For example, in the Safety module, the provider uses a structured checklist to count the number of accessible hazards in homes. It became clear that the differences in approaches were greater than anticipated. PAT does not typically conduct formal assessments of parenting behaviors via a standardized assessment form. Instead, the pedagogical approach is didactic and modeling oriented. The utilization of new intervention approaches in the braided curriculum made PATSCH providers uneasy in training because it was a shift in the manner they interacted with their families, though this unease diminished with time..
The role of home-visiting programs in preventing child abuse and neglect
Maintaining intervention fidelity and ensuring the intervention is delivered as designed is key to maximizing potential benefits Aarons et al. Fidelity is especially important when combining two interventions that conceptualize fidelity differently. For SafeCare, fidelity is assessed by observing or listening via audio recording how a given module is delivered during sessions. The lesson learned is that in developing a braided curriculum, more than the content and theoretical orientation must be considered.
The objectives of a braided curriculum must be operationalized and aligned with intervention and implementation strategies representative of the two models being braided, but specific to the braided curriculum. This balance requires structured compromise. Powell and colleagues offer suggestions as to how disparate implementation strategies between two curricula could be selected and tailored.
The Intervention Mapping approach balances theory, evidence, and stakeholder perspectives. Though we did not use this approach in our braided approach, it is likely that it may be useful in future efforts to braid existing curricula.. This differs from the intervention style because anchoring focuses on how the provider might use the braided curriculum. The implementation of PATSCH required some parent educators to alter considerably their interactions and involvement with the families they served. This may have included a combination of one or more of the following factors: an increase in the frequency with which they visited families e.
There are similar goals, but different approaches. Lesson 3: sustainability of a braided curriculum : Braiding inherently requires the cooperation and collaboration of two models beyond the provider level. In our case, funding support necessitated that staff at National SafeCare Training and Research Center take the lead on much of the work utilizing input and resources provided by the PAT National Center.
PATSCH is conceptually a coordinated effort by SafeCare and PAT, but the sustainability of the model requires consideration of which model takes leadership in pursuing further funding to improve the evidence-base. Cooperative agreements and memoranda of understanding are practical solutions, but sustainability in this context extends to intellectual property where the boundaries become blurred.
Though our models have not yet collectively reached a solution to this important lesson at the time of writing, we suggest that future braided efforts establish this agreement at inception of such an effort.. During the Pilot Phase, the initial conversations about the braided curriculum at some sites were with site supervisors and with supervisors and providers at others Guastaferro et al.
Of the two pilot sites trained in PATSCH, the one site that was recruited through conversation with only site supervisors discontinued participation following the Pilot Phase because of the perceived added time commitment to their already high caseloads. In contrast, the pilot site that was recruited through conversations with both the supervisor and parent educators remained active in the Effectiveness Trial. This provided us with a valuable lesson that we carried forward in the process of recruiting other sites, being sure to discuss the requirement with supervisors and staff.
Providers are most familiar with their caseloads, potential participants, and whether their families would benefit from the braided curriculum. In typical SafeCare implementation a readiness assessment, a tool commonly used in implementation science, is conducted with interested sites. Future braided efforts may benefit from developing a readiness assessment specific to the implementation of a braided curriculum..
Lesson 5: impact of research on provider — client relationship : Our trial was not possible without the assistance of the parent educators at control and PATSCH sites. They became the conduits of the family enrollment aspect of the research project, a task they were not necessarily familiar with and which they were not necessarily comfortable.
Third party data collectors administered the research assessments which included a computer questionnaire, a video recorded parent—child interaction, and environmental scan of two rooms. At least some parent educators believed use of video for the research negatively affected their relationships with families, some of whom they had been serving for some years.
As a matter of fact, ever since then we have met here at the school. She has not even wanted [me] in her home ever since then. They were really more careful about things around their house. The lesson is the introduction of research into the dynamic between service provider and family may be positive or negative and it is the responsibility of the researchers to reduce negative impacts as much as possible.
Overall, parent educators had a positive take on their involvement:. The objective of this paper was to describe the lessons learned from the implementation of a braided curriculum with the goal of informing future braiding efforts.
Braiding offers one potential solution to better meet the comprehensive needs and improve the well-being of children and families. There has been very little systematic work to understand which programs are most effective for particular kinds of families based on risk factors, needs, or even expressed desires.. Although the results of the Effectiveness Trial described here are forthcoming, there is a burgeoning interest in the concept of braided efforts and the braided approach is increasingly supported by researchers, model developers, and funders Guastaferro et al.
However, an alternative perspective on combining curricula is worth noting. Some have argued that programs with a few specific intervention targets will ultimately be more effective and successful than broader programs Berliner et al.
It may not be possible to address every need a family may have, especially for very high risk families such as those in the child welfare system. Further research to this end is warranted.. The research on braided programs is nascent. A more effectively braided curriculum might be developed with more empirical data. An emerging framework to provide that empirical evidence is the multiphase optimization strategy MOST. The goal is to engineer an optimized behavioral intervention that meets predetermined standards expressed as an optimization criterion , is efficient i.
MOST is directly applicable to the objectives of PATSCH: to develop a parent-support intervention that brings together components from two evidence-based programs to better address multiple risk factors. Future research might apply the MOST framework to the concept of braiding.. Ultimately, the goal is to provide the most effective intervention to each family Gardner, Ideally, we would have research and assessments to determine which interventions would do that based on family profiles, risk, demographics, or preferences.
However, the field of maltreatment prevention has not yet reached that level of sophistication and it is clear that no single program is a best fit for every family.
The research was supported by the Annie E. Casey Foundation. During the preparation of the manuscript for publication, K. The content is solely the responsibility of the authors and does not necessarily represent the official views of The National Institute on Drug Abuse.. The authors have no conflicts of interest to declare.. We would like to thank Maithili Bhat and Ambra Noble for their help transcribing the interviews, and Jon Reader for reviewing an early draft of the manuscript..
Inicio Psychosocial Intervention Implementing a braided home-based parent-support curriculum: Lessons learned. ISSN: Implementing a braided home-based parent-support curriculum: Lessons learned. Descargar PDF. Kate Guastaferro a ,. Autor para correspondencia. Under a Creative Commons license. Table 1. Table 2. Implications and future directions for braiding and implementation are also discussed. Palabras clave:. Texto completo. The braided approach is guided by model purveyors and delivered to all families with fidelity monitored throughout the implementation process.
Outcomes will be presented in future publications. The providers, referred to as parent educators, serve multiple children within a family's home and, thus, may provide services to a family for multiple years. Conceptual diagram: shared and unique elements by model. Overview of research question, design, and methodology. Outcomes from the trial will be presented in future publications. The purpose was to inform revisions to the braided curriculum and to garner insight about what factors were relevant to the dissemination and implementation of the braided program from the site perspective.
List of challenges, lessons learned, and suggestions. However, this is not sufficient in the sustainability of the braided effort beyond the funding period. However, the buy-in of providers is essential to the sustainability of project, particularly in an applied research setting. However, this may have an adverse effect on the provider—client relationship. Mechanisms to reduce this possibility are essential to the sustainability of a research effort and collaboration with service providers.
We would like to thank Maithili Bhat and Ambra Noble for their help transcribing the interviews, and Jon Reader for reviewing an early draft of the manuscript. Aarons, M. Hurlburt, S. Advancing a conceptual model of evidence-based practice implementation in public service sectors.
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Parenting and family processes in child maltreatment and intervention…
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