Exploring how intervention characteristics affect implementability: A mixed methods case study of common elements-based academic support in child welfare services

Abstract

BackgroundProminent implementation theories and frameworks articulate characteristics of interventions (e.g., contextual alignment) as important determinants of successful implementation in natural practice settings. Yet, few studies have explored such characteristics in-depth. Research is needed to understand how and why interventions' characteristics can make them more or less implementable in their intended practice settings. Child Welfare Services (CWSs) need evidence-informed academic interventions to help children's current and prospective wellbeing. CWSs are complex implementation contexts that likely need interventions to be highly implementable. This mixed-methods case study explored the implementability of Enhanced Academic Support (EAS), a co-designed common elements-based academic intervention for children and families in CWSs, and how characteristics such as flexibility and contextual alignment influenced its implementability. MethodsWe used a fully integrated mixed-methods design and collected data from 24 practitioners and supervisors from three Norwegian CWSs. Quantitative data included measures of intervention feasibility, acceptability, appropriateness, and usability. Qualitative data included focus groups, individual interviews, and feedback logs. Quantitative analyses were descriptive, and qualitative analyses mixed deductive and inductive coding and interpretation. Mixed analyses used convergence and expansion. ResultsEAS scored 75.33 (SD = 15.57) out of 100 on the implementability index, and convergence with qualitative data indicates that EAS is implementable for most practitioners in CWS, but not all. The core element structured tutoring was occasionally inappropriate with families. Specific content and design characteristics influenced implementability through different mechanisms. The influence could be positive or negative depending on practitioners' preferences and values and their perceptions about appropriateness for clients. Flexibility was a multi-faceted characteristic with potential benefits and pitfalls for implementation. Flexible cross-domain integration of core elements of EAS into other supports was crucial. DiscussionPerceptions about implementability can vary within groups of practitioners, which may call for designing for differentiation in interventions and implementations. Cross-domain integration may be a promising design characteristic for interventions in complex practice settings. Limitations in implementability and competing priorities may cause paradoxes where those children who need academic support the most may receive less of it.