Use of Research Evidence and Cultural Exchange in Child Welfare and Child Mental Health

Background and Purpose. Use of research evidence (URE) is associated with implementation of evidence based-practices (EBP) for high-risk youth in foster care placements. Knowledge transfer of such evidence may contribute to transformations in the organizational cultures of collaborating stakeholders.  However, the extent to which such transformations are associated with either EBP implementation or how evidence is acquired, evaluated and applied in decision-making is unknown.

Methods:  Information on URE and cultural exchange was collected from 151 directors and senior administrators of child welfare, mental health and juvenile justice systems in 40 California and 11 Ohio counties participating in an RCT of the use of community development teams to scale up implementation of Treatment Foster Care Oregon over a 3 year period (2010-12). Changes in agency knowledge, attitudes and practices (KAP) resulting from interactions with intermediary organizations, treatment developers, other agencies within the county, and agencies in other counties were assessed using the 15-item Cultural Exchange Inventory (CEI). Level of engagement in acquiring, evaluating and applying research evidence is decision-making was assessed using the 45-item Structured Interview for Evidence Use (SIEU). Implementation process was assessed using the State of Implementation Completion (SIC) scale.

Results. Cultural exchanges with intermediary organizations were significantly associated with accessing evidence through documents (r = 0.22, p = 0.041) and networks (r = 0.38, p  < 0.001), total acquisition (r = 0.27, p = 0.009), and total engagement in evidence use (r = 0.21, p = 0.048). Cultural exchanges with treatment developers were significantly associated with self-evaluation for validity and reliability (r = 0.32, p = 0.003) and evaluation in general (r = 0.25, p = 0.021).  Cultural exchanges with other agencies in the same county were significantly associated with use of evidence in decision-making (r = 0.28, p = 0.008), and total engagement in evidence use (r = 0.23, p = 0.033).  Cultural exchanges with agencies in other counties were significantly associated with acquisition of evidence through social networks (r = 0.23, p = 0.036), and total engagement in evidence use (r=0.26, p = 0.015). Exchanges involving intermediary organizations and treatment developers were significantly associated with farthest stage of implementation (r = .32, p = 0.002 and r = .34, p =< 0.001, respectively) and proportion of activities completed during the implementation phase (r = .35, p = 0.002 and r = .34, p =< 0.001, respectively).

Conclusions and Implications. Use of research evidence may contribute to transformational changes in knowledge, attitudes and practices in youth-serving systems, treatment developers and intermediary organizations. Variations in acquisition, evaluation and application of research evidence appear to be related to 1) the role on intermediary organizations in building and supporting social networks, as well as the importance of ties linking agencies in neighboring counties, 2) need to evaluate evidence provided by treatment developers for oneself; and 3) the application of evidence in collaboration with other agencies in the same county. Cultural exchanges involving intermediary organizations and treatment developers are associated with successful EBP implementation.