Implementation of System-Wide Change in Child Welfare and Behavioral Health: The Role of Collaboration, Capacity, and Readiness for Change

Background/Purpose: 

Children entering out-of-home care typically have experienced significant trauma and resultant behavioral health challenges. Child welfare and behavioral health systems are often fragmented and do not effectively collaborate to provide appropriate evidence-based treatment. Standardized universal screening and assessment for trauma and behavioral health needs are considered promising child welfare practices and there is a need for evaluation of the impact of these interventions as well as facilitators of successful implementation. The Administration for Children and Families (ACF) funded discretionary grants to test approaches to better serving these children and youth through such data-driven processes.

The purpose of this presentation is to report on the implementation of Project SAFESPACE, focusing on building interagency capacity, collaboration, and readiness for change. This project implemented the following interventions:  Universal, standardized screening for trauma and behavioral health needs by child welfare workers upon entry into out-of-home care, standardized functional assessment and periodic measurement of progress by behavioral health providers, use of data from screening and assessment to inform treatment selection, and use of aggregate data on the organizational level for capacity building and service array reconfiguration. The project utilized the implementation stages framework, one of five frameworks in the Active Implementation Frameworks, developed by the National Implementation Research Network, which considers critical factors in Exploration, Installation, Initial Implementation, and Full Implementation stages supporting implementation.

Methods:

To measure interagency capacity, collaboration, and readiness for change a statewide survey that included 12 validated scales was conducted at the pilot phase, and in years 3,4, and 5 with frontline staff and administrators in public child welfare and behavioral health agencies. A repeated measures statistical analysis approach utilizing ANOVAs and MANCOVAs was used to evaluate implementation and changes over time for Project SAFESPACE (N=1658).

Results:

Results demonstrated improved perceptions over time of inter-organizational collaboration, as well as readiness for trauma-informed care, particularly among child welfare staff. For example, among the total sample statistically significant differences were observed across grant years utilizing the Wilder Collaboration Scale (F(3,1002) = 4.02, p = 0.01). Mean scores decreased after the pilot phase before increasing in years 4 and 5. Bonferroni-corrected post hoc analysis indicated that the mean total score for year three (M = 132.3, SD = 22.5) was significantly lower than the mean total score for year five (M = 140.6, SD = 23.6). A significant interaction effect between year and employment setting was also observed (F(3,1002) = 3.69, p = 0.01).

Conclusion and Implications:

Based on the results of the study, implementation of systematic screening and assessment of child needs, and data-driven treatment was associated with attention to interagency collaboration, organizational capacity and readiness. Contributing to the outcomes was the intentional focus on factors supporting implementation.  This study has implications for organizations and managers considering implementing similar initiatives as child welfare systems strive to implement data-driven services to serve the needs of children and families. Implications for further research involves examining the relative influence of these implementation factors on outcomes, and the most effective and efficient strategies to promote them.