SafeCare in IsraelImplementation Processes and Dilemmas

Paula David, MSWDirector, Dept. of Learning Programs

Haruv Institute, Jerusalem, Israel

The Haruv Institute, Jerusalem

O established in 2007 by the Lynn and Charles Family Foundation

O Mission: training and research in the area of child maltreatment

O Provides training to all professionals working with abused or neglected children

O Tailor-made programsO Importation of evidence-based programs

and interventions from overseas

Evidence-based practice (EBP) in Israel

O The field of child welfare is still heavily influenced by psychodynamic theory

O EBP, while used in mental health and taught in various institutes (CBT, TB-CBT, EMDR, PE, etc.), is not widely recognized in this field, especially in services for early childhood

O The Haruv Institute is interested in importing programs that can potentially prevent child maltreatment, and especially neglect, which has less focus in Israel

O SafeCare was considered a viable intervention because it is relatively brief and can be taught in a short period of time..

Picking a City - AshdodO Israel’s fifth largest cityO 62,000 households, 74,760 childrenO 10,300 children ages 0-18 known to

social servicesO A multicultural city

Ultra-Or-thodox,

25%

New Immi-grants, 33%

Born in Is-rael, 42%

The implementation model

O Haruv Institute supports and finances the training of three potential leaders of SafeCare

O Haruv provides translation of all materialsO Ashdod Municipality provides time for the

leaders to be trained as home visitors, coaches, and trainers, and to work with clients

O Ashdod Municipality will hire home visitors to work with clients, whom the Israel trainers will train.

Key Stakeholders – Ashdod Municipality

Director, Dept. of Social Services

Deputy director

Director, Agency 1

Director, Agency 2

Social worker 1 (child

protection officer)

Social worker 2

(director of intake)

Social worker 3 (family

social worker)

Director, Agency 3

Key Stakeholder – Haruv Institute

O One senior professional from the Institute to coordinate and accompany the process

O My main task: to remind the Ashdod group of their motivation and commitment to SafeCare

1. Emails, phone calls and site visits to providers and senior administrators to check progress of implementation

2. Reminding senior administrators about the providers’ needs, and what was promised to them (a day a week for SafeCare)

3. Working with providers to edit and adapt translations of materials

Ashdod provider’s training program

O Home visitor training in Atlanta, GA.O Two families each in Ashdod,

coaching by their Atlanta coachO An implementation adaptation:

accelerated coaching training so they could coach one another in Hebrew (not previously a problem in SafeCare implementation, even in Spain)

O Another five families to practice HV skills before learning to become trainers

Translations – language, pictures, culture

dĂŬŝŶŐĂďĂďLJ͛ƐƌĞĐƚĂůƚĞŵƉĞƌĂƚƵƌĞ

Taking Your Child’s Temperature

The sections below will help you take your baby’s temperature in his bottom. This is the best way to see if your baby has a fever. Make sure to always use a digital thermometer. When do I take a rectal temperature?

Your child seems sick and you are not sure what is wrong or how serious the sickness is

Rectal temperature is best for newborn babies to 3 months.

Rectal temperature can be used for children up to 5 years

How do I take a rectal temperature?

Step 1. Step 2.

Rectal

Dip the tip of the thermometer in K-Y Jelly or Vaseline

Turn the thermometer on. Label this thermometer with the word RECTAL.

Step 3.

Lay your baby on your lap, with one hand on his back. Put the thermometer a half inch into the baby’s bottom. Wait for the beep.

Translations – cont.

ʯʦʥʠʡʭʥʧ ʺ ʣʩʣʮ

ʭʥʧʺʣʩʣʮ

ʭʫʣʬʩʭʥʧ ʺ ʣʩʣʮʡʭʫʬʲ ʩʩɦʩʤʦ̫ ʬʧʯʦʥʠʡ

ʭʥʧ ʣʥʣʮʬʩ̋ʮʯʦʥʠʡ?

ʡʶʮʤʤʮʫʣ̡ʥʤʡʩɦʤʩʤʮʭʩʧ ʥʨʡʠʬʭʺ ʠʥʤʬʥʧ ʤʠʸ ʰʭʫʣʬʩ́ ʫ.ʸ ʥʮʧ

ʭʥʧ ʣʥʣʮʬʪʩʠʯʦʥʠʡ?

.ʯʦʥʠʤʪʥ̋ʬʺ ʥhʩʣ̡ʡʥʬʹ ʤʁ ʷʤ̋ ʠʱ ʩhʫʤʬʥʭʥʧ ʣʮʤ̋ ʠʷʩʬʣʤʬʹ ʩ

!ʡʥ́ʧ ʭʥʧʯʦʥʠʡʬʹ38ʡʹ ʧʰʤʬʲ ʮʥɦʥʩʦʬʶʺʥʬʲ ʮ ʯʩ̫ʺ ʠʬʫ.

Buy-in at all levels

O Director of social services in Ashdod is committed to SafeCare implementation

O Agency directors less enthusiastic and hesitant to provide necessary level of support to providers

O Providers were formally promised one day a week to see families. In reality, their previous workload was not lessened

Inhibiting factors in implementation: “because life happens”

O Families dropped out Both parents went to prison a mother wasn’t working, then

started working, then stopped working

O War in Israel

Promoting factors in implementation

O Government funding in Israel for projects targeted for projects addressing child neglect

O SafeCare is easily learned and not dependent upon experienced clinicians

O Ashdod stands to gain in status as an early adopter, and champion of the intervention

Promoting factors in implementation (cont.) : potential cost effectiveness

O Cost of SafeCare: 408 GBP per family

O Cost of out-of-home placement for one child: between 1070-2035 GBP, per month

How do we keep the momentum?

O Keeping an eye on the goalsO Joint Ashdod Municipality-Haruv

conference in Ashdod, highlighting innovations in EBP to prevent child neglect, and SafeCare in particular

O Bringing key SafeCare developers to Ashdod (Prof. Lutzker, Prof. Chaffin)

O Bringing ambivalent stakeholders to Atlanta

The biggest implementation challenges

O Funding for home visitors

O allocating sufficient time for effective implementation (e.g., provider, coach, and trainer time needed to conduct their various roles efficiently and effectively)

What we have learnedO Implementation takes more time

than expectedO An organization’s original willingness

to adopt a new EBP does not preclude the existence of fundamental obstacles to its implementation

O It is difficult to imagine, in advance, all of the resources needed to implement a new EBP