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

Implementation Science

Mark J Chaffin¹  Debra B Hecht¹  Jane F Silovsky¹  John R Lutzker²  Daniel J Whitaker²  Shannon Self-Brown²  Lawrence A Palinkas⁴  Amy E Green³  Gregory A Aarons³ 

[1] Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA;Center for Healthy Development, Georgia State University, Institute of Public Health, Atlanta, GA, USA;Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, CA, USA;School of Social Work, University of Southern California, Los Angeles, CA, USA

关键词: Public sector;    Child maltreatment;    Fidelity;    Implementation;    Evidence-based practice;    Adaptation;   

Others  :  828801
DOI  :  10.1186/1748-5908-7-32

 received in 2011-10-03, accepted in 2012-04-18,  发布年份 2012

【 摘 要 】

Background

Adaptations 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.

Methods

This 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.

Discussion

The 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.

【 授权许可】

   
2012 Aarons et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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