A Theory of Planned Behavior Examination of Child Welfare Caseworker Referrals to an Evidence-Based Parenting Program

Background: Despite the proliferation of evidence-based practices (EBPs) for children and families, some children and families are not utilizing EBPs in the child welfare (CW) system. This may be caused by a lack of CW caseworker referrals since children and families access services through their caseworker. The limited research on caseworker referrals to EBPs has been descriptive in nature highlighting the need for theory-based research. Using an explanatory model can elucidate areas of intervention to increase CW referrals to EBPs. Therefore, this study sought to develop an adapted Theory of Planned Behavior (TPB) - a cognitive-social psychological theory used to explain the relationship between beliefs, intention, and behavior--to explain caseworker’s decisions to refer. The study examined whether the components of the full TBP model (attitudes, subjective norms, and perceived behavioral control) influence caseworker referrals and whether information-sharing and intra-organizational relationships, two contextual factors derived from the Diffusion of Innovations theory, are related to the TPB model components in the context of CW worker referrals to an EBP.

Methods: Participants (n=12) were caseworkers and support staff at two privately contracted CW agencies that could refer families to an EBP, the Positive Parenting Program (TripleP). Six staff from each agency were recruited as a subset of participants as part of a larger evaluation of the TripleP implementation process at both agencies. Over 70% of the sample identified as female (n=16) and African American (n=16), ranged in age from 23-49 years (µ=33), and earned a bachelor’s (n=8) or master’s degree (n=13). A semi-structured interview protocol was used to elicit staff perspectives on the implementation of TripleP and their decisions around referring to TripleP. Interviews were audio recorded, transcribed verbatim and analyzed using a directed content analyses approach in order to determine whether participant data supported an adapted TPB model, inclusive of information-sharing and intra-organizational relationships.

Results: Qualitative analyses revealed that 1) participants’ beliefs about TripleP’s effectiveness; 2) agency expectations and culture around referring to TripleP; 3) conflicting court mandates and 4) multiple job demands influenced caseworker referral decisions. Caseworkers particularly described how court mandates to refer parents to another parenting program hindered their ability to refer families to TripleP. However, agency culture and supports determined whether and how caseworkers navigated this barrier. Additionally, participants explained how vital effective means of communication were in facilitating awareness and knowledge of TripleP and in ensuring a clear understanding of agency norms around TripleP. It is through intra-organizational relationships between caseworkers, supervisors and TripleP providers that this information is shared.

Conclusions: Results lent support to an adapted TPB model, providing evidence of relationships between attitudes, subjective norms, and perceived behavioral control and intention and evidence of the influence of information-sharing and intra-organizational relationships in the model. Recommendations include increasing communication and training for caseworkers and court officials around TripleP, fostering intra-organizational relationships to promote information-sharing, and increasing agency support for EBP implementation.