Category: Dissemination / Implementation

Symposium

Barriers to Task-Shifting Evidence-Based Treatments in Child Welfare Settings: Qualitative Findings From an Implementation Trial

Friday, November 17
10:15 AM - 11:45 AM
Location: Indigo Ballroom A, Level 2, Indigo Level

Keywords: Implementation | Trauma | Public Policy
Presentation Type: Symposium

Youth involved in the child welfare system experience higher rates of behavioral disorders than non-involved youth, and are often unable to access evidence-based treatments (EBTs) for these disorders. Task-shifting is a promising strategy for improving access in which EBTs are embedded in agencies outside of the mental health system, such as the child welfare system, and delivered by professionals in those systems. This presentation will discuss organizational and policy barriers identified during an implementation trial of The 4 Rs and 2 Ss for Strengthening Families Program, an EBT for disruptive behavior disorders in children, in child welfare agencies in Maryland and New York. As part of that trial, we held seven collaborative advisory board (CAB) meetings with a group of child-welfare stakeholders (i.e., caregivers, caseworkers, supervisors, and administrators; N = 8) who provided feedback on the intervention, training, supervision, organizational/policy climate, client experiences, and research design. The topics of discussion during these meetings were guided by the Practical, Robust, Implementation, and Sustainability Model (PRISM). Data were captured by non-participatory observer field notes, feedback worksheets, observation guides, pictures, correspondence with regulatory bodies, and other administrative data produced by the board. Two researchers coded qualitative themes, using a deductive approach with a priori concepts based on PRISM constructs, from those data sources. Emergent subthemes were inductively coded using an iterative, grounded theory approach. Approximately 20% of the data sources were co-coded with 89.6% interrater agreement. The CAB was generally optimistic about task-shifting, but also enumerated several barriers at the organizational (e.g., funding, role ambiguity, low morale in agencies) and policy (e.g., licensing laws, civil penalties on peer-providers with child-welfare involvement histories, professional guild conflicts around who can provide mental health services) levels. The presentation will conclude by discussing the implications of these barriers for the implementation and dissemination of EBTs across professions.

Cole Hooley

Washington University in St. Louis

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