Child & Family Well-Being

We fund implementation support for public and private child- and family-serving agencies to adopt and sustain evidence-based and evidence-informed programs shown to prevent or treat child maltreatment.

Challenge

Several programs in the United States regularly gather and share evidence of their positive impact and outcomes for children. Historically, replication of these evidence-based programs in communities has failed to reproduce the outcomes or local capacity to sustain the programs. We believe that failure often can be traced to inadequate implementation support and inattention to continuous improvement.

Approach

Child and Family Well-Being has adopted the implementation framework developed by the National Implementation Research Network (NIRN) to sustain and scale evidence-based programs for preventing and treating child abuse and neglect. Implementation support consists of activities designed to help put defined programs into practice.

An implementation framework answers the questions of what needs to be done, how to establish what needs to be done in practice, who will do the work to accomplish positive outcomes and where will effective interventions and implementation thrive. The adoption of the NIRN framework counters passive approaches for sharing knowledge or depending on basic training programs.

Implementation support builds local ownership that is not reliant on external partners. 

Child and Family Well-Being considers applications from a variety of public and private agencies willing to use an implementation framework to adopt and sustain evidence-based programs. Individual nonprofits, provider associations, county and state public agencies are typical applicants. 

In 2016, Child and Family Well-Being began funding efforts to create statewide intermediary agencies. Intermediaries are centers or partnerships that support state, regional or local agencies’ efforts to design, adopt, scale and sustain evidence-based programs. Typically, intermediary functions include: 

  1. Partnership engagement and communications to ensure that the right partners are at the table;
  2. Proactive and responsive implementation supports to ensure that systems are in place, such as an outcomes monitoring method;
  3. Research, evaluation and data linking to ensure continuous improvement;
  4. Workforce development that ensures practitioners competently and confidently deliver the program; and
  5. Policy and finance that focuses on legislative and administrative environments to ensure those environments support and sustain the adoption of evidence-based programs.

Currently, Child and Family Well-Being is working with Prevent Child Abuse NC, Children’s Trust of SC and the Impact Center at the Frank Porter Graham Institute, part of the University of North Carolina at Chapel Hill, to build their capacity, either individually or in partnership, to serve as intermediaries.

Evidence-Based Programs

Our implementation support work centers on getting optimal impact from evidence-based programs. The Duke Endowment believes that evidence-based interventions are the most effective for successfully improving the lives of children and their families. However, relying on the evidence base of programs as the key determinant of success is insufficient unless all children, families and communities can benefit from the evidence-based program. Only then will population-level well-being outcomes be achieved. 

The Endowment has endorsed several evidence-based programs and offered funding primarily for implementation support to help encourage their use in North Carolina and South Carolina. The programs are as follows:

  1. The Incredible Years is designed to work with parents, children and teachers to prevent, reduce and treat aggression and related conduct problems in children. The Duke Endowment is partnering with the North Carolina Division of Social Services and the North Carolina Partnership for Children to deliver this program and implementation support to sites in North Carolina.
  2. Parent-Child Interaction Therapy is a specific, step-by-step, one-on-one coached behavioral training model for parents of children ages 2 – 7.
  3. Strengthening Families Program teaches parenting skills and life skills to high-risk families with children ages 3 – 17. The Endowment is partnering with the North Carolina Division of Social Services to deliver the program and implementation support for children ages 6 – 11 at sites in North Carolina. The Endowment is partnering with the South Carolina Department of Social Services to deliver the program and implementation support to 30 counties in South Carolina.
  4. Multi-Systemic Therapy is an intensive, home-based intervention for families with 10- to 17-year-olds with social, emotional and behavioral problems. Developed by the Medical University of South Carolina, it is being implemented in North Carolina by several agencies, most notably Youth Villages, a nationally-recognized leader in serving troubled youth and families.
  5. Trauma-Focused Cognitive-Behavioral Therapy is designed for children, adolescents and parents to reduce negative emotional and behavioral responses caused by or related to abuse. This program is being implemented across South Carolina through the Medical University of South Carolina and The Dee Norton Lowcountry Children’s Center. In North Carolina, it is being implemented in the state through a partnership with the University of North Carolina at Chapel Hill and the Center for Child and Family Health in Durham.
  6. Positive Parenting Program (Triple P) is a parenting and family support system that helps prevent child maltreatment, foster care entries and emergency room visits due to child maltreatment. The Endowment, the North Carolina Division of Social Services and the North Carolina Division of Public Health are funding the implementation support through ten lead agencies across North Carolina.

