Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol

Abstract

Background Delivering evidence-based interventions to refugee and immigrant families is difficult for several reasons, including language and cultural issues, and access and trust issues that can lead to an unwillingness to engage with the typical intervention delivery systems. Adapting both the intervention and the delivery system for evidence-based interventions can make those interventions more appropriate and palatable for the targeted population, increasing uptake and effectiveness. This study focuses on the adaptation of the SafeCare© parenting model, and its delivery through either standard implementation methods via community-based organizations (CBO) and a task-shifted implementation in which members of the Afghans, Burmese, Congolese community will be trained to deliver SafeCare. Method An adaptation team consisting of community members, members of CBO, and SafeCare experts will engage a structured process to adapt the SafeCare curriculum for each targeted community. Adaptations will focus on both the model and the delivery of it. Data collection of the adaptation process will focus on documenting adaptations and team member’s engagement and satisfaction with the process. SafeCare will be implemented in each community in two ways: standard implementation and task-shifted implementation. Standard implementation will be delivered by CBOs (n = 120), and task-shifted implementation will be delivered by community members (n = 120). All interventionists will be trained in a standard format, and will receive post-training support. Both implementation metrics and family outcomes will be assessed. Implementation metrics will include ongoing adaptations, delivery of services, fidelity, skill uptake by families, engagement/completion, and satisfaction with services. Family outcomes will include assessments at three time points (pre, post, and 6 months) of positive parenting, parent-child relationship, parenting stress, and child behavioral health. Discussion The need for adapting of evidence-based programs and delivery methods for specific populations continues to be an important research question in implementation science. The goal of this study is to better understand an adaptation process and delivery method for three unique populations. We hope the study will inform other efforts to deliver health intervention to refugee communities and ultimately improve refugee health.

Findings from a Structured Adaptation Process for the SafeCare Parenting Program to Address Family Needs in a Diverse Refugee Community

“…These adaptations may not reflect the needs of refugees from other ethnic groups or refugees living in different contexts. It should be noted, however, that the purpose of this adaptation process was to adapt SafeCare for implementation within the context of a research study, which will be conducted in Clarkston, Georgia (Whitaker et al, 2021). Thus, our aim was to develop adaptations to SafeCare that would be relevant in the populations that would be participating in the research trial and not necessarily generalize these preliminary findings to other refugee ethnic groups or refugees living in different cultural contexts (i.e., living in another city in the United States or another country).…”

“…Data from this article are drawn from an ongoing Center for Disease Control and Prevention-funded implementation trial launched in September 2019 that will test two implementation approaches to SafeCare PCI delivery for families residing in Clarkston, GA (Whitaker et al, 2021). In this paper, we focus on the first aim of this study: to engage in a structured approach to the adaptation of the SafeCare PCI curriculum for four refugee ethnic groups that are prominent in the Clarkston community (Afghan, Burmese, Congolese, and Ethiopian-Eritrean).…”

“…We followed Barrera and Castro’s Heuristic Framework (Barrera & Castro, 2006) to guide our adaptation process due to its iterative nature and emphasis on community engagement; and we categorized the types of adaptations based on Aarons and colleagues taxonomy of adaptations (Aarons et al, 2019), given this taxonomy was developed based on real-world adaptations to SafeCare during a large-scale implementation. Findings from this study will be used to inform the program delivery methods for a larger follow-up implementation trial (Whitaker et al, 2021).…”