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Life Skills Progression (LSP)


Life Skills Progression (LSP)

An Outcome and Intervention Planning Instrument for Use with Families at Risk
Authors: Linda Wollesen M.A., RN, LMFT, Karen Peifer Ph.D., M.P.H.   Foreword Author: Deanna Gomby Ph.D.

ISBN: 978-1-55766-830-1
Pages: 224
Copyright: 2006
Availability:
Available Stock
Paperback w/CD-ROM $49.95 Qty:

Size:  8.5 x 11.0
Stock Number:  68301
Format:  Paperback w/CD-ROM
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For use with at-risk families of children from birth to 3 years of age, the Life Skills Progression™ (LSP) is the only reliable, field-tested tool that provides the critical data home visiting programs need to demonstrate their effectiveness and receive support and funding. Generating a broad, accurate portrait of the behaviors, attitudes, and skills of both parents and children, the LSP helps professionals establish baseline client profiles, identify strengths and needs, plan interventions, and monitor outcomes to show that interventions are working.

View our recorded webinar: Improving Home Visiting Practice with the Life Skills Progression™ (LSP) presented by Linda Wollesen.

Home visitors use the LSP to measure a variety of family competencies. The tool is comprehensive and easy to use —in just 5–10 minutes, an experienced professional familiar with the family can record information on 43 scales in key categories:

  • relationships with family and friends
  • relationships with children
  • physical health care
  • basic needs
  • education and employment
  • mental health and substance abuse
  • infant/toddler development and temperament

Home visitors rate each competency from 1 to 5 on a simple form, where they can also record important case data such as how many visits have been attempted or completed. No judgment of family choices is implied — the LSP is used only to track the progress of children and parents, and can be repeated every six months until the child is 3.

Everything professionals need to use the LSP is contained in this all-in-one manual, which includes information on the tool's development and field testing, best practices in the field, detailed instructions on proper use, and the photocopiable tool itself. For easy printing of additional copies, the companion CD-ROM includes the entire tool and the instructions chapter.

Ideal for social workers, public health nurses, mental health care providers, and other home visitors, this essential tool will help professionals identify the needs of the families they serve, monitor their improvements, and vividly demonstrate the effectiveness of home visiting programs. Learn more about the LSP.

Recommended by Parents as Teachers, the LSP meets the new affiliate requirements for family-centered assessment and goal setting.

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Reviews

Review: Parents as Teachers
Recommended by Parents as Teachers, the LSP meets the new affiliate requirements for family-centered assessment and goal setting.
Review by: Carol Singley, Coordinator of Parent Education and Parents As Teachers, The Parent Center, Salinas Adult School
"With the LSP we are able to provide funders with data that more clearly indicates growth across a broader spectrum of skills."
Review by: Jan Paulsen, Regional Office Coordinator, Monterey Head Start and Early Head Start
"Invaluable for program evaluation, planning, and reflective supervision."
Review by: Olivia de la Rocha, Director, Research Support Services, Evaluation Consultant to the Children and Families Commission, Orange County
"Wherever there is a need to measure a client-population's progress across a wide variety of psychosocial issues, the LSP will be a useful and informative asset."
Review by: Mimi Graham, Director, Center for Prevention and Early Intervention Policy, Florida State University
"[The] LSP is a valuable tool for home visiting programs. . . . It will help us monitor outcomes for children, families and our program which will make reporting much easier . . . and more impressive to our funders!"
Review by: Joanne Martin, Indiana University School of Nursing; Director, Healthy Families Indiana Training & Technical Assistance Project
"The long wait is over! Home visitors, supervisors, program managers, evaluators and funders have needed this tool for at least 10–15 years. Now we can document specifically what works and direct resources toward effective interventions."
Review by: Brad Richardson, Research Scientist and Adjunct Associate Professor, University of Iowa School of Social Work
"The LSP helps demonstrate individual client achievements as well as programmatic achievements at the aggregate data level. More importantly, practitioners who use the LSP in their work are also required to utilize a strengths-based orientation; it is this aspect of the LSP that makes for more effective client interaction and improved outcomes for clients."

