Front Line Perspectives on Implementation of Evidence-Based Interventions in Child Welfare Settings

Purpose:  Policy makers, administrators, and practitioners experience frustration and disappointment when a significant investment into an evidence-based intervention (EBI) does not improve outcomes.  Responding to this, social scientists have broadened the scope of inquiry to better understand the barriers to replicability (e.g., Proctor, Powell & McMillen, 2013).  Despite a growing implementation science literature, researchers have paid limited attention to the compatibility between extant implementation frameworks and EBI implementation in the child welfare system.  Literature documenting EBI implementation in this context is sorely needed.  The purpose of the present study was to help fill this gap and explicate the implementation process of two EBIs across two separate state public child welfare systems.

Method:  This study implemented a Modified Analytic Induction (MAI) (Bogdan & Biklen 1998) methodology to conduct a comparative analysis. MAI is an emergent methodological design that allows for examination of preconceived hypotheses identifying patterns of behavior, such as EBI implementation in a practice setting.  Consistent with MAI, we began the study with the preliminary hypothesis that a number of implementation factors present supports and challenges that contribute to the successful EBI implementation. 

Study participants were varied agency staff implementing the Strengthening Families Program and Celebrating Families! programs with child welfare-involved families in two Midwestern states.  Participants included 3 administrators, 5 frontline service providers, and 2 administrative support staff who served as coordinators for the EBIs.  A semi-structured interview guide was developed based on the implementation literature and was used to conduct all interviews.  The guide included open-ended questions about: 1) practitioner background; 2) EBI training; 3) EBI coaching; 4) EBI practice with families; 5) families response to the EBI; and, 6) administrative and organizational supports.    

Results: Participants described aspects of the six hypothesized factors—process, provider, innovation, client, organizational, and structural, lending support to these key concepts in implementation.  Process factors deemed important to implementation success included staff selection, training, and coaching.  Providers appreciated EBIs as a guiding framework and believed use of EBIs enhanced credibility to families.  However, EBI training received mixed reviews. Practitioners felt that adaptations were needed during EBI implementation that required prior knowledge and flexibility.  Participants noted multiple client factors that influenced EBI implementation including caregiver substance abuse and foster care involvement.  Key organizational factors included leadership, organizational culture/climate, and implementation team.  Structural factors were viewed as having a mixed influence on implementation.

Implications: These findings contribute to the implementation literature by confirming that diverse but connected factors at multiple levels affect the success of EBI implementation.  While selecting and adopting an EBI is important, it is only the first step in a systematic process of using an EBI to affect change in child welfare settings. Administrators and practitioners should carefully consider the various factors that may impede or facilitate implementation of an EBI throughout different stages.   While there is no one right way to implement an EBI, informing the process of these factors may be key to supporting the path to improved outcomes.