Date of Award

9-6-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Child Development

First Advisor

Jon Korfmacher

Second Advisor

Linda Gilkerson

Abstract

Objective: Child-Parent Psychotherapy (CPP) is a therapeutic model that works within the caregiver relationship with children 0 – 6 years old who have experienced trauma or maltreatment. This study utilized a mixed methods design to evaluate how CPP was implemented within a child welfare waiver project in one Midwestern city. This study also looks at various factors impacts on CPP service delivery outcomes and examines how CPP impacts child welfare outcomes within the context of a larger evaluation. Methods: A sequential mixed methods design was completed with descriptive, and correlation statistical analysis completed. In addition, person-time fixed level analysis was completed within the waiver project’s intervention group to measure the impact of CPP on child welfare outcomes. Interviews were conducted (N=14) with CPP trainers, clinicians, and program staff to understand their experience with CPP in child welfare, and their impressions of preliminary results from the quantitative analysis to further contextualize the data. Further document analysis was completed to provide additional programmatic implementation details. Results: Results demonstrate an extensive time for children to start and participate in services. CPP in child welfare has increased case complexities that contribute to the implementation of services. Significant impacts were found, particularly when analyzing caregiver type (biological vs foster) who participated in the dyadic work of this intervention. Both through unadjusted analysis and when controlling for other factors through person-time-level fixed-effects analysis, results show CPP is positively associated with case closure, and increase reunification or adoption depending on caregiver participant type in CPP services. Conclusion: This study begins to demonstrate how CPP is implemented within a child welfare system. System barriers contribute largely to delayed referrals and delayed starts to services. Despite absence of existing literature on using CPP with foster caregivers, child welfare clinicians are working with foster caregivers at a high prevalence. Given such wide variation in service levels and differences in treatment participants than what has been previously published for CPP populations, further exploration of its implementation in CW is warranted. CPP has increased case complexities compared to the literature when delivered in CW. A key finding of this study is how CPP participant are chosen and considered for participation in CPP sessions within the context of child welfare and a child being removed from the home. Participant type, sibling participation, provider changes, and race all have an impact on CPP service outcomes. Participation in CPP relates to child welfare outcomes, both through within group analysis, comparing different participant types, and comparing the CPP treatment group to the non-treatment group within the child welfare project sample, and when controlling for other factors via person-time fixed level analysis CPP is showing to positively impact child welfare case closure.

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