Clinical trial NCT01332851: Supporting Parents Program: Intervention for Families in CPS
Official title: Training Social Work Providers: Intervention for Maltreating Families of Infants
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Child Abuse
Child Neglect
Keywords: child welfare
child protective services
child abuse
child neglect
infant
parenting
Lead sponsor: University of Washington
Sponsor class: OTHER
Collaborators: name: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
First posted: 2011-04-11
Enrollment: 270
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The study evaluates the feasibility and effectiveness of a well-documented relationship-based intervention (Promoting First Relationships), compared to a resource and referral condition, in improving outcomes for families of infants and toddlers referred to Child Protective Services (CPS) for maltreatment. In addition, it evaluates the effectiveness of training community social service workers in providing the intervention.

Detailed description: Child maltreatment has well-established, wide-ranging, and long-term negative effects on children. Most children who have experienced maltreatment and are receiving services through the Child Welfare System (CWS) remain in their homes with their caregivers. While the need for parenting services is extensive, few intervention programs have proven to be efficacious in reducing child abuse and neglect within the CWS population, especially for infants and toddlers. It is essential that social service practitioners within the CWS delivery system are equipped to provide brief interventions to maltreating parents. This grant, "Training Social Work Providers: Intervention for Maltreating Families of Infants and Toddlers," is an evaluation of a training program for social welfare providers to implement a brief attachment theory-based intervention to families who have been investigated for child abuse and neglect by Child Protective Services. The program (Promoting First Relationships \[PFR\]; Kelly, Buehlman, \& Caldwell, 2000) will be tested at two levels: through social welfare practice and at the level of outcomes for children and families.

Social service providers will be trained to deliver PFR to families under investigation for maltreatment by the Department of Social and Health Services, in two counties in Washington State. Subsequently, families under investigation by CPS will be recruited into the study and randomly assigned to the experimental group (receiving the PFR intervention) or to the comparison group (receiving resources and referrals).

The specific aims of this study are to (1) Test the effectiveness of training community social welfare service providers in the use of attachment-based interventions by measuring their pre-training and post-training service provision strategies and interactions with maltreating families; (2) To test the effects of a relationship and attachment-based intervention with infants/toddlers of parents identified as maltreating by comparing them to a control group on rates of re-referral to CPS, severity of referral, and foster care placement; and (3) To conduct a test of the effectiveness of an attachment-based intervention on child well-being by comparing experimental and comparison groups on important outcomes (attachment security, emotional regulation, behavior, and developmental functioning).

RELEVANCE Child maltreatment is a serious public health issue, affecting close to a million children nationally every year. The establishment of effective evidence-based interventions for high-risk families is essential to curtail the devastating long-term effects of maltreatment. The proposed study tests the feasibility and effectiveness of a well-documented relationship-based intervention (Promoting First Relationships) in improving outcomes for families referred to CPS for maltreatment.

Eligibility criteria: Inclusion Criteria:

* Biological parents and their child aged 10-24 months, who is an identified victim for referral to CPS, and who are parenting their child a majority of the time
* Families served by CPS offices in Snohomish and Skagit counties, in the state of Washington
* Families at moderate to high risk for maltreatment (physical abuse, neglect, or emotional maltreatment) and under investigation by Child Protective Services
* English speaking primary caregiver
* Telephone access
* Current housing

Exclusion Criteria:

* Experiencing an acute crisis (homelessness, hospitalization, imprisonment)
* Identified child (in a risk only CPS intake) or identified victim (in CPS intakes with allegations) has a voluntary services agreement within 2 weeks of a newly opened investigation
* Identified child (in a risk only CPS intake) or identified victim (in CPS intakes with allegations) has a dependency filing within 2 weeks of a newly opened investigation
* Previously received the Promoting First Relationships intervention

Primary outcomes:
measure: Child Welfare Outcomes: CWS Removal From Birth Parent Home
timeFrame: 1 year post intervention
measure: Parental Sensitivity (Video Recorded Observation Coded by Blind Coders)
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Secure Base Behavior (Observation During Research Visit; Higher Score Indicates Greater Security)
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
Secondary outcomes:
measure: Parenting Stress: Dysfunctional Interaction
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up from post intervention (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Parent Stress: Competence (Higher Score Means More Stress)
timeFrame: Baseline 3-month post-intervention (~7 months post baseline), 6-month follow up (~ ten months post baseline)
measure: Child Social Emotional Development (Higher Scores Indicate More Competence)
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Child Behavior Problems
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Child Emotion Regulation
timeFrame: Baseline and at the 3 month follow up (~ 7 months post baseline)
measure: Child Engagement/Exploration
timeFrame: Baseline and at the 3 month follow up (~ 7 months post baseline)
measure: Child Atypical Affective Communication (Observation)
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Parent-Child Interaction (Video Recorded Observation Coded by Blind Coders)
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Parental Confidence
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Parental Mindfulness
timeFrame: Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)
measure: Maternal Unrealistic Expectations
timeFrame: Baseline and Post intervention (~ 4 months post baseline)
Other outcomes:
Locations:
city: Seattle
country: United States
facility: University of Washington, Family & Child Nursing
state: Washington
Study officials:
affiliation: University of Washington
name: Monica L Oxford, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Promoting First Relationships(R): Randomized Trial of a 10-Week Home Visiting Program With Families Referred to Child Protective Services. Child Maltreat. 2016 Nov;21(4):267-277. doi: 10.1177/1077559516668274. Epub 2016 Sep 21.