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Background. Many studies have identified the risk and protective factors associated with child maltreatment. However, in practice, many agencies implement parenting programs which do not address some of the most serious risk factors. This study sought to examine the challenges and successes experienced by eight diverse communities in the first year of implementation of a state-funded child maltreatment prevention program. This program required local communities to develop a primary child maltreatment prevention strategy that is tailored to community needs and is targeted to families with children between ages 0-5. Each community strategy must include an EBP and a community collaboration.
Methods. Process evaluation components include focus groups with agency staff (n=8) and a survey of agency staff across all eight sites (n=81). Qualitative data were analyzed using conventional content analysis. Survey questions included questions from the Adverse Childhood Experiences Surveys (ACES) as well as study-developed questions assessing the comfort direct service staff had in discussing different topics with clients. Survey questions also asked staff using evidence-based curricula about their fidelity to the model and its perceived effectiveness with clients.
Results. Findings from the process evaluation suggest that (1) agencies experienced difficulties in recruiting and retaining certain families, and that (2) prevention strategies used by the communities may not target some of the key risk factors associated with child maltreatment. About 40% of survey respondents made adaptations to EBPS, with the majority of changes relating to procedures, such as location, time, assessment, recruitment process. Study findings further suggest that there are unique barriers to implementing EBPs with more high risk families where parents exhibit risk factors such as substance abuse, mental illness, domestic violence, and past childhood trauma. Some staff indicate that certain families were not ready to participate in parenting EBPs, because they had other more pressing needs that took priority. In the survey, 29% of respondents stated that EBPs are not useful for clients with multiple problems. Furthermore, parent educators voiced concerns that they were not equipped to address sensitive topics. For example, 31% of respondents thought they would be uncomfortable discussing ACES questions with clients. Additionally, 13% felt uncomfortable discussing family planning and birth spacing, and caregiver mental health, while 11% felt uncomfortable discussing alcohol and drug use with clients. Since most educators were not trained as social workers, they felt they were not able to set boundaries with their clients, and requested additional training on self-care strategies.
Implications. Funding initiatives requiring evidence-based practices should provide space for communities to make adaptations to meet the needs of the community. Agencies implementing structured evidence-based home visiting curricula need to provide training to staff without social work backgrounds on how to screen for and broach sensitive topics with clients, and how to employ self-care practices.