Lessons Learned

Insights

The allure of evidence-based practices is compelling but implementing them successfully in new locations requires the right infrastructure to assure appropriate service delivery and results. New sites must have the financial means and human resources to provide ongoing quality assurance, training, monitoring and data collection to remain true to the fundamental tenets of an evidence-based program.

The Duke Endowment determined that its support would be best used to create or strengthen infrastructure for implementing a program, rather than simply supporting service delivery. This approach allowed the Endowment to complement the existing efforts of public funders and expand their effectiveness.

Impact

Former U.S. Surgeon General David Satcher said that it takes roughly 17 years for a proven intervention strategy to take root in mainstream practice. With this initiative, the Endowment is accelerating the adoption rate of some evidence-based interventions in North Carolina and South Carolina.

For the past 11 years, the Endowment has provided more than $11 million for implementation support for the evidence-based programs noted above; it was matched by more than $25 million in federal and state funds.

More than 10,000 children and families have benefited from the supported programs. External evaluations of the evidence-based programs, executed with proper implementation support, find positive outcomes. For example, external evaluators of the Incredible Years and Strengthening Families Program tracked 21 outcomes. Each year since 2010, every outcome was statistically significant, and in the case of the Strengthening Families Program, the outcomes exceeded those of a national comparison group. The Duke Endowment’s investment in implementation averages $2,500 per family, as compared to traditional foster care costs of $35,000 per child, per year.

Strategies

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Support Implementation for Tested Programs

We fund implementation support for projects that adopt and sustain evidence-based or ‑informed models shown to prevent or treat child abuse and neglect and enhance well-being. Implementation” refers to activities that are designed to put defined programs into practice. An active implementation framework answers the questions of what needs to be done (effective interventions), how to establish what needs to be done in practice, who will do the work to accomplish positive outcomes and where will effective interventions and implementation thrive. Rather than letting change happen, we work with organizations and agencies to make change happen for children and families of all races and ethnicities. 

Strategy icons CFWB 02

Commit to Innovation

We recognize the lack of evidence-based or ‑informed models for the range of issues children and families face and the diverse populations served. If we did not commit to innovation, we would miss opportunities to identify programs that improve outcomes. We support grantees in developing and testing innovative, tailored, data-driven approaches. We encourage models that specifically look at risks and solutions through the lens of race.

Strategy icons CFWB 03

Advocate for Improvement

Many dedicated, knowledgeable professionals work in the child welfare system, but systemic challenges can inhibit their effectiveness. We use our resources and relationships to support advocacy and communications strategies that speed improvement of the prevention, early intervention and foster care systems. We believe that by working closely with government agencies and nonprofit organizations that reflect the communities served, we can enhance the spread of information and facilitate conversations within communities.

Project Details

Project Details

Commit to Innovation

The Duke Endowment is committed to developing and testing innovative approaches to address the needs of children who have been — or who are at risk of becoming — victims of child maltreatment.

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Project Details

Advocate for Improvement

The Duke Endowment works with public agencies and private organizations to ensure all children in the Carolinas grow up in families safe from maltreatment and supported by nurturing parents and caring adults, enabling them to live successful lives. Using lessons learned from our grantmaking, we support advocacy and communications strategies to accelerate improvements in the child welfare system.

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Project Details

Evidence-Based Interventions for Children

The Duke Endowment has committed $16 million since 2008 to help expand the use of proven, evidence-based interventions in North Carolina and South Carolina. This initiative is ongoing, but unsolicited requests for grants are not accepted.

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Apply for a Grant

Select 501(c)(3) organizations in North Carolina and South Carolina may be eligible to receive funding.

Child & Family Well-Being Grants

For a full list of our 2020 grants, see the 2020 Annual Report Grantmaking Addendum. Many of these grants represent multi-year commitments.

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