Dissemination of Evidence-Based Interventions in Child Welfare: An Experimental Study
Methods. An experimental design compared use of parent management training (PMT) to address child behavior problems after case managers and therapists (staff; N = 54) were randomized to receive one of two types of training: “training as usual,” which involved no additional support after the training and “enhanced training,” which involved contact with an intervention support specialist who provided consultation and held events focused on use of the intervention over a 10-month period. Reports of staff use of the intervention were provided by the staff and the foster parents of 119 children age 4-13 with behavior problems who were served by the enrolled staff. Use of the intervention was measured by the number of times staff used study materials (manuals or handouts) to talk with foster parents about PMT skills. Data collection occurred over five time periods spanning 15 months. Random effects regression models were used to test between-group differences in the individual growth curves of use of the intervention.
Results. The experimental condition resulted in significantly greater use of the intervention by staff (Intervention Group X Time B = .73, p < .01), with no difference in use between therapists and case managers. However, a significant non-linear effect also occurred, with use significantly decreasing after an initial increase. Additionally, level of use was low in both conditions, with staff in the experimental condition reporting an average use of just once per child in 30 days at the peak of use. Although staff reported that the “training as usual” received by both groups was of a higher quality than typical, use of the intervention by either control condition therapists or caseworkers was very rare, occurring on average just .21 times in a 30-day period at the peak of use and diminishing to no use at follow up.
Implications. This study’s results indicate that training as usual within child welfare settings may result in little uptake of a new practice without ongoing support for its use, particularly when the new practice is viewed as less essential than other practices such as court appearances and paperwork (for caseworkers) and individual child treatment (for therapists). Support by an intervention specialist improved initial intervention uptake, but additional supports and agency-level systemic changes are likely to be needed for adequate uptake and sustained use.