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

摘要 严重急性呼吸综合征冠状病毒2型(简称新冠肺炎)大流行撼动了 为涉及儿童或由儿童监测的弱势家庭提供服务的基础 保护性/福利制度。新冠肺炎改变了儿童和家庭与互联网互动的格局 儿童福利系统提供的重要服务。家访，其中包括基本的和 为参与儿童福利的家庭提供变革性的育儿支持服务不再安全或可行 在新冠肺炎的见证下。大流行摧毁了社会安全网。它向提供商、管理员、 和政策制定者，我们的儿童保护体系是多么脆弱。在这种紧张的状态下，儿童福利机构 精神卫生服务提供者创新服务提供系统。在华盛顿州，国务院 儿童、青年和家庭(DCYF)与提供循证方案的当地服务机构合作 修改程序协议。提供商团队和计划开发人员通力合作，实现面对面过渡 通过开发和向家庭提供远程医疗服务，向远程平台提供服务。这场大流行造成了 在华盛顿州进行自然的服务提供试验的条件。自然实验证明 远程保健服务是一种可行的服务提供系统；数千个涉及儿童福利的家庭 通过远程医疗服务。然而，我们不知道这些服务是否有效，也不知道哪些家庭有 参与的技术能力，或者对于那些确实参与的人来说，他们能够完成计划。做 在线家访产生了预期的效果吗？虽然在线交付是由 必要性在回应新冠肺炎时，许多问题仍然存在。这种潜力很大，但人们对此知之甚少。 儿童福利中的远程保健。这项建议是一项循证家访的三臂有效性试验 计划：1)在线交付，2)面对面交付，3)常规护理。我们将评估以下措施的有效性 促进第一次关系(PFR：10周模式)以改善观察到的亲子互动和 358名有以下儿童的照顾者对社会和情绪发展的了解 注册时年满18个月。我们还将评估PFR是否减少了儿童的外化行为，并减少了 把孩子安置在寄养家庭。我们将评估通过以下途径提供PFR的成本效益 远程医疗。我们将解决儿童保护机构(CPS)中的家庭拥有这项技术的程度 需要参与远程保健服务，以及家庭满意度和合规性。最后，我们会 衡量运营商对PFR模式的忠诚度，以及他们对通过远程医疗提供PFR的忠诚度。这个 拟议的研究利用了华盛顿大学和华盛顿大学之间的长期合作伙伴关系 国家儿童福利基金会，负责监督儿童福利服务，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.