ABSTRACT
BACKGROUND: The Australian evidence supporting the effectiveness of home visitation programs for families experiencing disdavantage is mixed. These inconsistent findings could be attributed to the varied ways in which home visitation programs are implemented, and a lack of evaluation. OBJECTIVE: This qualitative paper explores the barriers and facilitators to the implementation of Cradle to Kinder - a long-term, intensive, home visitation family support program for vulnerable young caregivers at risk of child removal across Victoria, Australia. METHOD: Semi-structured interviews and focus groups were conducted with 37 stakeholders from all levels of intervention delivery (i.e., clients, internal staff, external stakeholders). Data collection and thematic analysis were informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS: According to stakeholders, four key CFIR constructs facilitated the implementation of Cradle to Kinder: Effective Engagement, Relative Advantage, Organisational Culture, and Learning Climate. Implementation was challenged by factors within the Peer Pressure construct, which involved managing expectations and push-back from external organisations and services. CONCLUSION: The current findings highlight the importance of organisational commitment to successful implementation. The next phase of this research is to establish the effectiveness of Cradle to Kinder. Indeed, greater implementation-effectiveness evaluations of family support programs are required to ensure that such programs effectively meet the needs of families and improve their outcomes.
Subject(s)
Health Promotion , Child , Humans , Qualitative Research , VictoriaABSTRACT
International evidence supports the effect of intensive family preservation and reunification services in preventing children's placement in out-of-home care (OOHC). Evidence within Australia is scarce. This protocol paper describes a hybrid effectiveness-implementation evaluation of the Victorian Family Preservation and Reunification (FPR) Response implemented by MacKillop Family Services. Participants include families engaged in the program and staff involved in program delivery. A pre-post study design will be used to assess the effectiveness of the FPR in improving family outcomes from intake to closure, including: (i) parenting knowledge, skills, and capability; (ii) family safety and home environment; (iii) child development, adolescent behaviour, education attendance and attachment; (iv) connection to services; and (v) prevention of children from entering or re-entering OOHC. Interviews and focus groups will be conducted with staff to evaluate the program's fidelity, reach, feasibility, acceptability, and enablers and barriers to implementation. Quantitative data will be analysed using descriptive statistics and a series of paired-samples t-tests and F tests to examine changes in outcomes over time; thematic analysis will be used for qualitative data. If the FPR can yield significant improvements in families' outcomes, this would provide strong support for its scale-up across Australia, to better support vulnerable families.
