Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

Abstract

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP. Keywords dissemenation/implementation; parenting; child welfare services/child protection; neglect Many child welfare systems are moving to adopt structured, standardized, evidenced-based approaches to working with families, as evaluations of existing unstructured services have generally failed to find positive service effects (e.g., Chaffin, Bonner, & Hill, 2001;Westat, 2002). One promising evidence-based practice (EBP) being implemented in several child welfare agencies is the SafeCare® model. SafeCare is a behaviorally based parent training model that targets parents of children aged 0-5. SafeCare content focus on home safety, child health, and parent-child interactions (Lutzker & Bigelow, 2002) Method Statewide SafeCare Implementation PlanState funds were received in 2008 for training providers of family preservation services to conduct SafeCare. In this particular state, as in many others, most direct child welfare services are provided by private agencies following a child maltreatment investigation conducted by public child welfare workers. Accordingly, private providers were the most appropriate choice for SafeCare training. To build capacity for large-scale training and support, NSTRC recruited and trained a group of contracted employees to provide Safe-Care training throughout the state, with NSTRC faculty and staff providing supervision and quality control.The implementation was designed so that each agency was trained both to deliver SafeCare (termed home visitors) and to conduct ongoing coaching, consisting of regular fidelity monitoring with feedback. Coaching is a standard part of NSTRC's implementation model (Whitaker et al., 2008), and critical for implementation with fidelity...

Disseminating Child Maltreatment Interventions

“…In this issue, articles by Kolko et al (2012), Nelson, Shanley, Funderburk, and Bard (2012), and Whitaker et al (2012) examine initial implementation of Alternatives for Families-Cognitive Behavioral Therapy (AF-CBT), Parent–Child Interaction Therapy (PCIT), and SafeCare, respectively. Training procedures described in all three articles follow best practice recommendations for provider workshop and field training, with workshop training including behavioral rehearsal and feedback and postworkshop support including frequent consultation with EBP experts to discuss implementation of EBP skills with families.…”

The what, when, and why of implementation frameworks for evidence-based practices in child welfare and child mental health service systems

“…Framework selection may be contingent on the type or focus of the problem(s) being targeted by the EBP as well as the scope of the intended target. Wide-spread state level implementation, for instance, which is often the focus for child welfare recidivism prevention efforts (i.e., Whitaker et al, 2012), necessitates a carefully reasoned planning process, such as described in the PRECEDE-PROCEED approach, because of the multiple agencies, providers, and children and families targeted. In addition, frameworks that include planning stages allow for trouble-shooting and strategy development to address the potentially variable reimbursement and organizational infrastructures that exist within a system in public-private partnerships.…”

“Creative Financing”: Funding Evidence-Based Interventions in Human Service Systems

“…This substantial and descriptive dataset documents how these actors strategically arranged funding to implement and sustain SafeCare®, an evidence-based in-home parenting intervention for families reported or deemed at-risk for child maltreatment. [21][22][23] The dataset was compiled over more than 10 years from three iterative studies of implementation [24][25][26] and follow-up research on sustainment. 27 With the exception of one county, SafeCare was delivered by CBOs contracted by state or county government agencies (many of which also delivered behavioral health services and worked with clients receiving such services), and was funded by a variety of public and private sources.…”