It has been well documented that child maltreatment can lead to a multitude of child developmental, emotional, and behavioral difficulties. Preliminary trends from our ongoing site-randomized field trial with a family preservation service system in Oklahoma (R01MH065667) suggest that application of a single evidence based treatment (EBT), SafeCare, when implemented with ongoing fidelity monitoring, results in fewer future child welfare reports. These trends have been stable for three years. However, feedback from the front-line service providers, supported by our preliminary findings, suggests that the benefits of SafeCare may not be equivalent across case subgroups or outcome targets. For example, reductions of child neglect recurrences appear greater than reductions in child physical abuse recurrences, suggesting that a more complex evidence based practice (EBP) system may offer advantages. Parenting and child behavior management have been consistently identified as target areas not well addressed by the base SafeCare model. The overarching goal of this proposal is to use our existing child welfare research-practice network to develop and pilot a more complex, modular, child welfare family preservation/reunification EBP system, based on SafeCare but augmented with additional elements and simple decision tools. The proposed project will involve two main sequential activities: a) to develop an EBP system comprised of a set of feasible, theoretically coherent and technically consistent practice elements that are aimed at reducing future incidents of physical abuse, and a simple set of decision rules that match elements with key client or context factors and b) to conduct a feasibility and pilot trial of the modular model. This will involve both a small-sample comparison of complex EBP vs. simple EBT cases and within-subjects multiple baseline testing of the concordance of targeted changes with their matched practice elements. The laboratory for this pilot and feasibility test will be two provider teams from among the 20 teams currently delivering services in the ongoing statewide SafeCare trial. A major product of this proposal will be a collaboratively developed, pilot and feasibility tested, multi-element EBP model which can then be implemented in an envisioned statewide site-randomized trial and will allow for us to experimentally contrast the complex vs. simple models of SafeCare. To date, there are no studies examining the extent to which in home child welfare service programs can apply more modular systems across child welfare case subtypes and match target elements to specific target problems and case characteristics. The proposed project will help bridge the gap between science and practice and details an approach for adapting EBP in the real-world setting. The proposed project is part of a program of studies using the SafeCare model, which aims to reduce future occurrences of child maltreatment. Child maltreatment is a serious public health problem, and is associated with serious downstream physical, mental health and behavioral problems. Preventing child maltreatment recurrences improves the health and functioning of children and families. ? ? ?
