Using Relational Theory to Understand Practitioners, Supervisors, and Leaders Perspectives in Implementation

Background

Although there has been great progress in identifying general theories of implementation, the consistent use of theory to inform practice and research is still nascent in implementation science. Notably missing in the field are critical perspectives, such as feminist-based theories like Relational Theory. Relational Theory posits that improvement and development in organization and system change efforts are optimized in the context of connection and relational interactions. This highly relates to social work’s goal to strengthen relationships in practice and community. Moving beyond traditional theories and adopting a relational perspective offers the opportunity to understand how power, hierarchies, and oppression shape organizations, practice, and implementation.

Methods

This study used a secondary case study analysis to apply Relational Theory to qualitative data to understand how relational and transactional exchanges occur within practice and how practitioners, supervisors, and leaders describe in the implementation of Family Connections (FC), a child maltreatment prevention intervention.FC was implemented across eight community-based agencies. Secondary analysis of qualitative data is appropriate when a new theory is applied to further examine to explain initial qualitative results. Qualitative data included semi-structured 30–40-minute interviews with nine practitioners. Additionally, two focus groups were analyzed with a group of four supervisors and a group of six leaders. Leaders came from five different agencies that varied in size. First cycle coding involved deductively coding the interviews based on the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies by two reviewers to understand what strategies were used to support fidelity of FC. Next, reviewers used the Relational and Transactional Strategy Continuum measure to categorize the initial qualitative codes (and corresponding ERIC strategies) into the relational, operational, and transactional alliance

Results

Results from the deductive coding revealed that qualitative codes identified in the data related only to organizationally focused ERIC strategies; however, most organizational strategies noted by practitioners were not included in the ERIC compilation. Examples include appreciation of staff; creating flexible work schedules for staff; reasonable caseloads; networking with other providers; and worker retention strategies. Additionally, the systemic and individual factors noted by practitioners, supervisors, and leaders did not relate to the ERIC implementation strategies

Related to question two, the majority of codes were identified as semi-relational to highly relational alliances in the qualitative data. Highly relational alliances were characterized by exchanges at the practitioner-family, practitioner-supervisor, peer-to-peer or inter-organizational level that suggested strong connections with others (e.g., referral pathways for families, learning culture and practice improvement, group supervision) as well as worker characteristics relating to strong communication skills, empathy, and ability to reflect and adjust. Additional results along the continuum indicated some semi-relational and operational alliances.

Discussion

Understanding how Relational Theory can be used to describe the implementation process can facilitate progress in social work and human service organizations as we seek to strengthen the alliances within organizations, and across communities and systems. Presenters will share practice and research implications for social workers interested in the implementation and improvement of programs in community-based settings.