Introduction: Evidence-Based Practices (EBP) play an increasingly central role in the child welfare system, as organizations strive to improve client outcomes. EBP are typically highly structured and focused on specific issues, often replacing “usual care” in child welfare that uses a case management approach to address multiple client needs. Consumer perspectives on the two intervention types are important as client engagement is often poor and dropout high. Moreover, views of services (satisfaction, usefulness) can change over time as parents experience the service. This research compared parent perspectives of a structured parenting program (SafeCare) and services as usual (SAU) at two time points during service receipt.
Methods: Parents were recruited as part of a randomized trial of SafeCare and usual care being conducted at nine sites across four states. Parents eligible to participate in this trial were 18 or over, receiving services from a randomized provider, and had a child 5 years or younger. Sixty five parents participated in the study, and completed qualitative interviews at the beginning of services (n = 65) and the end of services (n = 51). Parents were asked about their expectations and experiences in services, perceptions of their provider, burden of services, and skills learned during services.
Results: Participants were primarily white (80.6%), female (84.1%) and low income (34.4% reporting monthly income >$1250). Both SafeCare and SAU parents generally reported positive expectations for their services at baseline, specifically regarding home safety, relationships, mental health, and parenting strategies. While assessments of service quality at follow up were generally positive, participants with negative perceptions were almost exclusively SAU recipients. Three parents reported negative feelings toward their home visitor, and all were SAU. Parents in SAU also had difficulty articulating any impact of the services they received, whereas SafeCare parents were more likely to report improvements in domains targeted by SafeCare home safety, child healthcare, and parent/child relationships.
Conclusions: Client perceptions of services can be an important driver of service engagement and effectiveness. Prior research on the SafeCare model has shown improved satisfaction and engagement. One reason for this, as shown here, may be that when specific behaviors are targeted, clients demonstrate the ability to articulate concrete accomplishments.