Agency Perspective on Implementation of Evidence-Based Models in Child Welfare

Background and Purpose: Implementation of evidence-based interventions (EBI) in child welfare improves safety, permanency, and well-being of youth and their families.  EBIs also improve service delivery and child outcomes. As the field of child-welfare continues toward the utilization and adaptation of practices informed by research, programs require installation support. Agencies often lack processes that can facilitate the implementation of several EBIs with different outcomes.  Current literature focuses primarily on developer strategies, with agency perspective on implementation often lacking.  Few interventions have been developed within child-welfare contexts, majority of interventions utilized in child-welfare were either developed in health or mental health settings.  The transportability of these interventions into child-welfare requires tailoring, adaptation and utilization of effective implementation strategies. The current study assesses; (1) factors that foster the implementation of four EBIs, (2) utilization of an organizational framework for implementation, and (3) provider attitudes towards acceptance and penetration of new innovations.  This study describes the perspectives of multiple stakeholders (e.g., case planners, supervisors, and administrators) regarding implementation.

Methods: Child welfare and preventive service staff (N=125, 4 EBIs) were surveyed during the exploration phase for knowledge, skills, and readiness for change to adopt a new practice.  The agency formed administrative teams which were charged with developing policies and procedures to ensure the roll-out of EBIs.  Developers provided technical assistance on the specific interventions, but didn’t provide cross EBI support.  A coherent approach towards installation activities was needed, and administrative teams were converted into implementation teams.  The Getting to Outcomes (i.e. GTO) Support System Model was chosen to guide the implementation of several EBIs.  This framework includes ten different steps and has four main components which include; development of tools, EBI training, technical assistance and coaching, and development quality improvement/quality assurance processes.  The GTO model guided implementation of EBIs and provided the framework for organizing the survey results.

Results: Staff survey suggests that the appeal of EBIs is consistent with provider attitudes. The majority of staff were open to adopting a new practice and only a quarter exhibited resistance in learning a new treatment approach.  More than half of the respondents felt that clinical experience is more important than manualized treatment, which could pose a barrier towards continued implementation. Overwhelmingly staff felt that the selection of EBIs was required by the state, agency, and/or supervisor. Survey results highlighted the importance of both outer (e.g., legislation, funding) and inner contexts (e.g., knowledge, skills, values, leadership, and culture).  Convening of implementation teams facilitated installation of EBIs, and GTO provided a guiding framework to structure that work.  The model specifies activities such as; conducting a needs assessment, model fit, goal setting, capacity building, structuring evaluations, developing quality improvement strategies, and sustainability.

Conclusions and Implications: Continued implementation requires building competence in provision of manualized treatment approaches. Findings from this study inform procedures and processes that build capacity within agencies to implement and sustain EBIs through greater collaboration between developers, agencies, and clients.