Child maltreatment is a public health problem of considerable magnitude. Though substantial progress has been made in the prevention of child maltreatment, one incident of maltreatment is one too many. Intervention and/or prevention efforts must always be dynamic. In this commentary, we highlight recent prevention and policy efforts in the United States, using SafeCare, an evidence-based parent support program with a focus on the prevention of neglect, as an example. We describe broad-scale implementation efforts and offer a vision for what the field must do to realize public heath impact, highlighting recent advances of parent support models in policy, advocacy, and programs. Strategies that might improve current efforts are suggested to ensure the field not become static.

Objectives This pilot study used a prospective mixed methods approach to examine predictors of retention in services during the transition from pregnancy to postpartum. Home visiting programs that serve pregnant women are an important means of improving child and maternal well-being. Providing services to women during the transition from pregnancy to postpartum is particularly important, because children under the age of 1 are at high risk for mortality. Morever, mothers face amplified levels of stress during the postpartum period. Unfortunately, home visiting programs in the United States that support pregnant and postpartum women suffer from high rates of attrition. General research on home visiting engagement suggests that the client-provider relationship is an important factor in predicting client engagement in services; however, few studies have examined factors related to maternal engagement during the transition from pregnancy to postpartum. Methods Measures administered during pregnancy for 39 pregnant women were used to predict attrition up to 15 months postpartum. Semi-structured interviews were conducted at 3 months postpartum with 33 of the original 39 women to qualitatively assess factors related to engagement in services during the transition from pregnancy to postpartum. Results Both quantitative and qualitative analyses indicated that clients' perceptions of the client-provider relationship was a critical factor in maintaining mothers' engagement in services. Both types of analyses indicated that perceived provider reliability was related to mothers' engagement in services. Quantitative analyses also found that perceived provider cultural competence predicted engagement in services. Other findings from qualitative analyses indicated that mothers' perception of the home visitor as trustworthy/supportive, personable/having good communication skills, knowledgeable, and collaborative/flexible, were factors that mothers noted when discussing engagement in services. Conclusions These results advance the literature on engagement in home visiting services by overcoming some of the limitations of previous literature and may have implications for home visitor training.

Home visiting is a widely supported intervention strategy for parents of young children who are in need of parenting skill improvement. However, parental engagement limits the potential public health impact of home visiting, as these programs often have low enrollment rates, as well as high attrition and low completion rates for those who enroll in these programs. The Coalition for Research on Engagement and Well-being (CREW) provided support for three pilot projects representing different home visiting models and aspects of engagement. The results of these pilot projects are presented in this special section. The purpose of this commentary is to introduce CREW and highlight the importance of a cross-model project to improve engagement among home visiting programs.

This chapter discusses the critical relevance of the social-significance aspect of behavioral psychology to antecedent behavioral control. In the ecobehavioral models described for child abuse and neglect and developmental disabilities, the assumption has been made that the problems faced by the families involved are multifaceted and need multifaceted treatment. The services provided by Project 12-Ways have included parent-child training, stress reduction, basic skill training for children, home safety, home cleanliness, and a host of strategies aimed at preventing abuse by single mothers. Antecedent control procedures were effective in nearly eliminating a serious medical problem of a child with developmental disabilities. PAI has proved to be an effective treatment tool for families with children with conduct disorder and developmental disabilities. Prompting, goal setting, and simple reinforcement were used by G. E. Bigelow, K. B. Huynen, and J. R. Lutzker to teach fire-escape skills to an adolescent with developmental disabilities who lived in a group home.

OBJECTIVES:There are a variety of parent-support programs designed to improve parenting and, thereby,the safety and well-being of children. Providers trained in multiple programs are likely to select components of interventions they feel will meet the needs of the families they serve leaving out aspects they deem unnecessary orredundant. In so doing, the fidelity of the evidence-based program is at risk. A potential solution is systematic braiding in which evidence-based programs are combined such that the fidelity to each original model and its implementation are maintained.METHODS:Drawing on qualitative feedback from a prior iteration, this paper discusses results of a feasibility and acceptability pilot of a modified version of the systematically braided Parents as Teachers and SafeCare at Home (PATSCH) curriculum This modification removed a provider-perceived "redundant" portion from the original PATSCH curriculum. A pre-post design (N=18) was used to evaluate the efficacy of the modified curriculum.RESULTS:Significant improvements were seen in trained parent behaviors surrounding home safety and child health. There was also improvement in self-reported parenting behaviors, the portion of the braided curriculum removed, suggesting that the PAT curriculum adequately teaches these skills. Providers and parents were highly satisfied with themodified curriculum.CONCLUSIONS:If a curriculum is modified to reflect provider and parent preferences, then the potential for delivery without fidelity is minimized.

More than 500,000 children experience neglect each year in the United States, yet few evidence-based parent-training programs focus primarily on preventing and mitigating the risk factors for neglect. A notable exception is SafeCare®. This review focuses on the research designs used at three phases of the SafeCare model: development, evaluation, and dissemination. Presented in chronological order, the purpose is to highlight the 40-year evidence-base of the SafeCare model and to demonstrate that certain research designs are specific to phases of intervention development. The cumulative evidence from those 40 years for the SafeCare model and its predecessor is powerful. Future research with a variety of experimental designs related to dissemination and implementation research are discussed.

