Comparative Effectiveness Trail to Reduce Child Maltreatment, Improve Client Outcomes and Examine Client Burden
Condition: Child Maltreatment
Study type: Interventional

Summary: 
      In child welfare services, structured behavioral parenting programs have been documented to
      reduce important child-welfare outcomes, including child maltreatment recidivism.1-3 In this
      study, we attempt to learn which factors impacted implementation of an evidence-based
      practice (EBP) in a diversity of child-welfare serving sites and systems. The primary aim of
      this study was to identify and assess barriers and facilitators of implementation of a
      structured behavioral parenting program (SC). We utilized a qualitative research strategy
      that included semi-structured interviews and focus groups with several levels of staff
      responsible for implementing the model: program administrators, supervisors, and frontline
      staff (providers). Our second aim was to understand parent and provider reactions to SafeCare
      (SC) services and Supportive Case Management (SCM), especially parents' perceptions related
      to trajectory of burden, engagement, satisfaction, and perceived impact across intervention
      receipt. We employed mixed methods (both quantitative and qualitative data collection) to
      inform this question. Specifically, we (1) conducted qualitative interviews with families at
      two time points during the course of service, (2) collected session-by-session ratings from
      families on service reaction (perceived burden satisfaction, perceived effectiveness) and
      providers on family engagement, and (3) collected organizational environment surveys from
      providers at two time points. The final aim of this study wass to examine the short-term
      impact of SC versus SCM on client-centered outcomes. Quantitative surveys collected in the
      family's home at the beginning and end of services measured parenting variables, parent
      mental health and well-being, and child behavioral, social, and emotional well-being.
    

Detailed description: 
      The study design was a cluster randomized trial, with randomization occurring at the team
      level within each study site. We randomized providers within each site to be trained in
      SafeCare (n = 96) or to continue to deliver SCM (n = 96) which allowed us to control for site
      differences. From a statistical power perspective, it would have been preferable to randomize
      clients to interventions, but the fact that teams at community-based organizations typically
      served a defined geographic area would have meant that home visitors within each team would
      have had to deliver two distinct interventions raising the likelihood of cross-contamination
      which, in our experience, would have not been well managed by the study. Providers that were
      randomized were invited to participate in the study by completing a survey at baseline and
      1-year follow-up which included measures of demographics, work experience, organizational
      factors (culture, climate, leadership) and individual attitudes and beliefs that may affect
      implementation and service quality. We recruited caregivers into the research study that were
      receiving services from randomized providers. Measurement of client-level outcomes were
      collected at baseline and 6-month follow up, as well as during service provision. Both
      quantitative and qualitative data were collected to capture both breadth and depth of family
      outcomes and experiences of the interventions.74 By focusing on measures of well-being, this
      study holds potential to expand the way in which the program effectiveness is conceptualized.
      This could be particularly important for dissemination of parenting programs to at-risk
      parents, who may be interested in different outcomes (e.g., improving their child's behavior)
      than child welfare systems, and findings may be useful for making interventions more
      appealing to consumers. To measure barriers and facilitators to implementing an
      evidence-based practice (EBP), we used a qualitative research strategy that included
      semi-structured interviews and focus groups with several levels of staff, responsible for
      implementing the model: program administrators, supervisors, and frontline staff (providers).
      This strategy would yield insight into an array of stakeholder perspectives concerning
      implementation. In contrast to most implementation studies, ours is the first to conduct a
      complementary set of interviews and focus groups with staff who have not been trained in SC,
      the SCM providers.
    

Intervention name(s): SafeCare; Supportive Case Management
Intervention type(s): Behavioral; Behavioral
Intervention description(s): An evidence-based home visiting program; Child welfare services as usual
Other intervention name(s): Services as Usual
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment