Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Methodological Issues in Randomized Trials

The Trials of Conducting a Randomized Trial in a Real-World Child Welfare Agency

PURPOSE: This pilot study used an experimental design to test the effects of an innovative video-based child maltreatment prevention intervention on parent and family functioning outcomes in at-risk Latino and African American families. Steeped in theories of social learning, empowerment, and communication, the intervention – Video Home Training (VHT) – has been widely used throughout Europe for decades. To date, evaluation of the intervention has been limited. The aim of this presentation is threefold: (1) it will provide a conceptual/theoretical framework for the intervention; (2) it will present pilot data on 20 at-risk families referred for child welfare family support and preservation services; and (3) it will discuss important implementation issues that presented obstacles when conducting a randomized trial in a real-world setting and strategies for overcoming those obstacles.

METHODS: Using an experimental pre/post design, 20 families were randomly assigned to experimental and control conditions. The intervention was delivered by agency social workers. Families received services for about nine months. Data on multiple parent and family domains were collected at baseline and termination of services from both the primary caregiver in the family and the family’s social worker using standardized measures (e.g., Family Environment Scale, Parent-Child Relationship Inventory, Family Assessment Functioning Scale, North Carolina Family Assessment Scale). In-person interviews were conducted using trained interviewers. Besides outcome data, implementation data were collected via interviews and meetings with key personnel to gain an understanding of all aspects of the intervention and to examine service delivery, organizational and contextual factors that impacted the intervention and its evaluation.

RESULTS: In nearly all instances, participants of the study in both experimental and control group showed improvements in functioning at posttest. No significant differences were found at posttest between experimental and control group with regard to parents’ maltreatment and risk history or parenting behaviors. Significant differences were found in the areas of family coherence and interaction. While these findings are of interest, multiple implementation issues arose during the course of the study warranting cautious interpretation of the findings. The primary implementation problems that affected the impact component of the evaluation to varying degrees included: staff turnover, workers’ caseloads, recruitment, and data collection processes.

IMPLICATIONS: University/agency collaboratives are essential in the dissemination and transportation of promising interventions into community-based agency settings. The gap in knowledge and practice between research conducted in randomized controlled trials and interventions delivered in community settings is well documented. This gap exists for many reasons, one of them being limited testing of interventions under real-world conditions. Within this context, the current evaluation constitutes an important effort to rigorously test an intervention that has considerable face validity and has some prior evidence of being effective. Recommendations for future studies of VHT (and similar efforts) include delivery of the intervention by research-trained practitioners and controlled recruitment into the study with subsequent adaptations that would increase involvement by agency personnel.

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