The Prevention of Child Maltreatment: Using SafeCare® to Highlight Successes and Needs for Improvement in Prevention Efforts.

Child maltreatment is a public health problem of considerable magnitude. Though substantial progress has been made in the prevention of child maltreatment, one incident of maltreatment is one too many. Intervention and/or prevention efforts must always be dynamic. In this commentary, we highlight recent prevention and policy efforts in the United States, using SafeCare, an evidence-based parent support program with a focus on the prevention of neglect, as an example. We describe broad-scale implementation efforts and offer a vision for what the field must do to realize public heath impact, highlighting recent advances of parent support models in policy, advocacy, and programs. Strategies that might improve current efforts are suggested to ensure the field not become static.

Engagement in home visiting: An overview of the problem and how a coalition of researchers worked to address this cross-model concern.

Home visiting is a widely supported intervention strategy for parents of young children who are in need of parenting skill improvement. However, parental engagement limits the potential public health impact of home visiting, as these programs often have low enrollment rates, as well as high attrition and low completion rates for those who enroll in these programs. The Coalition for Research on Engagement and Well-being (CREW) provided support for three pilot projects representing different home visiting models and aspects of engagement. The results of these pilot projects are presented in this special section. The purpose of this commentary is to introduce CREW and highlight the importance of a cross-model project to improve engagement among home visiting programs.

Modification to a systematically braided parent-support curriculum: Results from a feasibility pilot.

OBJECTIVES: There are a variety of parent-support programs designed to improve parenting and, thereby,the safety and well-being of children. Providers trained in multiple programs are likely to select components of interventions they feel will meet the needs of the families they serve leaving out aspects they deem unnecessary orredundant. In so doing, the fidelity of the evidence-based program is at risk. A potential solution is systematic braiding in which evidence-based programs are combined such that the fidelity to each original model and its implementation are maintained. METHODS: Drawing on qualitative feedback from a prior iteration, this paper discusses results of a feasibility and acceptability pilot of a modified version of the systematically braided Parents as Teachers and SafeCare at Home (PATSCH) curriculum This modification removed a provider-perceived "redundant" portion from the original PATSCH curriculum. A pre-post design (N=18) was used to evaluate the efficacy of the modified curriculum. RESULTS: Significant improvements were seen in trained parent behaviors surrounding home safety and child health. There was also improvement in self-reported parenting behaviors, the portion of the braided curriculum removed, suggesting that the PAT curriculum adequately teaches these skills. Providers and parents were highly satisfied with themodified curriculum. CONCLUSIONS: If a curriculum is modified to reflect provider and parent preferences, then the potential for delivery without fidelity is minimized.

Braiding Two Evidence-based Programs for Families at-risk: Results of a Cluster Randomized Trial.

Child maltreatment is a significant public health problem best addressed through evidence-based parent-support programs. There is a wide range of programs with different strengths offering a variety of options for families. Choosing one single evidence-based program often limits the range of services available to meet the unique needs of families. This paper presents findings from a study to examine the systematic braiding of two evidence-based programs, Parents as Teachers and SafeCare at Home (PATSCH), with the goal to provide a more robust intervention for higher risk families. A cluster randomized effectiveness trial was conducted to examine if PATSCH improved parenting behaviors known to decrease the risk for child maltreatment compared to Parents as Teachers (PAT) Alone. Parents (N= 159; 92 PAT Alone; 67 PATSCH) were enrolled to complete a baseline, 6-month and 12-month assessment. Results indicate the groups did not differ on number of environmental hazards in the home, parents' health care decision-making abilities, child abuse potential, and physical assault over time. However, with regard to the potential for child abuse, the PATSCH group showed a decrease in nonviolence discipline and increase in psychological aggression compared to the PAT group. Further research is needed to better examine this concept and its implications for the field.

Implementing a braided home-based parent-support curriculum: Lessons learned / Introducción de un currículo de apoyo parental «enlazado» con base en el hogar: lecciones aprendidas

A singular parent-support program is limited in its ability to address multiple child and family needs. One innovative solution is braiding, a process in which two evidence-based programs are systematically combined as a newly tailored, cohesive curriculum. In this paper we describe the systematic braiding of two parent-support curricula, Parents as Teachers(R)and SafeCare(R) We highlight implementation challenges to inform future planning and braiding efforts. Based on qualitative data (n=13), we discuss five lessons learned, including identifying a pedagogical approach and sustainability at the model- and site-level. Implications and future directions for braiding and implementation are also discussed

El programa de apoyo parental en solitario se ve limitado por su capacidad para abordar las múltiples necesidades de niños y familias. Una solución innovadora es el braiding (enlazado), un proceso en el que se combinan sistemáticamente dos programas basados en evidencia, como currículo cohesivo y de nuevo diseño. En este documento describimos el braidingsistemático de dos currículos de apoyo parental, «Parents as Teachers(R)»y «SafeCare(R)». Hacemos hincapié en las dificultades de su introducción para informar sobre la planificación futura y los resultados del braiding. Basándonos en los datos cualitativos (n=13), comentamos cinco lecciones aprendidas, incluyendo la identificación de un enfoque pedagógico y la sostenibilidad en relación con el modelo y la localización. También abordamos las direcciones futuras en cuanto a braiding y su introducción

Systematic Braiding of 2 Evidence-Based Parent Training Programs: Qualitative Results From the Pilot Phase.

