Evidence-Based Programs in “Real World” Settings: Finding the Best Fit

Abstract

Evidence-based programs and practices (EBPPs) pertinent to the prevention and treatment of child abuse and neglect remain underutilized in community settings. The purpose of implementation science is to generate a robust body of knowledge regarding the factors that influence professional and organizational behavior, and the types of strategies that can be used to effectively implement and sustain those EBPPs in community settings. In this chapter, we review the extant research and offer innovative examples that demonstrate how implementation science and practice can contribute to the promotion of child well-being. We begin by discussing emerging research that can inform the early and later stages of implementation. We then discuss a number of contextual factors that can influence implementation processes. Finally, we present eight areas that will be critical to advancing the science and practice of implementation, and ultimately, the well-being of children and families.

This work was supported in part by the Doris Duke Charitable Foundation Fellowship for the Promotion of Child Well-Being, which was awarded to all authors; the Fahs-Beck Fund for Research and Experimentation to BJP and EAB; a National Science Foundation Dissertation Research Improvement Grant to EAB; and a Ruth L. Kirschstein National Research Service Award from the National Institute of Mental Health to BJP (F31MH098378).

Reflection: Reflections on Implementation Science and Child Welfare

• Lawrence A. Palinkas 

1. University of Southern California, Los Angeles, CA, USA

   Lawrence A. Palinkas

In the past 10 years, there have been three specific developments that have significantly enhanced our ability to address the paucity of evidence-based practice (EBP) in general and evidence-based practices (EBPs), interventions, and treatments in child welfare. The first development has been the transition from conducting largely observational studies of the barriers and facilitators to developing, testing, and implementing evidence-based strategies to implementing and sustaining effective and accepted evidence-based program models. When I first began in the field of implementation science, our primary goal was to understand why only 10 % of youth-serving agencies, including child welfare systems, were using evidence-based service models. Since then, we have learned much about the barriers to successful and sustainable implementation and incorporated what we have learned into developing effective implementation interventions. Some of these interventions, like the Institute for Healthcare Improvement’s learning collaboratives model and Glasgow’s RE-AIM model, were developed in the broader context of health services. Others, like the Availability, Responsiveness, Continuity (ARC) intervention developed by Charles Glisson or the Dynamic Adaptation Process (DAP) and Interagency Collaborative Teams (ICT) interventions developed by Greg Aarons, were specifically tailored to child welfare and child mental health settings.

The second development has been a greater appreciation within child welfare of the value and potential of evidence-based practice. Ten years ago, many child welfare leaders and case managers were reluctant to adopt specific models out of concerns that the models deprived them of control over services delivery, were too expensive to implement, and were not validated with populations that mirrored their own clients. These attitudes have changed, in part, due to the increasing evidence of the successful outcomes these programs can achieve, the realization that child welfare workers liked them because they offered structure and a scientific rationale to what they had been doing previously, and because many child welfare workers are graduating from educational programs that have given greater emphasis to the teaching evidence-based practice and practices as the preferred approach to service delivery. My own research has demonstrated an increased use of web-based clearinghouses like the California Evidence-Based Clearinghouse for Child Welfare and the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices to identify and select service models that address the specific needs of child welfare-involved youth and families. Child welfare systems leaders also make extensive use of personal and professional networks to acquire information and resources to support the implementation of evidence-based models most relevant to the needs of their communities and client populations.

The third development has been the improvement in the methods used to both implement evidence-based programs and to understand and facilitate the implementation process. In the past 10 years, there has been greater use of qualitative and quantitative methods together in mixed methods designs. These designs have enabled investigators to answer the same question using different methods (through convergence) or answer related questions simultaneously or sequentially (though complementarity, expansion, development, and sampling). There has been greater use of hybrid designs where studies of practice effectiveness and implementation are conducted simultaneously or sequentially. Such designs are cost effective and help document the inherent linkage between effectiveness and implementation. In addition, researchers are making greater use of alternatives to traditional randomized controlled trial, including randomized encouragement trials, randomized fractional factorial designs, and sequential multiple assignment randomized trials. These designs promise strong external validity at reduced expense. Child welfare workers also are more likely to participate in research that does not require them to provide their clients with less than optimal care or delay access to optimal care.

As to whether these three developments alter the way institutions and organizations select and integrate specific interventions into their overall operation or represent a major new advancement in child welfare, only time will tell. However, it is clear to me that they are actively being used to support a drive for greater accountability and greater innovation in child welfare. These developments have also led to greater collaboration between researchers and child welfare practitioners. Such partnerships are leading to the creation and application of knowledge that is directly relevant to the needs of child welfare systems and the communities they serve.