Evaluating how Providers’ Competency to Deliver SafeCare® Relates to Provider Training and Family Outcomes

Evidence-based programs (EBPs) are the gold standard of prevention and intervention programs to address child maltreatment. SafeCare® is a parent-training EBP that significantly reduces risk factors and occurrences of child neglect and abuse. To ensure that EBPs are being implemented correctly and effectively, it is important to evaluate provider fidelity (adherence to program protocol) and competency (skill level to deliver protocol). Provider fidelity has been more frequently measured than provider competency. However, research has shown competency to be complementary to fidelity, and competency seems to be an important predictor of patient outcomes. The current study used SafeCare to analyze how provider competency relates to provider training and family outcomes. Results showed that provider competency was positively correlated with provider training quizzes but not to provider training role plays or family outcomes. These findings suggest that provider knowledge acquisition during training may be an important factor in providers achieving strong competency in the delivery of an EBP. PROVIDER COMPETENCY AND FAMILY OUTCOMES 3 Evaluating how Providers’ Competency to Deliver SafeCare Relates to Provider Training and Family Outcomes Child maltreatment, known as a caregiver’s action or lack of action resulting in physical or emotional harm to a child, affected 686,000 children in the U.S. in 2012 (U.S. Department of Health and Human Services, 2013). Child maltreatment includes neglect, physical abuse, psychological maltreatment, and sexual abuse, with neglect accounting for 78.3% of substantiated cases. The younger the child, the more susceptible he or she is to being a victim of child abuse or neglect. Eighty percent of abusers were parents of the victims, suggesting that parents are a key agency of change for prevention and intervention. Evidence-based programs (EBPs), which are rooted in empirical evidence, have become the golden standard of prevention and intervention for addressing a wide array of childhood and family issues, including child maltreatment (Chaffin & Friedrich, 2004). While neglect is the most common form of child maltreatment, few programs have documented success with reducing the reoccurrence of neglect. SafeCare is a widely known EBP that significantly reduces occurrences of and risk factors for both child neglect and abuse (Chaffin, Hecht, Bard, Silovsky, & Beasley, 2012; Gershater-Molko, Lutzker, & Wesch, 2002 & 2003; Lutzker & Rice, 1984; Lutzker, Van Hasselt, Bigelow, Greene, & Kessler, 1998). As demands for EBP implementation have increased, so have expectations for providers to be held accountable for its outcomes (Schoenwald, Garland, Chapman, Frazier, Sheidow, & Southam-Gerow, 2011). Provider fidelity and competency must be evaluated to ensure that an EBP is being implemented correctly and effectively (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005). Fidelity is the degree to which a provider adheres to the program’s protocol, while competency is a provider’s level of skill to effectively implement the program (Schoenwald et al., 2011). PROVIDER COMPETENCY AND FAMILY OUTCOMES 4 To date, fidelity is more commonly measured in the implementation of EBPs and is more frequently studied than competency. Furthermore, researchers advise that equating the importance of measuring fidelity to the importance of measuring competency is an unwarranted conceptual leap (Waltz, Addis, Koerner, & Jacobson, 1993). These two assessments are likely associated but capture unique aspects of provider delivery of EBPs (Palmer, 2012). Without evaluations of provider competency, it is difficult to ensure that a program was delivered with high proficiency, even if fidelity assessments showed providers conducted the program the way it was developed. Furthermore, it is necessary to understand what influences competency (e.g., training, support) and how provider competency impacts desirable program outcomes (e.g., client improvement). Limited research exist(s) on provider competency, and most research has been conducted on the delivery of mental health programs. In the present study, we examined provider competency in delivering SafeCare, a home-based parent training program, and how it relates to provider training and parents’ skill acquisition. Evidence-Based Practices EBPS are highly regarded in the realm of public health care with their promotion of programs and policies using scientific evidence to demonstrate their efficacy and utility. EBPs are objectively implemented with the development of manuals, and outcomes are documented through empirical evidence. Many parent training programs (e.g., The Incredible Years, Webster-Stratton & Hammond, 1997; Oregon Social Learning Center’s Parent Management Training, Forgatch & Martinez 1999; Parent-Child Interaction Training, Eyberg & Robinson, 1982; SafeCare, Guastaferro, Lutzker, Graham, Shanley & Whitaker, 2012) are identified by several highly regarded organizations as EBPs to address risk factors associated with child maltreatment including: Blue Prints for Violence prevention (Irwin, Elliott, Fagan, & Hansen, PROVIDER COMPETENCY AND FAMILY OUTCOMES 5 2001), California Clearing House (CEBC, 2010), The Kauffman’s Best Practice Report (Chadwick Center on Children and Families, 2004), and Substance Abuse and Mental Health Services Administration (SAMHSA; The National Registry for Evidence-Based Programs and Practices, 2010). EBPS are becoming more widely disseminated and implemented within community, realworld applications. However, it is important to ensure that the EBPs are implemented correctly and with high quality. Goense and her colleagues’ (2014) meta-analysis found that although 80% of programs assess fidelity, very few address therapist competence. Most programs have established fidelity measures; however, many lack or are in the process of developing competency measures. Much needed research on competency will help facilitate programs’ development and demonstration of the utility and effectiveness of competency measures.