About the Authors
Foreword Deanna Gomby
Preface
Acknowledgements

1. An Introduction to the Life Skills Progression™ (LSP)

Supporting and Measuring Family Progress
Poverty and Poor Outcomes
Chapter Overviews

2. The History of the Chase: The Elusive Outcome

History of Home Visitation Data: Demographics, Outputs, and Outcomes
Impact of Maternal/Child Home Visitation Studies

3. Maternal/Child Home Visitation Best Practices

Defining Concepts: Best and Promising Practices
Best Practice Components of Home Visitation

4. Development and Field Testing of the LSP

Purpose, Target Population, and Development
Reliability and Validity Testing
Interrater Reliability and Need for Training
LSP Content Validity Review Process
Description of the LSP Scales: Design Content and Limitations
Gifts of Experience from Pilot Sites
Reflective Supervision in Pilot Studies

5. Instructions for Using and Scoring the LSP

Using the LSP
Heading Information
General Scoring Instructions
Basic Data Instructions
Scale Scoring Instructions

6. Reflective Supervision Using the LSP

Visitor’s Goals for Reflective Supervision
Supervisor’s Goals for Reflective Supervision
Reflective Supervision Characteristics
Use of the Initial LSP for Reflective Supervision
Use of Ongoing LSPs for Reflective Supervision
Use of the Closing LSP for Reflective Supervision
Use of the Cumulative LSP Score Sheet

7. Using the LSP for Evaluation Purposes

Section 1: Using the LSP for Program Evaluation
Section 2: Database Development

8. Integrating the LSP into Sites and Systems

Incorporation Plan Overview
Does Using the LSP Fit Program Needs?
What Are the Training Needs?
How Does the LSP Fit with Forms and Screening Tools?
How Does the LSP Fit with the Data Management System?
How Will LSP Data Be Used for Reports?

References

Appendices
A. Life Skills Progression™ (LSP) Instrument
B. Abbreviations Used in the Life Skills Progression™ (LSP)
C. Emerging Best Practice for Home Visitation Checklist
D. “Better Together”: Home Visitation Community Collaboration Planning Worksheet
E. LSP Data Entry Form
F. Sample Scored LSP Instrument: “Selene and Jason”
G. Selene & Jason’s Story (as told with the LSP)
H. Cumulative LSP Score Sheet
I. Sample Cumulative LSP Score Sheet: "Selene and Jason"
J. LSP Instrument with Target Scores Shaded
K. LSP Data Report Planning Tool
L. Resources

Index

The CD-ROM contains printable versions of the following PDF files:

About the LSP

Chapter Five: Instructions for Using and Scoring the LSP

Using the LSP
Heading Information
General Scoring Instructions
Basic Data Instructions
Scale Scoring Instructions: Parent Scales
Scale Scoring Instructions: Child Scales

Appendix A: Life Skills Progression™ (LSP) Instrument

Parent Scales (pages 1–4)
Child Scales (page 5)

Appendix B: Abbreviations Used in the LSP

Appendix E: LSP Data Entry Form

Appendix H: Cumulative LSP Score Sheet

Excerpted from Chapter 4 of Life Skills Progression™ (LSP) An Outcome and Intervention Planning Instrument for Use with Families at Risk, by Linda Wollesen, RN, M.A., LMFT & Karen Peifer, Ph.D., M.P.H., RN

Copyright © 2006 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

PURPOSE, TARGET POPULATION, AND DEVELOPMENT

One purpose of the LSP is to describe the progressive outcomes of individual parents and children and of the caseloads served by home visitation programs. The young families enrolled in visitation programs usually are low-income households and have the various risk factors associated with poverty.

Most evaluation tools are developed in research settings located in universities or in private corporations specializing in field research consultation. The LSP was developed in the field primarily for clinical and outcome use and secondarily for use in research settings. It was written by Linda Wollesen as a distillation of more than 35 years of home visitation experience in public health nursing programs and was created in response to the need for a comprehensive outcome tool for home visitation services. The existing family outcome tools, the California Matrix, the Automated Assessment of Family Progress (AAFP), and the North Carolina Family Assessment Scale (NCAFS), focus on family outcomes rather than the individual parent and infant/toddler outcomes, which are needed by most home visitation programs (Endress, 2000; Kirk, 1998; NRCFCP, 1994). The AAFP, the Matrix, the nursing home visitation research of David Olds, and the home visitation articles edited by Deanna Gomby for the Packard Foundation became the main catalysts for the design of the LSP scales.

The thought process that was the basis for the content of the LSP consisted of four primary design components. The first component was to define which parent and child outcomes are unique to home visitation services versus which are the primary responsibilities of health care, child development, education, and/or other service programs. Among the community of care, there are many shared outcomes for healthy pregnancies and good child development, and the interventions by the various programs overlap in many cases. Home visitation services provide collaborative and supportive roles to the direct care providers and offer an array of unique approaches. The second component required in the design of the LSP was to identify what are basic parental life skills and to describe the range of progress or characteristics seen in each of these skill areas.

