Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems.

Lawrence A Palinkas,C Hendricks Brown,Thomas W Valente,Eric Rice,Ian W Holloway,Patricia Chamberlain

doi:10.1186/1748-5908-8-133

Abstract

BackgroundGiven the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice.MethodsSemi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions.ResultsOf those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network.ConclusionAlthough the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies.Trial registrationNCT00880126

Highlights

Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions
In a recent study that relied upon an adapted randomized design, we found that the implementation of an evidence-based practice (EBP) was associated with certain characteristics of the social networks of directors and senior administrators of child welfare agencies, probation departments and mental health departments [8]
As the community development teams (CDTs) counties had participated in two CDT meetings prior to data collection, these results suggest that the intervention was successful in creating or strengthening network steps among counties engaged in the shared goal of implementing Multidimensional Treatment Foster Care (MTFC)

Summary

Introduction

Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice. In a recent study that relied upon an adapted randomized design, we found that the implementation of an EBP was associated with certain characteristics of the social networks of directors and senior administrators of child welfare agencies, probation departments and mental health departments [8]. These networks cut across organizational and jurisdictional boundaries used to define the unit of randomization, i.e., the county. We concluded from this study that while the organizations may be responsible for the implementation of EBPs, the influence networks of the leaders of these organizations may represent more relevant units to consider, and possibly to randomize, in implementation research

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