Understanding How Approaches to Implementation Support Have Evolved over Time to Advance Improved and Equitable Outcomes in Child Welfare Systems

Background and Purpose: Implementation support has become a frequently used approach to strengthen organizational efforts to sustainably use evidence. In utilizing implementation support, individuals, child welfare agencies, and funders collaborate with implementation support practitioners (ISPs) whose explicit role it is to support the implementation, sustainment, and scaling of evidence-based and evidence-informed programs and practices to advance improved and equitable outcomes for children and families (Albers, Metz, et al,. in press). Ideally, the ISP has a unique combination of knowledge, skills, and attitudes that facilitate organizational change efforts and evidence use. On this front, there remain valuable opportunities to explore the extent to which experienced ISPs evolve over time in terms of what knowledge, skills, and attitudes they value and prioritize. Therefore, the goals of this study were to understand what experienced ISPs have learned about supporting evidence use in child welfare systems, and how their approach to providing implementation support has shifted over time as a result of this learning.

Methods: A purposive sample of 17 highly experienced ISPs participated in in-depth interviews. A semi-structured interview guide was used to ascertain participants’ perceptions about various aspects of their work providing implementation support, particularly in child welfare systems. Interviews were conducted via Zoom and were approximately 60 minutes in length. Following the verbatim transcription of interviews, we analyzed our data using a narrative analysis approach, focusing on broad narrative elements that highlighted the trajectory of respondents’ professional journey in the context of providing implementation support in child welfare systems. A multi-researcher team engaged in data coding and analysis in an effort to triangulate observations and maintain consensus with respect to emerging findings.

Results: Respondents foregrounded the development of five main components to their approach in supporting evidence use: (a) supporting participatory learning (e.g., using data and improvement methods, promoting an organizational learning culture; facilitating peer learning); (b) engaging in co-creation (e.g., building teams, supporting co-learning, co-designing strategies); (c) building trusting relationships (e.g., demonstrating vulnerability, empathy, humility, credibility and responsiveness); (d) understanding context and community perspectives (e.g., aligning support with community values and principles, designing or identifying culturally relevant interventions); and (e) supporting communication, coordination and collaboration (e.g., using transparent communication and feedback loops, customizing information for specific stakeholder groups).

Conclusions and Implications: Almost all interviewees described a necessary evolution in their approach to supporting evidence use. Three main shifts in implementation support practice were observed: (a) didactic to participatory approaches, (b) expert-driven to co-creation approaches, and (c) framework-based to relationship-focused approaches. More specifically, respondents highlighted the need to move away from a top-down approach focused on dissemination of expertise through didactic training and use of specific frameworks and methods and towards a model of multi-level implementation support focused on co-creation with stakeholders, peer learning, and collaborative work. At the heart of this work is development of trusting relationships. All interviewees reported that high quality relationships between ISPs and system stakeholders in child and family services was the most critical factor for achieving implementation results (Metz, Boaz, et al., 2020).