For the purposes of the LSP, a life skill is defined as a behavior, ability, attitude, or characteristic used to achieve and maintain a satisfying and healthy life, free from the negative effects of poverty. It includes the ability to

  • Have nurturing relationships
  • Provide for health care and healthy life styles
  • Utilize resources and information
  • Complete a basic education
  • Have regular gainful employment
  • Provide for basic needs (housing, transportation, nutrition)
  • Raise children who have optimal health and development

A third design goal was to produce a tool to quantify outcomes and have high content validity and interrater reliability. The tool also needed to capture the sequential comparison of situational progress of individual parent–child dyads and for program caseloads.

This chapter describes the reasoning behind each scale and what material is and is not covered in the LSP as a whole. An underlying premise of the LSP is that behavior is learned, relationships and life skills are learned, and progress can happen and be described and quantified.

Purpose of the LSP

The LSP has a number of clinical and outcome specific purposes:

  • To profile service population characteristics, including an individual parent or child, a caseload, or a caseload subset
  • To document baseline characteristics and quantify sequential change by comparing baseline profiles with ongoing and closing data
  • To identify parent and child strengths, needs, and goals for thoughtful, collaborative planning
  • To compare service populations enrolled in different programs within an agency, visitation system, or community
  • To demonstrate long-term outcomes, accounting for variables such as service dose (months of service and number of visits, type of staff or service model)
  • To provide an information resource for reflective supervision
  • To identify life skills categories and types of clients showing the most and least progress
  • To support outcome data analysis using multiple psychosocial and health-related variables
  • To provide data and a perspective for program improvement, funding, community planning, and training

Target Population

The LSP targets at-risk and high-risk parents and their children from pregnancy to age 3 years who are living in poverty. The health, social services, justice system, and educational costs related to impoverished families are extremely expensive to our society.

Unfortunately, the programs bearing the costs of preventive services usually are not the ones incurring the benefit of the costs saved. This makes funding for home visitation services a challenge.

In the now classic 1989 book, Within Our Reach: Breaking the Cycle of Disadvantage, Lisbeth B. Schorr describes “the high cost of rotten outcomes,” defines risk factors associated with poverty, and makes a powerful case for reforming national policies. Unlike other advanced countries, the United States does not have the elimination of poverty as a goal, although some would argue that welfare reform was intended to do this (Schorr & Schorr, 1989). Inadequate funding for poverty prevention exists in spite of spiraling costs related to poverty–associated health care, child development, and early failure in school; welfare and foster care costs; and justice system, violence, and substance treatment.

The impressive outcomes of the research by Olds and associates and the cost–benefit study of the Olds and the Perry Preschool models by the RAND Corporation resulted in national acclaim for these models. Since then, the combined impact of the attacks of September 11, 2001, the depressed economy, and the costs of antiterrorism measures and war have combined to create funding cuts and cause programmatic changes even to well established and effective programs. Funding shortfalls for foundations and governmental resources emphasize the challenge facing the field of home visitation to clearly describe complex skills that are needed by families in order to prevent “rotten” outcomes. A related challenge is to demonstrate how much positive family change is possible and to show which programs are effective in supporting the development of these skills. A common parent/child outcome tool and data bank, which spans programmatic boundaries, may contribute to the ability of the home visitation field to advocate effectively for funding for the services needed to eradicate poverty.

LSP Pilot Study Environment

The pilot study for the LSP was originally conducted in several community-based home visitation programs in one California county. The LSP is now used by a variety of programs in many states, including several of the nationally linked programs (HFA, National Healthy Start [NHS], PAT, EHS) and statewide systems.

Field testing and academic support from experts in evaluation and early childhood came after the initial development and as the result of other clinicians hearing about the LSP at conferences or from colleagues. Word spread among evaluators providing consultation to local programs through Federal or State grants such as EHS, Safe Schools, and First 5 of California. Valuable support came from ZERO TO THREE/National Center for Clinical Infant Programs, an organization that provided the LSP’s author with a Fellowship in 2000–2002 that resulted in access to national experts. The collaborative thinking and ongoing dialogs, which developed between the LSP’s author and the pilot sites using the LSP, resulted in valuable clarifications to the scales and training materials. Field testing was conducted by each site or cluster of programs using separate databases that were designed in response to site–specific program goals, funding requirements, and technical ability. Each site had to develop its own database using Access (Microsoft Corporation) or SPSS (SPSS Inc.) software. Some sites were fortunate enough to have Grant–linked evaluator assistance from private consultants or university-based research groups.

