Pilot Test of an Innovative Implementation Strategy to Improve Reach, Quality, and Access in Child Maltreatment Prevention

Medical University Of South Carolina, Charleston SC

Investigators

Abstract

Research Project 4: Hannah C. Espeleta, PhD – Abstract Child maltreatment (CM) is a public health priority, affecting millions of children each year. Evidence-based home visiting (HV) models are gold standard CM prevention programs that intervene on modifiable risk factors. Despite their effectiveness and national implementation, HV is resource intensive which limits their potential reach and impact. HV programs serve only 3% of high-risk families, with limited access for medically overlooked populations and rural-dwelling families. Rigorous research is needed to guide approaches to implementing HV to ensure agencies can deliver the highest-quality care with more accessibility without compromising child safety. Preliminary data during the COVID-19 pandemic offered insight to the benefits of virtual, telehealth-based visits for CM prevention and enabled service agencies to observe that quality and safety concerns can be managed in most cases. The consensus of experts and HV providers is that hybrid, telehealth leveraged HV implementation can enhance access, quality, and efficiency of CM prevention models. Moreover, technology-based supports are needed to engage families, drive skill acquisition, support model fidelity, and improve accuracy in safety and skill assessment. Through an institutional KL2 award (PI: Espeleta), leveraging community advisory boards, secondary data analysis of clinical services data, and user-centered design methods, she is developing a telehealth-compatible, technology-enhanced, hybrid in-person/virtual implementation package for CM prevention. This package will consist of protocol adaptations, evidence-informed guidelines, and digital health resources to improve implementation outcomes related to reach and quality. However, the KL2 does not include a pilot RCT, which is essential to establish the feasibility of the implementation package as well as the RCT methodology in preparation for a future R01. The project’s goals are to 1) Refine and preliminarily evaluate the TEIP and the feasibility of the research methodology with 12 providers and 40 families; and 2) Assess implementation factors related to the TEIP including its usability, acceptability, and feasibility with key constituents. Findings will inform a future R01 submission to evaluate the hybrid HV/virtual implementation on dimensions of reach, effectiveness, implementation, and maintenance. The Building Resilience through innovative Interventions to promote Growth & Health after Trauma (BRIGHT) COBRE will provide an ideal research environment, invaluable Cores and resources, and professional development opportunities that will undoubtedly launch a promising, NIH-funded career focused on building family strengths and preventing CM. Her mentorship team has experience in developing and integrating digital health tools in the context of broader healthcare initiatives for medically overlooked populations and are well suited for this project. Mentorship and consultation from experts in health technology solutions, implementation science, CM prevention, health disparities, and advanced statistics will prepare Dr. Espeleta well for a highly competitive R01 application.