Supporting Sustainable Positive Interactions in the Child Welfare System: The R3 Supervisor Strategy

 描述（由申请人提供）：关于促进公共儿童福利系统（CWS）变革的战略，仍然存在很大的知识差距，但很少有机会评估创造全系统变革的战略及其对公共卫生的影响。在美国的CWS中居住着易受伤害的儿童和家庭，他们面临着高风险的负面后果，包括物质使用、危险的性行为、犯罪、监禁、无家可归和过早死亡。该提案通过解决NIH的优先事项，以了解“循证干预措施的规模扩大和可持续性”的方法，映射到PAR 13-055。“利用现实世界，联邦政府资助，系统发起的努力，在田纳西州CWS劳动力的多层次中注入循证原则的使用，这项研究将评估以监督者为目标的实施策略的有效性在创造组织变革和随后的积极家庭成果。R3监管策略的制定是为了修改CWS工作面支持家庭完成其治疗计划的方式，通过利用在以前的NIDA资助的干预试验中发现的循证行为原则来改善系统水平的结果，包括儿童永久性，稳定性和福祉。R3战略提供培训、咨询和可靠性监控 主管，他们在系统中处于个案工作者（与涉及社区服务的家庭进行日常互动）和领导层（做出影响家庭接受服务的组织的决定）之间的中心位置。三个R包括加强（1）努力， (2)关系和角色，以及（3）实现目标的小步骤。R3建立在社会学习理论的基础上;这些强化目标在监督者和他们的被监督者-个案工作者之间以及个案工作者和他们所服务的家庭之间的互动中得到鼓励。利用动态等待名单设计的变化，四个田纳西州CWS地区（每年为12,000多名儿童提供服务）已被授予联邦标题IV-E豁免，并选择采用R3作为其豁免计划的一部分。将招募CWS员工（n = 85名区域管理员，50名主管和220名个案工作者）参加R3在实现组织和随后的积极系统级，客户级结果方面的有效性的混合II型试验。该项目将研究R3影响主管与个案工作者互动以及随后的家庭结果的潜力（目标1）; R3对已知影响员工保留和成功采用创新的组织特征的影响，如气候，领导力，准备和公民身份（目标2）;以及随着咨询和辅导完全转移到系统中，保持对R3战略的忠诚度标准的潜力（目标3）。该项目将告知R3的潜力，以有效地将循证原则注入到参与儿童福利系统的人的日常互动中，并缩小全国最昂贵和最脆弱的人群之一--参与儿童福利系统的家庭--的差距。

 DESCRIPTION (provided by applicant): Large knowledge gaps remain regarding strategies to promote change in public child welfare systems (CWS), yet opportunities to evaluate strategies to create system-wide change and the resulting public health impact are rare. The CWS in the United States is populated with vulnerable children and families at high risk for negative outcomes, including substance use, risky sexual behavior, delinquency, incarceration, homelessness, and early mortality. This proposal maps onto PAR 13-055 by addressing the NIH priority to understand methods for "scale-up and sustainability of evidence-based interventions." Leveraging a real-world, federally funded, system-initiated effort to infuse the use of evidence-based principles throughout the multi-levels of the Tennessee CWS workforce, this study will evaluate the effectiveness of a supervisor-targeted implementation strategy in creating organizational change and subsequent positive family outcomes. The R3 Supervisor Strategy was developed to modify the way that the CWS workface supports families toward completing their treatment plans, by utilizing evidence-based behavioral principles found in previous NIDA-funded intervention trials to improve system-level outcomes, including child permanency, stability, and well-being. The R3 strategy provides training, consultation, and fidelity-monitoring to supervisors, who are centrally positioned in the system between caseworkers (who have daily interactions with CWS-involved families) and leadership (who make decisions that affect the organization in which families receive services). The three Rs include reinforcement of (1) effort, (2) relationships and roles, and (3) small steps toward goal achievement. R3 is founded on social learning theory; these reinforcement targets are encouraged in interactions between supervisors and their supervisee- caseworkers and between caseworkers and the families they serve. Utilizing a variation of a dynamic wait-listed design, four Tennessee CWS regions (serving over 12,000 children annually) that have been awarded a federal Title-IV-E Waiver and have opted to adopt R3 as part of their waiver plan will be observed. The CWS workforce (n = 85 regional administrators, 50 supervisors, and 220 caseworkers) will be recruited to participate in a Hybrid Type II trial of the effectiveness of R3 in achieving organizational and subsequent positive system-level, client-level outcomes. This project will examine the potential of R3 to influence supervisor interactions with caseworkers and subsequent family outcomes (Aim 1); the impact of R3 on organizational characteristics known to impact staff retention and the successful adoption of innovations such as climate, leadership, readiness, and citizenship (Aim 2); and the potential for maintaining fidelity standards to the R3 strategy as consultation and coaching are fully transferred to the system (Aim3). This project will inform the potential for R3 to effectively infuse evidence-based principles into the daily interactions of those involved in th CWS, and to narrow the gap for achieving outcomes for one of the nation's most costly and vulnerable populations-families involved in the child welfare system.