Identifying enablers and barriers to the implementation of Functional family Therapy-Child Welfare (FFT-CW?) into the routine delivery of child protection services in New South Wales, Australia

Background: Functional Family Therapy - Child Welfare (FFT-CW (R)) aims to reduce the risk of child maltreatment and out-of-home care entry for vulnerable children.Objective: To identify enablers and barriers to implementing FFT-CW (R) into the routine delivery of child protection services from policy and service provider perspectives.Participants/setting: Eighteen program and policy experts, and 54 service providers, involved in the delivery of FFT-CW (R) across 6 districts in New South Wales, Australia. Methods: Semi-structured interviews with policy and program experts, and four discussion groups with service providers using nominal group technique (NGT). Interview data were thematically analyzed to identify enablers and barriers. An adapted Consolidated Framework for Implementation Research (CFIR) scoring system was used to quantify themes, with scores of -2 assigned for barriers, 0 for neutral, and 2 for enablers. NGT was used to generate and rank enablers and barriers of program implementation with service providers.Results: The semi-structured interviews generated 16 themes, from which three enablers and four barriers were identified using CFIR scoring. The NGT discussions generated nine enablers and eight barriers. Key enablers common to both interviews and NGTs were FFT-CW's therapeutic and empowering approach, model purveyor training and support, and the supervision and feedback provided to service providers. Key barriers included referral difficulties, staff burnout, turnover and training logistical challenges, and problems with data collection and the safety impacts of outcome measures on participants.Conclusions: Sustained uptake of FFT-CW (R) is likely feasible and evaluating its effectiveness within the routine delivery of NSW child protection services is warranted.