The LSP was written originally in 1998&ndash1999 when the author was a supervising public health nurse with management and supervision responsibility for four home visitation programs run by the Monterey County (California) Public Health Department. The programs included public health nursing, a state-funded high-risk infant follow-up, an Adolescent Family Life Program (AFLP), and the NFP program. The latter was an approved replication site for the “best practice” model developed by David Olds and colleagues at the University of Colorado. The health department programs were joined under consultation agreements by other countywide visitation programs, which included PAT and a new EHS site. All of these programs participated in the pilot study for the LSP. They used a common database and had interagency agreements and informed parental consents.

This collaborative effort gave a countywide snapshot of the baseline profiles of families being served by home visitation. The experience provided a population of about 800 families in the open caseloads for anonymous study as each program's data became available. Substantial grant–based funding was acquired by programs using the LSP for sequential outcome data. The analysis of some of the anonymous versions of LSP pilot database will be used to provide the examples of evaluation described in Chapter 7.

History of LSP Development and Testing

1998–1999

  • LSP written with 37 scales
  • Preliminary inter- and intrarater reliability estimated at 90% by Brad Richardson, Ph.D., lead evaluator for the National Resource Center for Family Centered Practice at the University of Iowa School of Social Work

1999

  • LSP use and Access database piloted internally in Monterey County public health nursing and associated community programs

2000

  • LSP expanded to 43 scales
  • LSP used to demonstrate Monterey County NFP and PAT outcomes for California First 5 grants
  • LSP training began for 11 other California programs, counties, and First 5 sites, and expanded to sites in Montana and Pennsylvania

2001–2002

  • ZERO TO THREE National Fellowship awarded to the LSP’s author, to refine and publish the LSP. Kathryn Barnard, Ph.D., R.N., was Board Member and mentor for the LSP.

2002–2003

  • Content validity study carried out using 46 multiethnic expert reviewers representing nine disciplines and consisting of ZERO TO THREE Fellows, trainers from national home visitation programs, evaluators, and staff from sites using the LSP
  • LSP instructions for use in reflective supervision completed in collaboration with Sandra Smith, M.P.H., C.H.E.S.; the work was funded by two ZERO TO THREE grants and incorporated into reflective function training and materials. The materials are linked to the Beginnings Guides curriculum, illustrated by Laurel Burch, and subsequently published in 2004 as a CD with training required for use.

2003–2004

  • LSP database designed using MS Access XP Professional 2000 software and available for programs that do not wish to develop their own LSP software
  • LSP data web site for data entry and analysis reports is being considered in collaboration with the University of Washington, Center for Health Education and Research (CHER), in Seattle. This will create easy access to sophisticated data analysis for individual home visitation programs or systems of programs. It is expected that the Access data entry screens currently used by most programs using the LSP will form the basis for entry into a web-based system. Plans are being made to transfer existing LSP data into the Web data banks to provide important continuity for programs. CHER at the University of Washington in Seattle is considering management of the Beginnings & Life Skills Progress trainings to ensure reliability and for related trainer trainings.

RELIABILITY AND VALIDITY TESTING

Definition of Reliability and Validity

It is important to understand the difference between validity and reliability. A valid instrument measures the constructs it says it is measuring in a clear and consistent way. The Weiss definition of validity is “the extent to which a measure captures the dimension of interest” (Weiss, 1998). Reliability means “the consistency or stability of a measure over repeated use” (Weiss, 1998). It is measured by the proportion between the true score variance and the total variance. This is called partial correlation and indicates the proportional relationship between item measurements.

Validity and item analysis are used to construct measurement scales, to improve existing scales, and to evaluate the reliability of scales already in use. Specifically, validity and item analysis aid in the design and evaluation of the scale that is made up of multiple individual measurements (e.g., different items, repeated measurements, or different measurement devices). The LSP has 43 different scales that measure different constructs. Some scales are related directly to each other and other scales are related indirectly or are related sequentially in time to each other. For example, a pregnant mother would not have an infant scale scored until after the birth of the baby. A mother with depression might show a high correlation score on the relationship with spouse scale.

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