Feasibility of improving child behavioral health using task-shifting to implement the 4Rs and 2Ss program for strengthening families in child welfare

BACKGROUND Children whose families are involved with child welfare services manifest disproportionately high levels of behavioral difficulties, which could be addressed in community-based organizations providing services to prevent out-of-home placement. Unfortunately, few evidence based practices have been successfully implemented in child welfare settings, especially those originally delivered by mental health providers. Given that such settings typically employ caseworkers who lack prior mental health training, this is a significant barrier to implementation. Consequently, the overall aim of the current study is test the feasibility of shifting a mental health intervention from specialized services to community-based organizations. It uses task-shifting and the Practical, Robust, Implementation, and Sustainability Model (PRISM) to implement an evidence based intervention to reduce child behavior difficulties, originally provided by mental health practitioners, so that it can be delivered by caseworkers providing placement prevention services to child welfare-involved families. Task-shifting involves (1) modifying the intervention for provision by non-mental health providers; (2) training non-mental health providers in the modified intervention; and (3) establishing regular supervision and monitoring by mental health specialists. METHODS This study uses the 4Rs and 2Ss Program for Strengthening Families, a multiple family group service delivery model to reduce child behavior difficulties, as the example intervention. This intervention has had prior success with child welfare-involved families. The proposed study objectives are: (1) to tailor the content, training, and supervision of the intervention for delivery by caseworkers serving child welfare-involved families; and (2) to assess the feasibility and acceptability of the modified intervention. Mixed quantitative and qualitative methods will assess feasibility and acceptability from key stakeholders (caseworkers, supervisors, administrators, caregivers). In Phase I, a Collaborative Advisory Board will be convened (1) to modify the intervention to be delivered by caseworkers in placement prevention service settings; and (2) to develop training and supervision protocols for caseworkers. In Phase 2, the modified intervention will be pilot tested for delivery by n=4 caseworkers to n=20 families receiving placement preventive services (where children manifest behavior problems). Mixed quantitative/qualitative methods will be used to assess feasibility and acceptability. DISCUSSION This protocol will be of particular interest to agency administrators, program managers, and researchers interested in developing and testing cross-setting implementation guidelines for similar evidence based practices.