Implementing An Evidence-Based Intervention to Reduce Long-Term Foster Care: Practitioner Perceptions of Key Challenges and Supports

Purpose: This study describes key challenges and supports of implementing an evidence-based intervention (EBI) to reduce long-term foster care. Although a growing literature defines core components of systematic implementation (e.g., Aarons, Hurlburt, & Horwitz, 2011; Fixsen, Blase, Naoom, & Wallace, 2009; Kitson, Harvey, McCormack, 1998), little information exists about real-world successes and setbacks from child welfare practitioners’ perspectives. Prior studies identified various factors that influence implementation, including individual differences such as gender and education level; organizational influences like culture and climate, leadership, supervision, and peer support; resources issues; and, fit between the EBI and target population (e.g., Aarons 2005; Aodeo et. al, 2011; Gooiea & Dziadosz, 2008; Gray et. al, 2012; Lundgren et. al, 2011; Patterson et. al, 2012). Using an implementation framework from the National Implementation Research Network (NIRN) (Fixsen et. al, 2009), this study builds actionable knowledge about systematic implementation in a child welfare system as informed by experiences of practitioners.

Method: Semi-structured, individual interviews were conducted with 28 child welfare practitioners implementing an EBI, Parent Management Training Oregon Model (PMTO). The sample represented all but 2 of 30 practitioners involved with a new federally-funded project to reduce long-term foster care. Among those interviewed were 3 practitioners that had resigned from their positions within 12 months and 25 practitioners employed for 12-15 months. Interview questions were informed by the existing literature and the NIRN framework. Transcripts were coded and analyzed using theoretical thematic analysis (Braun & Clarke, 2006). Member checking was used to confirm identified themes across interviews.

Results: Thematic analysis showed descriptive information about factors that influence child welfare practitioners’ experience of implementing an EBI. Key facilitators were: a) individual characteristics of shared values with EBI, use of EBI for enhancing self, flexibility, and willingness to learn; b) organizational and leadership factors of strong leadership, good fit between values of the EBI and organization, and plentiful information-sharing; c) competency drivers including strengths-oriented supervision and coaching, supportive teams, and timely feedback; c) resource factors of adequate time for learning and infrastructure/working conditions; and, d) fit issues of relevance of EBI to population’s needs, and client responsiveness. Implementation barriers included: a) organizational and leadership factors related to lacking knowledge of the model, incongruent values between the organization and the EBI, unresponsive managers; b) competency drivers including training sequence and pace, opportunity for applied learning, inadequate written materials, weak/inexperienced supervisors, infrequent coaching, and inferior coaching due to vague feedback; c) resource issue of poor working conditions; and, d) fit issues related to client contextual factors and poor engagement.

Conclusion: This paper contributes to the current knowledge by describing experiences of practitioners implementing an EBI in child welfare. It offers a realistic picture of the factors that challenge and facilitate effective implementation from a practitioner viewpoint. Findings demonstrate the complexity of implementation and the necessity of resources – both tangible and intangible – that must be leveraged for successfully operationalizing an EBI. Policy and practice implications for overcoming barriers and promoting effective implementation strategies in child welfare are discussed.