Delivering Evidence-Based Parenting Services to Families in Child Welfare Using Telehealth

摘要 严重急性呼吸系统综合征冠状病毒2型（称为COVID-19）大流行动摇了 向涉及儿童或受儿童监测的弱势家庭提供服务的基础 保护/福利制度。2019冠状病毒病改变了儿童和家庭如何与 儿童福利系统提供的重要服务。家访，其中包括一个基本的， 为涉及儿童福利的家庭提供的变革性育儿支助服务不再安全或可行 在COVID-19的存在下。大流行病摧毁了安全网。它向供应商，管理员， 我们的儿童保护系统是多么脆弱。在这种紧张的状态下，儿童福利机构 和精神健康提供者创新的服务提供系统。在华盛顿州， 儿童、青年和家庭组织（DCYF）与当地服务机构合作，提供基于证据的方案 修改程序协议提供商团队和计划开发人员共同努力， 通过开发和向家庭提供远程保健服务，将远程保健服务扩展到远程平台。大流行病造成了 在华盛顿州进行服务提供的自然实验的条件。自然实验证明 远程保健服务是一个可行的服务提供系统;成千上万的儿童福利涉及家庭， 通过远程医疗服务。然而，我们不知道这些服务是否有效，或者哪些家庭有 参与的技术能力，或者对于那些参与的人来说，他们能够完成计划。做 在线家访是否产生了预期的效果？虽然在线交付是一项创新， 在应对COVID-19的必要性方面，仍然存在许多问题。潜力很大，但对它知之甚少。 儿童福利远程保健。这项建议是一个三臂有效性线索的循证家访 计划：1）在线交付，2）亲自交付，3）常规护理。我们会评估 促进第一关系（PFR：一个10周的模型），以改善观察到的亲子互动， 在358名儿童照顾者的样本中，照顾者的社会和情感发展知识 入组时18个月。我们还将评估PFR是否减少了儿童的外化行为， 把孩子送到寄养家庭。我们会评估透过以下途径提供定额供款的成本效益： 远程保健我们将解决儿童保护服务（CPS）中的家庭拥有技术的程度 需要参与远程保健服务，以及家庭的满意度和遵守。最后我们将 衡量服务提供者对PFR模型的忠诚度以及他们对通过远程医疗提供PFR的坚持程度。的 一项拟议的研究利用了华盛顿大学和华盛顿之间的长期合作关系 国家DCYF，监督儿童福利服务，以回答这些问题。

ABSTRACT The severe acute respiratory syndrome coronavirus 2 (denoted COVID-19) pandemic has shaken the foundation of services delivered to vulnerable families involved with or monitored by the child protective/welfare system. COVID-19 has changed the landscape of how children and families interact with the vital services provided by the child welfare system. Home visitation, which includes a bedrock of essential and transformative parenting support services for families involved with child welfare, was no longer safe or viable in the presence of COVID-19. The pandemic shredded safety nets. It made evident to providers, administrators, and policymakers how fragile our child protective system is. Under this strained state, child welfare agencies and mental health providers innovated service delivery systems. In Washington State, the Department of Children, Youth, and Families (DCYF) worked with local service agencies providing evidence-based programs to revise program protocols. Provider teams and program developers worked together to transition in-person services to remote platforms by developing and delivering telehealth services to families. The pandemic created the conditions for a natural experiment in service delivery in Washington State. The natural experiment proved that telehealth services are a viable service delivery system; thousands of child welfare involved families were served via telehealth. We do not know, however, if these services were effective, or which families had the technological capacity to engage, or for those who did engage were they able to complete the program. Did online home visiting produce the expected outcomes? While online delivery was an innovation driven by the necessity in response to COVID-19, many questions remain. The potential is high, but little is known about telehealth in child welfare. This proposal is a three-arm effectiveness trail of an evidence-based home visiting program: 1) delivered online, 2) delivered in-person, and 3) usual care. We will assess the effectiveness of Promoting First Relationships (PFR: a 10-week model) to improve observed parent-child interaction and caregivers’ knowledge of social and emotional development in a sample of 358 caregivers with children under age 18 months at enrollment. We will also assess if PFR reduces child externalizing behavior and reduces out of home placements of the child into foster care. We will assess the cost-effectiveness of providing PFR via telehealth. We will address the degree to which families in Child Protective Services (CPS) have the technology needed to engage with telehealth services, as well as family satisfaction and compliance. Finally, we will measure service providers’ fidelity to the PFR model and their adherence to delivering PFR via telehealth. The proposed study leverages a longstanding partnership between the University of Washington and Washington State DCYF, overseeing services in child welfare to answer these questions.