Evaluating a Learning Collaborative Approach to Enhance Caregiver Engagement in Early Childhood Services

Background/Purpose: Studies have demonstrated that 40-60% of children receiving mental health services drop out early, and no-shows are a common occurrence. Social work researcher Dr. Mary McKay and colleagues developed an evidence-based intervention to enhance engagement that has been successfully implemented through a Learning Collaborative (LC) model. The LC model consists of monthly meetings whereby teams are trained by an expert to translate Dr. McKay’s intervention into practice. Between meetings are action periods where teams implement change ideas to improve caregiver engagement and study the effectiveness of those ideas using the Plan-Do-Check-Act (PDCA) cycle of learning. To date, this LC model has not been applied to enhancing engagement in community-based early childhood services. The current study examines the feasibility and utility of implementing the LC model to disseminate Dr. McKay’s intervention in four community-based programs that serving children ages birth to 5 in a large geographically diverse County.  Research questions include: 1) was the LC feasible for enhancing engagement?; and 2) did the LC improve participant perspectives on engagement?

Methods: Participants were employees from four community-based programs administered by the Rady Children’s Hospital-San Diego Developmental Services Division and primarily funded by the First 5 Commission of San Diego (funding for data collection was supported by NIMH K23-MH080149 awarded to the first author, who served as the trainer). Programs provide screening, assessment, case management, and treatment for developmental and social-emotional problems in children ages 0 to 5 throughout San Diego County. Program leadership selected LC participants. Twenty-nine enrolled in the LC. Of those 25, 17 completed the post-test (three dropped out; five did not return the post-test) and comprise the sample. Participants were 59% Caucasian, 24% Latino, and 17% Other. All were female. Average age was 31 (SD=4.6). Twelve percent had a doctorate; 53% Master’s; 35% BA/AA.

Nine LC sessions were held over a nine-month period. Pre- and post-evaluations were given at the initial and final sessions, including questions about demographics, attitudes about evidence-based practices (Modified Practice Attitudes Scale), and the utility of the LC. Programs also completed PDCA worksheets about their change ideas and outcomes.

Results: Regarding feasibility, participants attended an average of 8.1 sessions. One hundred percent considered the LC worth their time and would recommend it to a friend; 94% reported their program met its LC goals. Regarding participant perspectives, a significant improvement in openness to evidence-based practices was found on the MPAS, t(16)=-3.254, p<.001. Ninety-four percent reported changes in their approach to interacting with families, 82% reported improved attendance, and 100% reported being likely to continue the strategies they implemented. Three programs compared baseline attendance/retention data to post-LC rates and reported improvements (the fourth program was new and unable to provide baseline data).

Conclusions/Implications: Results indicate that the LC is a feasible method for implementing social work engagement interventions for community early childhood services. The LC method appears to enhance participants’ openness to using evidence-based practices and may be effective for implementing additional evidence-based interventions for these populations.