Dynamic adaptation process to implement an evidence-based child maltreatment intervention

Gregory A Aarons,Debra B Hecht,Shannon Self-Brown,Amy E Green,Lawrence A Palinkas,John R Lutzker,Jane F Silovsky,Mark J Chaffin,Daniel J Whitaker

doi:10.1186/1748-5908-7-32

Abstract

BackgroundAdaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.MethodsThis project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Highlights

Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process
One of the critical challenges in large-scale implementations of EBPs is the tension between adaptation and attaining fidelity [5,6,7,8]
Because there has been limited research on models that allow for intervention and contextual adaptation while maintaining both structural fidelity [10] and fidelity to the core elements of an EBP, we proposed a model based on current literature and our own research and experience in multiple EBP implementation studies

Summary

Introduction

Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The DAP involves identifying core elements and adaptable characteristics of an EBP, supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. For the purposes of this paper, we define adaptation as “to make fit (as for a specific or new use or situation) often by modification” [11]. This definition leaves room for adaptation of both an EBP and of the context into which the EBP is to be implemented

Objectives

Methods

Conclusion