Looking at engagement and outcome from the perspectives of child protection workers and parents
Highlights
► This mixed-methods study explores worker–parent engagement in child protection work and its role in the change process. ► Engagement was measured and explored as an interactional process by examining worker–parent dyads in Ontario, Canada. ► Client and worker engagement appear to have a reciprocal influence on each other. ► Several contextual factors that impact client and worker engagement are identified. ► Engagement appears to be related to the outcome of both workers and parents believing intervention has increased child safety.
Introduction
Client engagement is considered to be a critical element of the helping process in child welfare (Altman, 2008). Still needed, however, is a clear conceptualization of change that shows how engagement is related to outcome. The purpose of this paper is to advance our thinking about worker–parent engagement and how we conceptualize its role in the change process.
The literature on engagement has primarily focused on 3 areas: defining what client engagement is and determining ways of measuring it; identifying factors related to its occurrence; and looking for associations between engagement and outcome.
Several definitions and measures of client engagement appear in the literature. Client engagement has been defined in several ways, including “involvement,” (Randolph, Fincham, & Radey, 2009), “collaboration,” (Altman, 2008), “compliance,” (Littell, 2001), and “participation” (Darlington, Healy, & Feeney, 2010). Many of the related measures of engagement include frequency and duration of client attendance, agreement with treatment plans, and completing tasks (Altman, 2008, Littell and Tajima, 2000, Okamoto, 2001). More comprehensive measures of engagement have addressed client “attitudes” as well as behavior. These include measures developed by Yatchmenoff (2005) who sampled parents of children receiving services from a child welfare agency; Alpert and Britner (2009) who collected data from parents whose children were in foster care; and Cunningham, Duffee, Huang, Steinke, and Naccarato (2009) who interviewed youth in residential treatment centers.
Various factors have been related to aspects of client engagement. Littell and Tajima (2000) refer to 3 types of predictors of client “participation” in family preservation services. These include case characteristics, referring to the type of problems that clients are facing; worker characteristics, such as education and attitudes towards clients; and program characteristics, such as workload and organizational climate. Darlington et al. (2010) found that parents' “participation” in child protection decision-making was contingent on client factors, for example, their being motivated to change behavior; and system factors, such as caseload size and workers having the time to build relationships with clients. Okamoto (2001) found that attendance at a parent training program was significantly associated with informal social support and with the time and location of the meetings. Kemp, Marcenko, Hoagwood, and Vesneski (2009) have identified family and organizational factors as impacting client “engagement” in child welfare services.
Randolph et al. (2009) describe factors related to parent “engagement” in prevention programs. These include susceptibility and severity of problems, that is, a parent's belief that a child is at risk of experiencing a problem behavior and if so, its severity; benefits and barriers, referring to perceived gains of taking action; and expectations and self-efficacy, namely, the expectation that taking action will be successful and that parents can effectively do what needs to be done in order to achieve success.
Altman's (2008) study of child welfare services moved beyond the assessment of worker–parent dimensions to include a more dynamic understanding of the relationship. Altman (2008) found that client “engagement” was related to collaborative goal setting, having a sense of hopefulness, acknowledging problems, being motivated to change, feeling that workers were respectful and culturally sensitive, and receiving clear communication.
Client engagement has also been linked to the balance of power between social workers and clients. The concept of “power” and how it is used by social workers can influence the way that engagement unfolds for both parties. Spratt and Callan (2004) refer to 2 styles of working: “covert surveillance/high engagement” where social workers address issues around risk but also focus on family concerns and provide support; and “overt surveillance/low engagement” where social workers concentrate on protection issues with little attention paid to developing relationships with families. Corby, Millar, and Young (1996) found that the power imbalance between workers and clients causes what appears to be participation, to actually be clients ascertaining what workers expect of them and complying with these wishes. Dumbrill (2006) points out that clients who perceive social workers to be using “power over,” rather than “power with”, them are more likely to feign cooperation by “playing the game.”
Finally, some studies have examined engagement as part of a helping relationship and its association with treatment outcomes. Two separate meta-analyses found a “modest” but “consistent” (Shirk & Karver, 2003) or “reliable” (Horvath & Symonds, 1991) association between the development of a helping relationship and positive treatment outcomes across a broad range of therapeutic approaches. Similar findings have been reported by Marziali and Alexander, 1991, Horvath and Luborsky, 1993.