An effective approach in early intervention for children and families, including child maltreatment prevention, is home-based services. Although several evidence-based programs exist, they are often grouped or delivered together, despite having different foci and approaches. This article describes the development and pilot phases of a trial evaluating the systematic braiding of 2 evidence-based home-based models, SafeCare and Parents as Teachers. We describe the methodology for braiding model implementation and curriculum, specifically focusing on how structured qualitative feedback from pilot families and providers was used to create the braided curriculum and implementation. Systematic braiding of 2 models at the implementation and curriculum levels is a mechanism that has the potential to meet the more comprehensive needs of families at risk for maltreatment.

Implementing a Braided Home-based Parent-support Curriculum: Lessons Learned.

A singular parent-support program is limited in its ability to address multiple child and family needs. One innovative solution is braiding, a process in which two evidence-based programs are systematically combined as a newly tailored, cohesive curriculum. In this paper we describe the systematic braiding of two parent-support curricula, Parents as Teachers® and SafeCare®. We highlight implementation challenges to inform future planning and braiding efforts. Based on qualitative data (n = 13), we discuss five lessons learned, including identifying a pedagogical approach and sustainability at the model- and site-level. Implications and future directions for braiding and implementation are also discussed.

Mark Chaffin (1952-2015).

Presents an obituary for Mark Chaffin, who passed away unexpectedly on August 23, 2015, in Atlanta, Georgia, while riding his bike on the Atlanta Beltline, a joy and passion for him. Mark was a leader in the field of child maltreatment research. He dedicated his career to helping at-risk children and families. His distinguished career belied his self-proclaimed, self-effacing lack of accomplishment.

Addendum to "Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial".

A previous article published several years ago (Prinz et al. Prevention Science, 10, 1-12, 2009) described the main results of a place-randomized-design study focused on the prevention of child-maltreatment-related outcomes at a population level through the implementation of a multilevel system of parenting and family support (the Triple P-Positive Parenting Program). The current report, prepared at the encouragement of the journal, provides additional details about procedures, measures, and design-related decisions, presents an additional analysis of the main outcome variables, and poses questions about the study and its implications. We also offer guidance about how the field can move forward to build on this line of research. From the outset, the three designated primary child maltreatment outcomes were county-wide rates for substantiated child maltreatment cases, out-of-home placements, and hospital-treated child maltreatment injuries, derived from independent data sources available through administrative archival records. Baseline equivalence between the two intervention conditions was reaffirmed. The additional analysis, which made use of a 5-year baseline (replacing a 1-year baseline) and ANCOVA, yielded large effect sizes for all three outcomes that converged with those from the original analyses. Overall, the study underscored the potential for community-wide parenting and family support to produce population-level preventive impact on child maltreatment. Issues addressed included (1) the need for replication of population-oriented maltreatment prevention strategies like the one tested in this randomized experiment, (2) the need to demonstrate that a parenting-based population approach to maltreatment prevention can also impact children's adjustment apart from child abuse, and (3) the role of implementation science for achieving greater population reach and maintenance over time.

Public child welfare staff knowledge, attitudes, and referral behaviors for an evidence based parenting program / Conocimientos, actitudes y prácticas de derivación a un programa de intervención parental basado en la evidencia en profesionales de un servicio público de protección infantil

Little is known about how the knowledge, attitudes, and behaviors of the public child welfare workforce influence implementation of evidence-based practice (EBP) as most research has focused on the private workforce. This paper reports on public child welfare staff knowledge, attitudes, and practices in a state implementing the EBP, SafeCare. A survey of public child welfare staff (N = 222) was conducted to assess knowledge, familiarity, and referral barriers and practices. Knowledge of and familiarity with SafeCare were low, especially among front line staff (case managers). Attitudes toward SafeCare were fairly positive, but somewhat less so than attitudes toward a standard, non-evidenced based parenting program. Case managers were significantly less likely to have made a referral (15%) than other staff (46%). Job tenure had few effects on familiarity, knowledge, attitudes, or referrals. The strongest predictors of having made referrals were familiarity with SafeCare and job position

