Assessing Non-Inferiority in an Adapted Communities That Care Model Aiming to Prevention Child Maltreatment

Introduction: Child maltreatment is a challenge that communities nationwide struggle to address. A variety of intervention and prevention efforts aim to address child maltreatment; however, few aim to prevent child maltreatment at the community level by addressing community-specific risk and protective factors. This paper describes findings from Keeping Families Together (KFT), a project that has adapted the evidence-based Communities That Care (CTC) community mobilization model (which is traditionally used in youth risk behavior prevention) for use in community child maltreatment prevention, and compares these findings to those from the 24-site trial of the traditional CTC model. More specifically, comparisons are made on community board functioning and community adoption of a science-based approach to prevention (both of which include established indicators of successful CTC implementation and predictors of outcome achievement), in addition to program sustainability.

Methods: KFT is being implemented in two communities in Oregon. Adapted evaluation instruments measuring the same constructs as those measured in the 12-site trial were used to collect implementation data, community board functioning data, and community/ system transformation data. Non-inferiority testing was used to statistically compare coalition functioning, prevention system transformation, and program sustainability of the adapted and traditional CTC sites. Tests of non-inferiority are based on rejecting the directional null hypothesis that achievement of these factors in the adapted CTC approach is significantly (p < .025) lower than levels achieved in the traditional sites.

Results: Regarding board functioning, non-inferiority testing revealed that, 1 year into implementation, Board Member New Skills, Community Readiness/Support for KFT, Efficacy, and Opportunities for Participation in KFT were slightly but significantly inferior in adapted KFT sites compared to those in traditional CTC sites; however, at 3.5 years into implementation, there were no longer any board functions for which adapted sites were inferior. Neither diverse community sector participation nor adoption of a science-based approach to prevention differed between groups at either time point.

Conclusions: Based on these implementation findings, the Keeping Families Together adapted Communities That Care approach seems to be a promising adaptation for use in community maltreatment prevention. Further testing of community maltreatment outcomes will provide more definitive evidence for the effectiveness of this adapted approach.