Child Welfare Involved Families Participation in Triple P: The Role of the Provider-Client Relationship on Program Engagement

Background & Purpose:

Despite the promising benefits of evidence-based behavioral parent training (BPT) interventions in reducing child maltreatment, program engagement continues to be a major challenge. Indicators of program engagement include session attendance, active participation during/between intervention sessions, and progress toward treatment goals. Recent program evaluations suggest that program engagement is essential to the successful implementation of evidence-based interventions. Yet, the evidence on program engagement strategies for child welfare-involved families is scant. Furthermore, it is still unclear how provider behaviors and the provider-client relationship influence program engagement. Improving outcomes for families with histories of child maltreatment will require further examination of engagement strategies that increase the likelihood of optimal outcomes for families in need.

Methods: This qualitative study explores how providers’ therapeutic qualities and the provider-client relationship influence program engagement with child welfare involved parents receiving Triple P, an evidenced-based BPT. To assess perceptions of provider qualities and provider-client relationships, semi-structured interviews were conducted with program completers (n=29) and non-completers (n=18) in one Midwestern city. Interview questions were designed to elicit information about parent’s perceptions of their interaction with Triple P providers that contributed to participant engagement. Data were collected from 47 parents (65% African American; 35% Caucasian; 100% female caregivers). All parents had a child between the ages of 3 and 11 years, who lived in the home. Interviews were conducted in the parents’ home, audio recorded, transcribed, and coded thematically in NVivo.

Findings: Three themes emerged as parents identified provider behaviors that aided in their engagement in the program:  First, parents found it helpful that providers used a variety of teaching techniques to meet their individual needs.. Next, parents’ consistently reported how the providers’ use of rapport-building strategies, such as empathy and encouragement, was particularly useful during sessions in which parents were having difficulties practicing new skills. As a result, parents seemed to gain confidence in their ability to progress in their parenting goals. Finally, parents considered their provider to be a source of social and emotional support for those who were suffering with daily life stressors most common to parents involved with child welfare. Notably, the majority of parents reported the quality of their interactions with providers’ as a critical component in their engagement with Pathways Triple P.

Conclusions & Implications: These findings suggest that provider behaviors and positive provider-client relationships can create a positive learning environment and aid in program engagement among child welfare-involved parents receiving BPT. Additionally, understanding the role of provider behavior on program engagement may also lead to strategies to improve implementation outcomes for clients (e.g., acceptability and appropriateness) and providers (e.g., adoption, acceptability, fidelity, and appropriateness). Therefore, a shift in how program engagement is conceptualized, as well as more research conducted on the use of providers as an engagement strategy is of great need.