Preventing Child Maltreatment: Implementation Effectiveness, Fidelity, and Scaling up of the Family Check-up in Community Mental Health Agencies

Objective: We examine the implementation effectiveness of the Family Check-Up (FCU; Dishion & Stormshak, 2007). The FCU was adapted for ease of implementation in three low resource community mental health agencies serving high-risk families referred by the Department of Health and Human Services (DHHS) following investigation for child maltreatment. Maltreated children are at high risk for later maladjustment in multiple domains and deleterious developmental outcomes. Effect prevention programs that can be implemented in community settings that typically serve these families are sorely needed. The FCU is a family-based intervention shown to improve family management practices and reduce problem behaviors in youth ages 2-18 (e.g., Dishion et al, 2008; Stormshak & Dishion, 2009). It is recognized as an empirically supported home visiting program by DHHS (Paulsen et al., 2010). Method: Families were randomly assigned to receive the FCU (N = 42) or community treatment as usual (TAU) (N = 32). Of the 36 therapists engaged in the study, 17 were randomly assigned to the FCU condition and 19 to TAU. Therapists in the FCU condition received intensive training followed by ongoing implementation support to promote uptake and counter drift. Results: Intention to treat analysis revealed intervention effects on youths’ conduct problems and emotional symptoms, reductions in caregivers’ negative parenting behaviors and improved limit setting, assessed by observational methods, and the number of traumatic events experienced by the child during the intervention. Interventionists were found to have positive attitudes toward evidence-based practices, a desire to learn evidence-based approaches, and acceptable implementation fidelity, assessed using the COACH rating system. Furthermore, variations in fidelity were associated with reliable change in multiple parenting behaviors. Conclusions: The FCU is a viable and effective family-based community intervention for child maltreatment. Families in the FCU condition were observed to have better parent management practices and the children’s problem behaviors and emotional symptoms were improved compared to TAU. Ratings of therapist implementation fidelity indicate initial training in the FCU and ongoing bi-weekly to monthly supervision are sufficient to adequately deliver the intervention. The implications of these findings for future scale-up efforts of the FCU will be discussed.