depth interview with the caretakers	100%	100%	100%	no change
A doctor's examination	100%	86%	100%	+ 14%
Knowledge about failure to thrive	100%	97%	94%	- 3%
Extensive experience with failure to thrive cases	20%	17%	11%	+ 6%

4. When examining a referral concerning risk to the child, many different factors can be considered. This may include which of the following?

Item	Experts	Pretest %	Posttest %	Change %
Time between child was seen and referral was made	80%	89%	97%	+ 8%
Address/phone # of grandparents/ other relatives	0%	22%	8%	+ 14%
The child's age	100%	97%	94%	- 3%
The family's method of transportation	20%	14%	8%	+ 6%
Any previous abuse history in the family	100%	100%	100%	no change
The referent's opinion about seriousness of case	80%	56%	64%	+ 8 %
The description provided by the referent	100%	83%	75%	- 8 %
The nature of the injury	100%	100%	97%	- 3%
Referent’s opinion about the home cleanliness	80%	44%	44%	no change

5. Before going on an initial investigation home visit, which of the following would you do?

Item	Experts	Pretest %	Posttest %	Change %
Carefully read the referral	80%	100%	100%	no change
Call the home and talk to the caretaker	0%	14%	11%	+ 3%
Call home, see if anyone is home, hang up if anyone answers	0%	8%	0%	+ 8%
Talk with your supervisor	80%	86%	81%	- 5%
Talk with the referent	80%	50%	89%	+ 39%
Fill out the SMART form	20%	8%	0%	+ 8%
Sign out the camera	80%	78%	92%	+ 14%
CANRIS the case	0%	42%	0%	+ 42%

6. In order to assess risk to the child, which of the following should be considered?

Item	Experts	Pretest %	Posttest %	Change %
The child's physical condition	100%	97%	97%	no change
The child's age	100%	97%	100%	+ 3%
The condition of the child's home	100%	89%	89%	no change
The social status of the child's parents	20%	11%	8%	+ 3%
Parent's response to the CPS intervention	100%	56%	83%	+ 27%
The financial stability of the family	80%	44%	39%	- 5%
The parents' childhood history	100%	86%	83%	- 3%
The parents' substance abuse history	100%	94%	94%	no change
The parents' description of the child.	100%	92%	89%	- 3%

7. A thorough investigation must be conducted before considering placement outside the home. This would include:

Item	Experts	Pretest %	Posttest %	Change %
Interviewing all caretakers	100%	100%	94%	- 6%
Finding a foster home for the child	20%	22%	14%	+ 8%
Examining the child	100%	94%	89%	- 5%
Talking with your supervisor	100%	100%	97%	- 3%
Investigating resources & support systems of the caretakers	100%	97%	86%	- 11%
Checking previous records	100%	94%	92%	- 2%
Gathering collateral information	100%	83%	86%	+ 3%
CANRISing the case	0%	58%	30%	+ 28%
Gathering information about relative placements	80%	69%	69%	no change

8. Before petitioning the court for temporary custody during an investigation, certain steps may be taken. These steps might include which of the following? (Missing one expert)

Item	Experts	Pretest %	Posttest %	Change %
Obtaining supervisory approval to petition court for custody	100%	92%	97%	+ 5%
Finding a foster home for the child	75%	72%	61%	- 11%
"Coaching" the child to testify properly in court	0%	3%	3%	no change
Preparing of an affidavit by the caseworker	100%	92%	94%	+ 2%
Submitting any and all other affidavits by other persons involved in the case situation	100%	94%	94%	no change
Preparing and submitting any home studies of relatives being considered for placement	25%	72%	61%	+ 11%
CANRISing the case	0%	61%	36%	+ 25%

Reading FTT cases and assessing risk where 1=severe, 2=serious, 3=moderate, and 0=not found

Case name	Experts*	Pre mean	Post mean	Change **
Kenny	5=3	2.28	2.50	+ .22
Betty	4=2; 1=1	1.36	1.34	- .02
Richard	4=1; 1=2	1.45	1.19	+ .26
Carrie	5=1	1.56	1.23	+ .33
Bobby	4=1	1.67	1.77	- .10
Michael	3=3; 1=2	2.06	1.88	- .18
Sarah	2=2; 2=3	1.80	1.77	- .03
Cody	4=2	2.08	2.03	+ .05
Matthew	3=1, 1=2	1.68	1.59	+ .09

Trainees were given 9 short FTT cases to analyze and to establish the TDPRS priority for action.

* 1st number is the number of experts, second is the severity checked. For example, 4=2, 1=1 means that 4 experts checked 2 (serious) and 1 expert checked 1 (severe)

** Change is + if the post means is closer to the experts score than the pretest means and - if the posttest means is further away from the experts score than the pretest means. The total positive change was .95. The total negative change was .33.

Satisfaction with Keisha (this part of the evaluation was completed with only 16 respondents)

Effects of the computer-based training on practice skills

Due to using the computer based training, I can better do the following: (1=no, 5=yes)

Due to using the computer based training, I can better do the following:	1	2	3	4	5	Mean
Analyze an intake form for priority level.	2	0	6	6	2	3.4
Analyze an intake form for risk to the child	0	0	7	8	1	3.6
Analyze an intake form for worker safety concerns	0	2	4	1	0	3.5
View the outside of a client's house for child health and safety risks	1	3	2	9	1	3.3
View the outside of a client's house for worker safety concerns	2	3	6	4	1	2.9
View a client's room for child health and safety risks	2	1	5	7	1	3.3
View a client's room for worker safety concerns	2	3	5	5	1	3.0
Examine a child for indicators of FTT	0	1	3	7	5	4.0
Develop a personal plan of action when working a case	1	1	3	6	4	3.7
Complete the SMART assessment form	2	0	7	6	1	3.3

Effects of the computer-based training on your knowledge (1=no, 5=yes)

Overall impression of the computer-based training (1=no, 5=yes)

Open Ended Comments

Liked most about using the Keisha case study

It guided me through the program so I knew what to do at various steps

The information given

Comparison with expert answers; interactive learning; case guidance

Self paced

Visuals - working from the office environment simulation

Thorough records - able to go back and forth

I learned more because I was typing it in and not listening how to do it

The graphics and guide were of great help; colors OK

Printed pictures to manually view of Keisha and the house

I feel the need for more training and exposure

Liked least about using the Keisha case study

Long and tedious. Because I had no choice but to do it, I learned as opposed to being trusted to read the materials on my own.

Time consumption, data taking procedures

Time to complete

I wish that we would have begun Keisha at the beginning of the program to allow more time to work the case

The problems getting back into the program

I didn’t like the fact that you could hit the button on the mouse until the right answer came up, for example, on the part where you had to find 3 risk issues. Also, I didn’t like the fact that you could look at the expert opinion and go back and answer it.

Pictures were very unclear. Too much information in the file

Memory problems while trying to operate Keisha

Program bugs, poor pictures, vague instructions

Waiting for photo and poor photo quality

Computer problems with not being able to access certain portions due to glitches. Had to repeat two sections due to not being sure it was saved.

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