We Built It and Only a Handful Came: Community Stakeholder Perspectives on Implementation Challenges and Barriers of an Evidence-Based Parenting Intervention within Child Welfare

Background/purpose: Successful community implementation of evidence-based (EB) parenting programs is fundamental to improving the lives of vulnerable children and families and program sustainability. Despite the proliferation of information about the effectiveness of EB parenting interventions (i.e., outcomes evaluation) real-world challenges such as low referrals, attrition and limited adoption or utilization by organizations persist. Existing evidence identifies several potential reasons for these challenges, such as: resource constraints, organizational culture, and complexity of EB implementation within diverse community settings. This study presents findings from a retrospective implementation survey administered to professional stakeholders engaged in a collaborative, regional partnership grant (RPG) initiative. Specifically, from the perspective of professionals who were engaged with the initiative, the authors wanted to identify barriers that potentially underpinned successful implementation, community/professional buy-in, and low referrals rates. Identification of the unique system barriers related to community implementation and uptake is essential for successful implementation, program outcomes, professional buy-in, and sustainability.

Methods: The RPG initiative implemented an EB parenting intervention in an urban, Midwestern county between December 2019 and July 2022. Following implementation, a retrospective electronic survey was administered (via REDCap) to identify barriers and challenges associated with RPG enrollment, implementation, and retention of intervention families. Survey questions included quantitative and qualitative fields. The survey was administered to 84 pre-identified individuals involved in intervention selection, implementation, recruitment, or project management. Univariate and bivariate analyses were performed to examine respondent demographics, characteristics, and survey responses. Institutional Review Board approval was received prior to survey administration.

Results: In total, 20 professionals (24% response rate) completed the survey. Respondents were primarily White (65%) females (90%) with an average age of 39 years (SD=9.0). Among the respondents, 65% were social workers/case managers, 15% were clinicians, and 10% were supervisors. Analysis revealed that nearly 85% of identified key personnel stakeholders were not engaged in the initial RPG planning stages or the EB intervention selection process. Only 52% reported feeling that the RPG initiative received adequate support within their respective agencies. Respondents qualitatively highlighted various implementation challenges, including issues related to COVID-19 (such as technology limitations), pre-existing agency requirements, and service ambiguity arising from the provision of multiple organizations implementing the same EB intervention.

Conclusion: This study retrospectively investigated implementation barriers encountered by community professionals following the adoption of an evidence-based intervention (EB). Findings underscored a significant lack of involvement among professionals in the initial decision-making process, with organizational leadership largely driving decisions. Unforeseen challenges, such as those presented by the COVID-19 pandemic, further complicated implementation efforts. The study highlights the critical need for a comprehensive EB program that amalgamates clinician insights, client preferences, empirical evidence, and robust implementation frameworks to facilitate the effective adoption of evidence-based practices within targeted initiatives. Findings stress that it is not enough to have sufficient resources or leadership buy-in to see an uptake in EP use. Addressing these challenges requires proactive engagement, ongoing training, and adaptable strategies to navigate complex implementation landscapes.