A collaborative practice pilot between child welfare and child health care providers: Lessons in implementation and evaluation of cross-sector interventions

Background: Improved collaboration between child welfare and health care offers the possibility of improved child well-being after child welfare involvement. Objective: To pilot a collaborative practice model between CPS caseworkers and pediatric primary care providers (PCPs). Participants and setting: Infants remaining at home following child welfare involvement in 2 regions of a Western state were randomly assigned to collaborative vs. standard practice between 11/2017 and 03/2019. Methods: CPS caseworkers were trained and randomized into standard vs collaborative practice model developed to promote information sharing between caseworkers and PCPs. A mixedmethods evaluation integrated administrative and qualitative data from child welfare, caregivers, caseworkers and PCPs. Outcomes evaluated included practice implementation; caregiver, caseworker, and PCP satisfaction with collaborative practice; and preliminary descriptions of practice impact. Results: There were 423 eligible cases randomized to either collaborative or standard practice. Uptake of all elements of the collaborative practice by caseworkers was limited. There were no significant differences in parental satisfaction with caseworkers, parental communication with PCPs regarding social risks or CPS involvement or repeat CPS investigations within 6 months of case closure identified between practice arms. Qualitative themes regarding facilitators of and barriers to implementation were explored from both PCP and CPS caseworker perspectives. Conclusions: Limited uptake challenges our ability to identify potential benefits of a collaborative practice for infant health or welfare outcomes. CPS caseworkers and pediatric PCPs report barriers to implementation as well as potential benefits for children and families with a more successful collaborative practice model.