Dissemination of Evidence-Based Interventions in Child Welfare: An Experimental Study

Purpose. Although research demonstrates improved outcomes for foster children who receive evidence-based interventions in clinical trials, there is a critical need for effective means to transport these interventions to real-world practice conditions.  Unfortunately, little research documents the process of translating evidence-based practices to community settings, and even fewer studies have experimentally tested implementation models that promote adoption of evidence-based treatments in child welfare settings. Given that half of foster children have significant emotional and behavioral problems, it is essential that an effective model to implement and sustain evidence-based mental health services be developed for child welfare settings.  This implementation study tested an innovative strategy based on Rogers’ conceptualization of the key role of change agents in the diffusion of innovative practices. 

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.