R3: A Supervisor Targeted Implementation Strategy to Create Organizational Change in the Child Welfare System

Introduction: 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 the New York City 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. R³ aims to expose families to these Rs in every interaction with CWS staff to increase progress toward completing CWS treatment plans yielding a significant public health impact by improving system-level outcomes related to child permanency and placement stability.

Methods: A supervisor targeted implementation strategy was developed to maximize the potential reach across the system. Through developer-system partnership, R³ was created, implemented, and piloted in the NYC CWS. Lessons learned informed modifications to implementation methods; these key changes are under investigation in a recently funded implementation trial in the CWS across the state of Tennessee.

Supervisors are coached to use R³ in their interactions with caseworkers and to support the caseworkers to use R³ with their families. Fidelity to R³ is assessed using web-based technology designed to provide rapid observational feedback. Group supervision meetings are video recorded for observation and fidelity rating, written feedback, and monthly virtual consultation coaching. Modifications in the implementation process include changes to the training protocols, incorporation of locally-run, introductory trainings to supervisors and caseworkers prior to full and half day trainings provided by experts, and increased technology support.

Results: The feasibility of R³ was demonstrated in a pilot across five foster care agencies in NYC (supervisor n = 45). Outcomes demonstrated improved supervisor fidelity over time and qualitatively reported improved organizational change. We will further describe baseline outcomes from the recently launched Tennessee rollout of R³, and describe CWS staff (n = 355) self-report of organizational climate, citizenship, leadership, and readiness, in addition to feedback regarding their training experiences. Baseline differences between supervisor and caseworker enthusiasm for supervisory change will be described.

Conclusions: Strategies to infuse evidence-based principles across an entire workforce require developer-system collaboration and strategic target of training and consultation efforts. Observation-based, rapid, fidelity monitoring and feedback facilitates the potential for efficient system-wide behavior change.