Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial.

C Hendricks Brown,Gracelyn Cruden,Wei Wang,Lisa Saldana,Patricia Chamberlain,Courtenay Padgett

doi:10.1186/s13012-014-0134-8

Abstract

BackgroundMuch is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices. This paper presents outcomes from a randomized implementation trial of Multidimensional Treatment Foster Care (MTFC) in child public service systems in California and Ohio, including child welfare, juvenile justice, and mental health.MethodsFifty-one counties were assigned randomly to one of two different implementation strategies (Community Development Teams (CDT) or independent county implementation strategy (IND)) across four cohorts after being matched on county characteristics. We compared these two strategies on implementation process, quality, and milestone achievements using the Stages of Implementation Completion (SIC) (Implement Sci 6(1):1–8, 2011).ResultsA composite score for each county, combining the final implementation stage attained, the number of families served, and quality of implementation, was used as the primary outcome. No significant difference between CDT and IND was found for the composite measure. Additional analyses showed that there was no evidence that CDT increased the proportion of counties that started-up programs (i.e., placed at least one family in MTFC). For counties that did implement MTFC, those in the CDT condition served over twice as many youth during the study period as did IND. Of the counties that successfully achieved program start-up, those in the CDT condition completed the implementation process more thoroughly, as measured by the SIC. We found no significant differences by implementation condition on the time it took for first placement, achieving competency, or number of stages completed.ConclusionsThis trial did not lead to higher rates of implementation or faster implementation but did provide evidence for more robust implementation in the CDT condition compared to IND implementation once the first family received MTFC services. This trial was successful from a design perspective in that no counties dropped out, even though this study took place during an economic recession. We believe that this methodologic approach of measurement utilizing the SIC, which is comprised of the three dimensions of quality, quantity, and timing, is appropriate for a wide range of implementation and translational studies.Trial registrationTrial ID: NCT00880126 (ClinicalTrials.gov).Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0134-8) contains supplementary material, which is available to authorized users.

Highlights

Much is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices
There is a considerable debate in the field about the best scientific approaches for answering such questions; one approach suggests that multiple baseline and other non-randomized designs often are the most appropriate or most acceptable [1,2], while others argue for the use of randomized implementation trials that contrast implementation strategies against each other [3,4,5,6,7,8]
We tested whether a peer-to-peer Community Development Team implementation strategy for county child public service systems (CDT; experimental condition) could improve the speed and quality of implementation, the quantity of families who received Multidimensional Treatment Foster Care (MTFC), and the ability of counties to reach competence in continued delivery of MTFC [10] compared to the existing individualized, single independent county implementation strategy (IND) or comparison condition

Summary

Introduction

Much is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices. As a type of learning collaborative, CDT required counties to work together to develop their respective implementation plans and overcome barriers in implementation, whereas counties in IND developed their own plans and worked individually with the MTFC purveyor (i.e., as is typically done in MTFC implementation efforts). These two implementation strategies are compared to one another, holding fixed the same evidence-based intervention

Methods

Results

Discussion

Conclusion