Child neglect is a serious public health concern that accounts for 64% of child-welfare referrals - more than physical or sexual abuse. Child neglect is associated with developmental delays, cognitive difficulties, delayed language development, social and emotional withdrawal, and low confidence and assertiveness in learning new tasks. As adults, neglected children are at increased risk for violence and criminal behavior and related problems. Thus, child neglect is a clear risk factor for poor individual developmental trajectories and for negative societal impact. Implementation of evidence-based practices (EBPs) in child welfare systems has been very slow. Most neglect cases are served with non evidence-based in-home family preservation/family reunification (FP/FR) services, based on loose social support and case management. Safecare(R) is an EBP designed specifically to improve parent neglect behaviors. More than 60 publications support SafeCare efficacy or effectiveness. Implementation of SafeCare is also associated with reduced staff burnout and turnover. Results from two ongoing NIMH-funded studies of a statewide controlled-trial of SafeCare implementation in Oklahoma have yielded initial findings that some implementation features are critical (e.g., in vivo provider coaching). In this proposal, we will test a new and promising implementation approach developed for transporting EBPs like SafeCare into existing networks of community-based organizations. The implementation approach uses Interagency Collaborative Teams (ICTs) to develop local expertise in an EBP, to provide in-vivo coaching to therapists in training, and to counter common threats to implementation by distributing expertise, responsibility, and workload across multiple agencies. The ICT approach first develops an interagency team of exceptionally high quality. The initial ICT (seed team) then provides in-vivo coaching and training for sequential implementations at additional provider agencies. The ICT model is hypothesized to support transition away from reliance on intervention developers, while sustaining high levels of fidelity to the EBP model. This study takes advantage of a foundation-funded implementation of SafeCare in San Diego County, California. The proposed research will examine whether or not the ICT model can develop system- wide SafeCare expertise across all FP/FR service providers while maintaining high levels of model fidelity. We propose a mixed-methods (quantitative/qualitative) study to examine and describe the relationships between individual provider staff, system, and organizational factors, and processes and outcomes of the ICT approach.

Public Health Relevance

Child neglect is a serious public health concern responsible for poor child development and adult outcomes. This study will test an innovative model to implement an evidence-based child-neglect intervention. Interagency Collaborative Teams will be developed to provide local expertise distributed across agencies to train and coach service providers to high levels of evidence-based practice fidelity while reducing reliance on intervention developers.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Chambers, David A
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University of California San Diego
Schools of Medicine
La Jolla
United States
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Willging, Cathleen E; Sommerfeld, David H; Aarons, Gregory A et al. (2014) The effects of behavioral health reform on safety-net institutions: a mixed-method assessment in a rural state. Adm Policy Ment Health 41:276-91
Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R et al. (2014) Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation. Annu Rev Public Health 35:255-74
Aarons, Gregory A; Fettes, Danielle L; Hurlburt, Michael S et al. (2014) Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. J Clin Child Adolesc Psychol 43:915-28
Fettes, Danielle L; Aarons, Gregory A; Green, Amy E (2013) Higher rates of adolescent substance use in child welfare versus community populations in the United States. J Stud Alcohol Drugs 74:825-34