Se sabe poco sobre cómo influyen el conocimiento, las actitudes y las conductas de los profesionales del sistema público de protección infantil en la implantación de programas basados en la evidencia (PBE), ya que gran parte de la investigación sobre este tema se ha centrado en el ámbito privado. Este artículo informa acerca de los conocimientos, las actitudes y las prácticas de un equipo público de protección infantil que lleva la implantación en un Estado de EE.UU. de un PBE (SafeCare). Se aplicó una encuesta a 222 profesionales que trabajaban en protección infantil para evaluar el conocimiento, la familiaridad y las dificulta- des y prácticas de derivación de casos. El conocimiento y la familiaridad con SafeCare® era bajo, especialmente entre profesionales de primera línea (responsables de casos). Las actitudes hacia SafeCare eran bastante positivas, pero un poco menos que las actitudes hacia un programa utilizado habitualmente y no basado en la evidencia. Los responsables de casos tenían significativamente menos posibilidades de derivar (15%) que otros profesionales (46%). La antigüedad en el trabajo influye poco en el conocimiento, las actitudes o las derivaciones al programa. Los predictores que más influyeron en el número de derivaciones a SafeCare fueron la familiaridad con el programa y el tipo de contrato laboral

Erratum to: An Analysis of Training, Generalization, and Maintenance Effects of Primary Care Triple P for Parents of Preschool-Aged Children with Disruptive Behavior.

CONFLICT OF INTEREST: The Triple P-Positive Parenting Program is owned by the University of Queensland (UQ). The University through its main technology transfer company UniQuest Pty Limited has licensed Triple P International Pty Ltd to disseminate the program worldwide. Royalties stemming from this dissemination activity are distributed to the Parenting and Family Support Centre, School of Psychology, UQ; Faculty of Health and Behavioural Sciences at UQ; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Matthew Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International. Karen Turner is an author of various Triple P programs. Ronald Prinz is a consultant to Triple P International. Cheri Shapiro is a consultant to Triple P America.

SafeCare®: Historical perspective and dynamic development of an evidence-based scaled-up model for the prevention of child maltreatment

SafeCare is an evidence-based parent-training program that reduces child maltreatment, particularly neglect. The risk of child maltreatment, a public health issue affecting millions of U.S. children each year, can be markedly reduced by interventions such as SafeCare that deliver in-home services. Drawing from applied behavioral analysis roots, SafeCare focuses on providing parents with concrete skills in three areas: health, home safety, and parent-child/-infant interaction. This paper will include an overview of the SafeCare model, an historical perspective of its history and dynamic development, description of the theoretical underpinnings of the model, a description of the program targets and content by describing its modules and delivery, an overview of program outcomes, and data discussion of dissemination and implementation (AU)

SafeCare es un programa basado en la evidencia de enseñanza de habilidades parentales que reduce el maltrato infantil, particularmente la negligencia. El riesgo de maltrato infantil, un problema público de salud que afecta cada año a millones de niños y niñas en Estados Unidos, puede ser reducido de forma notable mediante programas como el SafeCare, que desarrolla su intervención en el domicilio. Basado en la psicología conductual aplicada, el SafeCare se centra en dotar a los padres y madres de habilidades específicas en tres áreas: salud, seguridad en el hogar, e interacción padres-hijos. Este artículo expone una visión general del modelo de intervención del SafeCare, una perspectiva histórica de su desarrollo y evolución, sus bases teóricas, sus objetivos y contenido a través de la descripción de sus módulos y forma de provisión, recoge una visión general de sus resultados, y comenta los datos acerca de su diseminación e implantación (AU)

Dynamic adaptation process to implement an evidence-based child maltreatment intervention.

BACKGROUND: Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings. METHODS: This project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n=3) or IAU (n=3) to implement an EBP to prevent child neglect. DISCUSSION: The DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Initial implementation indicators from a statewide rollout of SafeCare within a child welfare system.

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.

Using a Digital Frame and Pictorial Information to Enhance the SafeCare® Parent-Infant Interactions Module With a Mother with Intellectual Disabilities: Results of a Pilot Study.

Parents with intellectual disabilities (ID) are disproportionately represented in the child welfare system. Parents with ID can be better served by developing curricula that support various modes of learning. Technology offers a potentially effective tool because it is visual, interactive, and self-instructional. SafeCare® is an evidence-based parenting program with flexibility to adapt its curricula while maintaining fidelity. This research presents the results of a pilot study that examined the effectiveness of an adaptation to the SafeCare® parent-infant interactions (PII) module for a mother with ID by using a digital picture frame with pictures of the mother and her infant engaged in skills that met the performance criteria for PII. A multiple-probe design across behaviors was used with the mother and her infant, showing a dramatic increase in PII skills that was maintained across 3 monthly follow-ups. Although further research is necessary, the preliminary data suggest the digital picture frame enhancement to the SafeCare® PII module may be a promising instructional tool for parents with ID.