How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations: a study protocol

Henna Hasson,Håkan Uvhagen,Åsa Hedberg Rundgren,Gunilla Avby,Ulrica Von Thiele Schwarz,Hedvig Gröndal

doi:10.1186/s43058-020-00005-9

Abstract

BackgroundUsing evidence-based interventions (EBIs) is a basic premise of contemporary social services (e.g., child and family social services). However, EBIs seldom fit seamlessly into a specific setting but often need to be adapted. Although some adaptions might be necessary, they can cause interventions to be less effective or even unsafe. The challenge of balancing adherence and adaptations when using EBIs is often referred to as the adherence and adaptation dilemma. Although the current literature identifies professionals’ management of this dilemma as problematic, it offers little practical guidance for professionals. This research aims to investigate how the adherence and adaptation dilemma is handled in social services and to explore how structured decision support can impact the management of the dilemma.MethodsThe design is a prospective, longitudinal intervention with a focus on the feasibility and usefulness of the structured decision support. The project is a collaboration between academic researchers, embedded researchers at three research and development units, and social service organizations. A multi-method data collection will be employed. Initially, a scoping review will be performed, and the results will be used in the development of a structured decision support. The decision support will be further developed and tested during a series of workshops with social service professionals. Different forms of data—focus group interviews, questionnaires, and documentation—will be used on several occasions to evaluate the impact of the structured decision support. Qualitative and quantitative analysis will be performed and usefulness for practice prioritized throughout the study.DiscussionThe study will contribute with knowledge on how the adherence and adaption dilemma is handled and experienced by social service professionals. Most importantly, the study will generate rich empirical data on how a structured decision support impacts professionals’ management of adherence and adaptions. The goal is to produce more strategic and context-sensitive implementation of EBIs in social service, which will increase value for service users.

Highlights

Using evidence-based interventions (EBIs) is a basic premise of contemporary social services
The study contributes with knowledge on how the balance between adherence and and adaptions of EBIs is achieved by social service professionals
The current study aims at investigating the adherence and adaption dilemma in social service and exploring how a structured decision support impacts how the dilemma is managed

Summary

Introduction

Using evidence-based interventions (EBIs) is a basic premise of contemporary social services (e.g., child and family social services). EBIs seldom fit seamlessly into a specific setting but often need to be adapted. Professionals in social services are struggling with determining how to use their own specific expertise as well as clients’ experiences and preferences in relation to evidence and EBIs [7,8,9]. Workforce, provider capacity, staff training, welfare systems, resources, and service user characteristics can be different [14]. These misfits between contexts mean that EBIs often need to be adapted to fit the new context [15, 16]. An accumulation of findings has shown that between 44 and 88% of users adapt the procedure, dosage, content, format, and/or target group when using EBIs (e.g., [19,20,21,22])

Objectives

Methods

Findings

Conclusion