Lessons Learned from Adapting and Implementing an Evidence-Based Prevention Program in Child Welfare Settings

Background and Purpose: The goal of this research study is to adapt an evidence-based, self-administered, parenting program called Staying Connected with Your Teen for foster teens and their caregivers using the ‘ADAPT-ITT’ framework which was developed to systematically adapt evidence-based interventions.  By strengthening family connections, this prevention program has been found to reduce high-risk behaviors among teens in the general population. This study evaluates the feasibility of adapting this program to determine its effectiveness with child welfare involved families.

Methods: The ADAPT-ITT process includes eight phases: Assessment, Decisions, Adaptations, Production, Topical Expert review, Integration, Training and Testing. Assessment involved analysis of qualitative data from 9 focus groups conducted with former foster youth aged 18-21 (n=20), foster parents (n=16), and child welfare agency staff (n=27) which were used to inform decisions on program modifications.  Adaptations to the original program involved the creation of program activities to build connections between foster teens and their caregivers including the use of digital stories made by former foster youth to facilitate conversation between the teen and caregiver about the teen’s experiences prior to entering foster care. Adaptations were tested with nine caregiver/foster youth dyads in a ‘theater test’. Feedback on the program modifications from the theater test were incorporated into program materials and reviewed by topical experts and further modifications were integrated into the program prior to the final training and testing phases of the study.  Finally, we conducted a wait list controlled pilot with 60 caregiver/foster youth dyads testing the feasibility of using this modified program within a public child welfare setting and the impact on proximal outcomes.

Results: The ADAPT-ITT process yielded critically important information that systematically shaped the current program being tested. This included changes to the name and target age group for the program, the development and testing of activities to develop a strong connection between caregivers and foster youth before beginning the program.  Implementation of the RCT within real-world child welfare settings has yielded numerous lessons regarding the complexity of doing research with a vulnerable and highly protected population and the necessity for strong researcher-child welfare agency collaboration as child welfare staff played a critically important role in this collaborative research. Overall measures of implementation fidelity were high; 61% of participants completed all 91 program tasks. Caregivers reported high satisfaction with the program; 100% would recommend the program to another caregiver. The proximal outcomes showed some promising changes in communication about sex and substance use (OR=2.03), family rules related to monitoring (OR=4.02) and media use (OR=3.24), and teens’ perception of conflict (OR = .48). Teens’ deviant attitudes decreased (3%) and prosocial involvement increased (17%) compared to controls. 

Conclusions and Implications: This study is critically important due to the high-risk behavior among foster youth and the dearth of evidence-based parenting supports for foster families caring for teens.