Caregivers' readiness for change: predictive validity in a child welfare sample

OBJECTIVE: To assess the predictive validity of continuous measures of problem recognition (PR), intentions to change (ITC), and overall readiness for change (RFC) among primary caregivers who received in-home services following substantiated reports of child abuse or neglect. METHOD: A modified version of the University of Rhode Island Change Assessment scale was included in interviews with a sample of 353 primary caregivers at 4 weeks, 16 weeks, and 1 year after referral for in-home services. Additional data were obtained from administrative records and caseworker surveys. Hierarchical linear and nonlinear models were used to assess relationships between PR, ITC, RFC and changes over time in measures of individual and family functioning (e.g., parenting behaviors, children's behaviors, housing and economic problems, social support, and life events). Bivariate probit regression analysis was used to examine relationships between PR, ITC, RFC and the likelihood of subsequent reports of child maltreatment and out-of-home placements within 1 year after referral. RESULTS: Initial problem recognition and intentions to change predict a few improvements in individual and family functioning, along with significant reductions in the likelihood of additional reports of child maltreatment within 1 year. Initial intentions to change also predict reductions in the substantiation of subsequent reports of maltreatment. An overall measure of readiness for change predicts reductions in the likelihood of out-of-home placement. CONCLUSIONS: Problem recognition and intentions to change predict somewhat different outcomes; hence, there are few advantages of a combined measure of readiness for change. Further inquiry is needed to determine whether and how these associations are mediated by intervention processes or other factors in child welfare services populations.