A singular parent-support program is limited in its ability to address multiple child and family needs. One innovative solution is braiding, a process in which two evidence-based programs are systematically combined as a newly tailored, cohesive curriculum. In this paper we describe the systematic braiding of two parent-support curricula, Parents as Teachers® and SafeCare®. We highlight implementation challenges to inform future planning and braiding efforts. Based on qualitative data (n = 13), we discuss five lessons learned, including identifying a pedagogical approach and sustainability at the model- and site-level. Implications and future directions for braiding and implementation are also discussed.

Child maltreatment is a significant public health problem best addressed through evidence-based parent-support programs. There is a wide range of programs with different strengths offering a variety of options for families. Choosing one single evidence-based program often limits the range of services available to meet the unique needs of families. This paper presents findings from a study to examine the systematic braiding of two evidence-based programs, Parents as Teachers and SafeCare at Home (PATSCH), with the goal to provide a more robust intervention for higher risk families. A cluster randomized effectiveness trial was conducted to examine if PATSCH improved parenting behaviors known to decrease the risk for child maltreatment compared to Parents as Teachers (PAT) Alone. Parents (N= 159; 92 PAT Alone; 67 PATSCH) were enrolled to complete a baseline, 6-month and 12-month assessment. Results indicate the groups did not differ on number of environmental hazards in the home, parents' health care decision-making abilities, child abuse potential, and physical assault over time. However, with regard to the potential for child abuse, the PATSCH group showed a decrease in nonviolence discipline and increase in psychological aggression compared to the PAT group. Further research is needed to better examine this concept and its implications for the field.

Evidence-based practices, particularly home-based parent-support programs, have been effective in preventing child maltreatment. Given the high rate of maltreatment, in particular the relative lack of decline in neglect, the question is what more can evidence-based practices do to maximize effectiveness and responsiveness in the prevention of maltreatment? This chapter describes the movement towards increasing use of evidence-based practices and discusses the challenges for agencies in selecting an appropriate model for the population they serve. SafeCare® is used as an applied example and the content, effectiveness, dissemination, and implementation are highlighted. The chapter reviews challenges in dissemination and implementation of evidence-based practices in the child welfare population and providing recommendations and suggestions for improving the effectiveness and implementation processes effectively and consistently in this population.

An effective approach in early intervention for children and families, including child maltreatment prevention, is home-based services. Although several evidence-based programs exist, they are often grouped or delivered together, despite having different foci and approaches. This article describes the development and pilot phases of a trial evaluating the systematic braiding of 2 evidence-based home-based models, SafeCare and Parents as Teachers. We describe the methodology for braiding model implementation and curriculum, specifically focusing on how structured qualitative feedback from pilot families and providers was used to create the braided curriculum and implementation. Systematic braiding of 2 models at the implementation and curriculum levels is a mechanism that has the potential to meet the more comprehensive needs of families at risk for maltreatment.

This chapter describes the Hart and Risley research, applications of their work, and its role with SafeCare, an evidence-based parent training programme that has a footprint in 25 US states, the United Kingdom, Israel, Canada, Australia, Spain and Belarus. It discusses the historical development of the SafeCare model, reviews its evidence base and describes the Parent-Infant Interaction (PII) training module. With the discovery and understanding of the 'word gap' identified by Hart and Risley's research, the city of Providence, Rhode Island, US found that two-thirds of their prospective kindergarteners arrived at school with below national academic reading levels. To address this problem, the City of Providence launched 'Providence Talks', the first municipality-driven intervention programme aiming to close the 'word gap' and increase childhood literacy. Families referred to Project 12-Ways had significantly more child maltreatment reports to child protective services prior to any intervention than the comparison families did, suggesting that the Project 12-Ways families were more 'difficult' to begin with.

An effective approach in early intervention for children and families, including child maltreatment prevention, is home-based services. Although several evidence-based programs exist, they are often grouped or delivered together, despite having different foci and approaches. This article describes the development and pilot phases of a trial evaluating the systematic braiding of 2 evidence-based home-based models, SafeCare and Parents as Teachers. We describe the methodology for braiding model implementation and curriculum, specifically focusing on how structured qualitative feedback from pilot families and providers was used to create the braided curriculum and implementation. Systematic braiding of 2 models at the implementation and curriculum levels is a mechanism that has the potential to meet the more comprehensive needs of families at risk for maltreatment.

A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions.

ABSTRACT Effective parent training programs may need to be tailored for at-risk parents by using simple language, presenting concrete concepts, and simple technologies. We present four single-case research-design studies examining if the use of digital frames enhances parent-infant interactions with a diverse range of mothers with varied levels of risk for maltreatment. Based on self-modeling, the frames contain photographs of mother-infant dyads in posed interactions representing desired criterion behaviors from the parent-infant interaction (PII) module of SafeCare®. Results indicate that the use of inexpensive digital frames appears to enhance already good outcomes of the SafeCare PII module.

A brief primary care intervention for parents of preschool-aged children with disruptive behavior was assessed using a multiple probe design. Primary Care Triple P, a four session behavioral intervention was sequentially introduced within a multiple probe format to each of 9 families to a total of 10 children aged between 3 and 7 years (males = 4, females = 6). Independent observations of parent-child interaction in the home revealed that the intervention was associated with lower levels of child disruptive behavior both in a target training setting and in various generalization settings. Parent report data also confirmed there were significant reductions in intensity and frequency of disruptive behavior, an increase in task specific parental self-efficacy, improved scores on the Parent Experience Survey, and high levels of consumer satisfaction. All short-term intervention effects were maintained at four-month follow-up. Implications for the delivery of brief interventions to prevent conduct problems are discussed.