Targeting Supervisors to Create Child Welfare System Change: A State-Initiated Rollout of the R3 Supervision Model

Objectives Numerous empirically supported behavioral health preventive interventions show improved outcomes for high-risk children and families, yet few are assimilated into public service systems enough to have a measurable... [ view full abstract ]

Objectives
Numerous empirically supported behavioral health preventive interventions show improved outcomes for high-risk children and families, yet few are assimilated into public service systems enough to have a measurable public health impact. R3 was born out of a request by a large child welfare system (CWS) to train their workforce in the use of evidence-based principles in their every day interactions with families. R3 draws from three areas of reinforcement shown across child and family EBPs to produce positive outcomes: Reinforcement of (1) effort, (2) relationships and roles, and (3) small steps toward goal achievement. The aim of R3 is to expose families to these three Rs in each interaction with their caseworkers to bolster positive progress toward completing CWS treatment plans and to yield a significant public health impact by improving system-level outcomes related to child permanency and placement stability.

A supervisor targeted implementation strategy was used to maximize the potential reach across the system, while working under the real-world limitations of training and coaching capacity. Supervisors have the greatest influence over the behavior of caseworkers, and are well situated to shape interactions between caseworkers and families.

Method
A recent state-initiated rollout of R3 is underway in the United States providing a real-world opportunity to evaluate the R3 strategy and examine potential system level impacts. Observation-based, rapid, fidelity monitoring and feedback facilitates the potential for efficient system-wide behavior change. Through developer-system partnership, full day supervisor and half-day caseworker R3 trainings were rolled out by state region. Each region was trained fully within the same week, with multiple concurrent training sessions occurring.

Following training, supervisors met a minimum of once monthly with their supervisee caseworkers for group supervision. Group supervision sessions were video recorded and uploaded to a secure fidelity monitoring web-based system for review by an R3 expert coach. Expert coaches provided monthly observational monitoring and fidelity rating, written feedback, and virtual consultation coaching. Supervisors were coached to use R3 in their interactions with caseworkers and to support the caseworkers to use R3 with their families.

Results
Four cohorts of child welfare staff including regional leadership, supervisors, and caseworkers were trained in R3 strategies and principles between September 2015 and February 2016 (n = 355). Lessons learned regarding system collaboration and large-scale rollout will be shared, including workforce considerations (e.g., inability to take entire workforce offline for training, meeting supervision policy requirements) and the need for flexibility to address system contexts. While supervisors and caseworkers reported high levels of satisfaction with the training, both groups reported ambivalence toward implementing the R3 supervision approach, with anxiety about being recorded and lack of time for an additional meeting being cited as the most frequent concerns. Qualitative reports from supervisors following the initiation of coaching suggest a majority of supervisors increased their level of engagement in and positive feeling toward implementation of R3 once the group supervisions and coaching was underway.

This presentation will include results from 6-month post-training supervisor feedback collected from brief phone interviews. Moreover, change in fidelity scores from baseline to 6-months will be described.

Conclusions
The R3 supervisor strategy was developed to improve interactions between families and the child welfare system. Improved interactions and feelings of support have the potential to lead to increased collaboration toward child welfare treatment plan completion. By infusing evidence-based strategies into everyday interactions between child welfare staff and the families they serve, there is an increased potential for quality and timely service plans to be achieved ultimately leading to improved child and family outcomes.