We are thrilled to share an exciting research study by Antonio Medina, Mark Beyeback, and Felipe E. Garcia on the effectiveness and cost-effectiveness of a solution-focused intervention in child protection services. This article became available as open-source online on October 27th, 2022. I know Insoo Kim Berg and Steve de Shazer would be thrilled to hear of the positive results of this very important study. Thank you to Antonio Medina, Mark Beyeback, and Felipe E. Garcia for this very important contribution. Below is a summary of the findings of the article.
Medina, A., Beyebach, M., & García, F. E. (2022). Effectiveness and cost-effectiveness of a solution-focused intervention in child protection services: A randomized controlled trial. Children and Youth Services Review, 106703.
SIGNIFICANT EFFECTIVENESS AND COST-EFFECTIVENESS OF A SOLUTION-FOCUSED INTERVENTION IN CHILD PROTECTIVE SERVICES
This research aimed to evaluate the impact of solution-focused principles and intervention techniques in the local child protection service on the island of Tenerife, Spain.
Solution-focused Brief therapy is a collaborative and empowering approach that offers clients choice, voice, and speaking the client’s language. This approach builds on parents’ competencies and agency and emphasizes family capacities. The solution-focused approach can be combined with more traditional problem-focused models, including Solution-Focused Trauma-Informed care.
There has been limited empirical evidence on solution-focused training and its effectiveness in child protection. This study aimed to address this need.
The aim of this quasi-experimental design was to evaluate the impact of a solution-focused approach to child protection by comparing the performance of a group of workers who received training in SFBT with that of child protection workers who employed treatment as usual.
- What is the impact of solution-focused practice on goal achievement and subjective well-being as perceived by workers, parents, and children?
- What is the impact of solution-focused practice on child welfare outcomes such as referral for further intervention, child placement, or recidivism?
- What is the cost-efficiency of solution-focused practice compared to treatment-as-usual in terms of length of the intervention, number of sessions used, and number of additional resources deployed (home assistance, daycare, specialized mental health services, etc.)?
A quasi-experimental design was followed. Two equivalent blocks of child protection teams were created and randomized to the control or experimental group.
Child Protection Workers:
The experimental group received free solution-focused training and supervision. Workers in the control group were offered solution-focused training after completing the study. There were no significant differences between workers in the experimental and the control group in relation to age, professional degree, and gender. Participants had received no previous training in SFBT. The training included two months of training and six months of supervision in solution-focused brief therapy. This included initial training in SFBT, 30 hours distributed over two 15-hour workshops, taught two months apart to the experimental group. The workers also received another 30 hours of group supervision consisting of monthly -five-hour sessions with the experimental group over six months. The emphasis was on integrating the SF approach in their interventions while fulfilling statutory obligations such as assessing children’s risk and safety and monitoring intervention plans.
477 families serviced by the child protection teams during the duration of the study accepted to participate and consented according to the Helsinki declaration. All 477 families filled in the Time 1 pre-test measures. 329 families filled in the Time 2 Post-test measures when the cases were closed or at study termination. The attrition rate in the control group was 36% and 25% in the experimental groups, which was statistically equivalent. No statistical differences were found between the families that dropped out of the study and those that did not.
- The Solution-Focused Treatment Fidelity Questionnaire (SFTFQ) measured the use of solution-focused principles and techniques. The SFTFQ is an 18-item questionnaire that asks workers how frequently they perform a number of solution-focused practices in their work with users.
- Goal achievement as rated by workers was measured by asking workers to rate on a scale from 1-10 to what extent goals had been met during the intervention (1 not at all and 10 completely)
- Parents’ well-being was measured using the Outcome Rating Scale (ORS) using a visual analog scale to assess individual well-being (personal well-being), interpersonally well-being (family, close relationship), social well-being (work, school, friendships), and an overall general sense of well-being.
- Children’s well-being was measured with the Child Outcome Rating scale.
- Referral to risk teams was registered in child protection services case records and is an indicator of the deterioration of safety in a family.
- Child removal was registered in the case records.
- Recidivism was defined as the re-referral of the family to child protection after the case had been closed.
- The length of the intervention was operationalized as the difference in the month between the records beginning of the team intervention with any given case and the termination of the intervention.
- The number of sessions was recorded in the case reports.
- The number of additional resources activated was recorded in the case reports and included such things as daycare, specialized mental health services, family mediation, and in-home assistance.
- The use of SF practices became significantly higher in the experimental group, almost tripling the SFTFQ value of the control group, a very large effect size (η2p= 0.88).
- In the four-goal attainment variable, at post-test, parent well-being was higher in the experimental than in the control group with a large effect size (η2p=0.19)
- Children’s well-being also increased in the experimental group with a large effect size (η2p=0.23).
- Goal attainment was higher in the experimental group than in the control group, as rated by parents and workers.
- In the experimental group, there were significantly fewer child removals from home (1.10% in the experimental group and 4.83% in the control group) a large effect size (η2p = -0.60).
- Recidivism was also significantly lower in the experimental group (1.80% in the experimental group and 6.97% in the control group), a large effect size (η2p = 0.41).
- The number of sessions was almost 40% lower in the experimental group (on average, 14.48 sessions per case) than in the control group (22.12 sessions per case).
- The number of complementary resources that had to be allocated to cases was significantly lower in the experimental group than in the control group.
- The length of the intervention in months was three times shorter in the experimental group than in the control group.
- Child protection workers who received training and supervision changed their self-reported practices in a solution-focused direction.
- This study demonstrates the feasibility of disseminating solution-focused principles and techniques in a child protection system. The cases in the solution-focused group achieved superior outcomes, including higher goal achievement rates from both caseworkers and parents.
- Importantly, children removals had dropped to one-fourth of the initial figure in the experimental group and that child protection teams in the solution-focused group became more able to help families without having to remove children from their homes. This is the first time a positive effect on this variable is documented for an SFBT intervention.
- The superior outcomes of the experimental group were achieved with significantly fewer sessions than those of the control group providing initial support for the cost-efficiency of a solution-focused child protection practice.
- The experimental group allocated fewer additional social services resources to the families which may be related to the holistic, family-centered perspective of the solution-focused approach.
Implications for Policy and Practice:
This study adds to the evidence of the effectiveness of solution-focused child welfare practices in child protection settings. This study shows that solution-focused practices can be disseminated at a low cost and provide cost-efficient treatment, reducing the number of sessions and the number of complementary resources that had to be deployed. This is important for policymakers in promoting the training of child protection workers in solution-focused practices to provide better services to their users.