Scaling Out the SafeCare Parenting Program: Comparing Task-Shifted and Standard Implementation in a Refugee Community.

Abstract

Scale-up efforts of parenting programs have not served diverse communities well due to inadequate curricular adaptations and the lack of a culturally and linguistically competent workforce. We compared delivery of the parent-child interaction module of SafeCare© (SC-PCI) in a refugee community using two implementation approaches: standard delivery via community-based agencies and a task-shifted delivery via community members trained as community health workers (CHWs). Two hundred and six mothers received SC-PCI from trained SafeCare providers. Implementation metrics included the number enrolled and completed, service satisfaction, and in-session skill uptake. Family outcomes were collected via surveys at baseline, post-intervention, and 4-month follow-up and included parenting skill, stress, and child social-emotional development. Analyses compared differences between implementation approaches. CHWs recruited (Ns = 136 vs. 70) and completed more families (98 to 90%, Cohen's h = 0.36), and their families were more satisfied with their provider (Cohen's d = 0.43). Observed parenting skills rated by providers during SafeCare sessions favored agency-served families over CHW-served families (ds = 2.6 vs. 1.2). In contrast, parent reports of use of positive skills favored CHW-served families (ds = 0.80 vs. 0.46), as did improvements in children's social-emotional outcomes of attachment, initiative, and self-regulation (ds range from 0.34 to 0.69 for CHW-served clients vs. ds = 0.14-0.38 for agency-served clients). SC-PCI was effectively implemented in a refugee resettlement community in both implementation approaches. Though some findings favored agencies, most implementation and outcome measures favored task-shifted delivery by CHWs. Task shifting represents a promising strategy for implementing behavioral parenting programs in highly diverse settings in the USA.