Lee and Ayon (2004) sampled former child welfare clients and found a “mild” but significant relationship between the worker–client relationship and the client's ability to provide appropriate discipline and emotional care to their children. In Littell's (2001) study, greater collaboration between workers and clients in treatment planning was associated with greater compliance, which in turn was negatively associated with out-of-home placements. Littell (2001) has also pointed out that client participation and outcome can influence each other. A similar point has been made by Reisinger, Bush, Colom, Agar, and Battjes (2003) who state that change is a dynamic process that can take place in a cyclical manner.
In summary, much of the work on engagement has focused on individualized factors contributing to its development, despite a longstanding understanding about the importance of its interacting perspectives. Over a decade ago, Dore and Alexander (1996) pointed to the lack of information about “the helping alliance” and its relationship to outcome. While some progress has been made in this area, much is still unknown about the interactional aspects of engagement and how it is related to change, particularly in the field of child welfare where the implications for child well-being are so pronounced. It is clear, therefore, that engagement needs to be better understood. We set out to build this understanding through a study that examined engagement from the perspectives of both child protection workers and adult clients. Our goal was to extend our knowledge of the contextual factors contributing to both parent and worker engagement, as well as to learn more about the ways that engagement is related to outcome as perceived by both parties.
Our study is placed in the context of “child welfare transformation” which reflects the Ontario government's plan to administer a differential response model in its assessment of risk. Involvement with service users is based on the Eligibility Spectrum in Ontario. This represents a practice guide that takes sections of the Child and Family Services Act and elaborates the various forms of child maltreatment and risk of maltreatment providing a focus for service. In the transformation model, children at a high level of risk receive a full protection investigation while those at a lower level of risk receive a more flexible response. The intent is for child protection workers to develop a collaborative relationship with families in order to bring about positive outcomes for children at risk.
Agencies across the province of Ontario close between 40 and 80% of the referrals received following an initial assessment, and if required, investigation at intake (Trocme et al., 2010). The remaining cases are transferred to ongoing services. Length of service can vary from months to years.
We address the following questions in this paper:
- 1.
Under what conditions do parents involved with child welfare agencies and child protection workers engage with each other?
- 2.
How is parent and worker engagement related to outcome in the child welfare context?
Section snippets
Design and sample
Quantitative and qualitative data were gathered through personal interviews with child protection workers and clients receiving ongoing service from 11 Children's Aid Society (CAS) agencies in Ontario, Canada (CAS's are the agencies responsible for providing child protection services in Ontario).
Our sample consisted of 131 worker–parent dyads. Data were gathered from an additional 28 parents and 19 workers (in these 47 cases one party declined to participate after the other party had already
Results
We begin with our findings regarding parent and worker engagement scores and the relationship between them. The mean score for parent's perception of their own engagement was 65.602 (95% CI 62.845–68.359). Worker perception of parents' engagement was 70.73. This relationship between workers' perception of parent engagement and parents' perception of their own engagement is significant (r = .619, p < .001).
The mean score for workers' perception of their own engagement was 57.85 (95% CI 56.50–59.20).
Discussion
Our findings began with an examination of parent and worker engagement scores. Parents and workers were relatively well engaged with each other. The mean engagement score for parents was 65.6. Yatchmenoff (personal communication June 2, 2010) states that on this scale scores of 66 or higher indicate moderate to strong engagement. The relatively high engagement scores could be an artifact of sampling. Cases, however, were selected through a process that involved randomization and the range of
Conclusions and limitations
Our study has limitations which point to additional lines of inquiry. Our design was cross-sectional. Examining engagement longitudinally from the point of intake until case closure would provide more information as to whether engagement changes over time. Becoming engaged and remaining engaged are not necessarily the same conceptually or in practice (Horvath and Luborsky, 1993, Randolph et al., 2009). Measures of child well-being are needed to determine more specifically how parent engagement
Acknowledgment
Partially funded by the Ontario Ministry of Children & Youth Services.
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