Beyond Inclusion: Addressing Power and Privilege in a Community-Engagement Intervention to Improve Foster Care Services

Background: As community-level interventions become a more common approach to complex problems, the role of power and privilege in the engagement process must be addressed in intervention development, measurement, and evaluation. To effect meaningful change and reduce inequity, this process must move beyond simply including members from marginalized groups in the process. Without an explicit acknowledgement of the inequality that results from structural racism and other power imbalances, community-based interventions will replicate the dominant groups’ perspectives. Quality Parenting Initiative (QPI) is a community-engaged intervention designed to improve foster care by bringing stakeholders together to identify a common vision for what quality foster parenting is, strategize solutions for aligning the local foster care system with that vision, and develop workgroups of diverse stakeholders to move the system closer to the vision.

Parents involved in the child welfare system are disproportionately poor, less-educated, women, and people of color. In addition to their marginalized position in the larger society, they are further disempowered by the foster care system, which includes the case managers, foster parents, courts and mental health professionals controls their access to their children.  The perspectives of all stakeholders are essential to improving the foster care system’s outcomes for children and families. 

Additionally, determining the critical concepts to assess and identifying measures that can be used for implementation of interventions and research will improve research on the evaluation of community-level interventions.

Methods: Using structural racism theory to guide the process and modifying measures from implementation science, organizational studies, and community-based participatory research, a toolbox of measures was developed for QPI. These measures can be used to guide a dynamic implementation of the intervention to assess whether all groups were able to participate as equals at each step of the process and where adjustments may need to be made by the site lead to allow for all participants’ opinions and perspectives to be included. 

Results: The toolbox includes fifteen measures to be administered throughout the nine-month intervention. Some measures were tailored to specific aspects of the foster care system, such as identifying the resources necessary for an effective foster care agency. To assess equitable participation, some of the concepts measured after community meetings are participant’s perceptions of their own and others’ ability to participate, and the facilitator’s ability to respect all members while reconciling disagreements.  The toolbox is written in a user-friendly manner including detailed instructions on scoring and applying the results so that staff members at the organization can effectively administer the measures and use the results to adjust the implementation process.

Implications: Community-level interventions hold great promise for addressing complex and multi-faceted issues, however without explicit focus on equitable participation (i.e., addressing structural racism, power, and privilege), these interventions will fall short of their promise.  Research designs and measures that assess these concepts are essential because it can aid in the identification of measures that can be applied to facilitate implementation research and further quality improvement efforts.