A Comparison of Provider and Caregiver Recommendations to Modify a Child Mental Health Intervention to be Implemented in Child Welfare Services

Background/Purpose: 

Despite high rates of behavioral difficulties among children involved in child welfare (CW) services, service utilization, particularly among those youth who remain at home with their families, remains poor. Limited availability of qualified providers is a frequent barrier. Given that child behavioral difficulties are significant risk factors for future maltreatment, innovative ways to increase access and utilization of effective evidence�]based interventions (EBIs) for families are needed. One potential solution involves utilizing task-shifting strategies guided by implementation science theoretical frameworks to implement such EBIs in CW settings.

The purpose of this presentation is to report on the perceptions among CW staff and caregivers who were members of a collaborative advisory board (CAB) involved in the implementation of the 4Rs and 2Ss Strengthening Families Program (4R2S) in CW placement prevention settings utilizing task-shifting strategies. CAB meetings were guided by the PRISM model to promote feasibility and acceptability of a modified intervention. Given that CW staff and caregivers have varying perspectives and resultant buy-in, the presentation will discuss areas where CAB member recommendations for modifications converge and diverge.

Method:

Seven CAB meetings were held with a group of child-welfare stakeholders (caregivers, caseworkers, supervisors, and administrators; N = 8) to elicit feedback on the intervention, training, supervision, organizational/policy climate, client experiences, and research design. These meetings were guided by the Practical, Robust, Implementation, and Sustainability Model (PRISM). Data were captured by non-participatory observer field notes, feedback worksheets, observation guides, and pictures produced by the CAB. Three researchers coded the data using a directive approach. The deductive coding was based on a priori PRISM constructs, and the inductive coding was based emergent subthemes. Approximately 20% of the data sources were co-coded, resulting in 89% interrater agreement.

Results:

CW staff reported difficulties in engaging families, heavy workloads, and conflicting implementation initiatives. While 4R2S was perceived as generally aligned with their organization's mission, modifications to the intervention and to agency procedures were recommended to promote implementation success. Caregivers described several potential engagement barriers for child-welfare involved families such as stigma, literacy issues, system navigation difficulties, concerns about mandated reporters, prior negative service experiences, cultural mismatch with child welfare workers, and ongoing crises. CAB members converged on 4R2S modifications such as adapting the content to support in-home delivery in addition to group-based delivery, and providing training and supervision to CW staff on intervention components. CAB members diverged on modifications such as providing concrete resources (e.g. transportation, connection to services), and including parent advocates in the training.

Conclusions/Implications:

Role clarity was a central theme that emerged with transparency regarding caseworkers’ mandated reporting status strongly recommended by caregivers within the modified 4R2S curriculum. Findings underscore the importance of understanding the experiences of stakeholders when implementing an EBI. Administrators are faced with competing demands when considering recommendations from stakeholders with different perspectives. This study has implications for future research, where stakeholder perspectives should be explored across multiple organizations, jurisdictions, and with a variety of interventions in order to identify core similarities, as well as variations in perspectives.