The role of collaborations in sustaining an evidence-based intervention to reduce child neglect

Abstract

Child neglect is the most prevalent form of child maltreatment and represents 79.5% of open child-welfare cases. A recent study found the evidence-based intervention (EBI) SafeCare® (SC) to significantly reduce child neglect recidivism rates. To fully capitalize on the effectiveness of such EBIs, service systems must engage in successful implementation and sustainment; however, little is known regarding what factors influence EBI sustainment. Collaborations among stakeholders are suggested as a means for facilitating EBI implementation and sustainment. This study combines descriptive quantitative survey data with qualitative interview and focus group findings to examine the role of collaboration within the context of public-private partnerships in 11 child welfare systems implementing SC. Participants included administrators of government child welfare systems and community-based organizations, as well as supervisors, coaches, and home visitors of the SC program. Sites were classified as fully-, partially-, and non-sustaining based on implementation fidelity. One-way analysis of variance was used to examine differences in stakeholder reported Effective Collaboration scores across fully-sustaining, partially-sustaining, and non-sustaining sites. Qualitative transcripts were analyzed via open and focused coding to identify the commonality, diversity, and complexity of collaborations involved in implementing and sustaining SC. Fully-sustaining sites reported significantly greater levels of effective collaboration than non-sustaining sites. Key themes described by SC stakeholders included shared vision, building on existing relationships, academic support, problem solving and resource sharing, and maintaining collaborations over time. Both quantitative and qualitative results converge in highlighting the importance of effective collaboration in EBI sustainment in child welfare service systems.

Predicting evidence-based treatment sustainment: results from a longitudinal study of the Adolescent-Community Reinforcement Approach

“…We operationalized sustainment by assessing the extent to which core treatment elements were maintained following the end of the implementation support period and adequate organizational capacity to continue maintenance of these core elements was demonstrated. This definition is consistent with the recommendations from a recent systematic review [8], and this operationalization was also recently employed by Aarons and colleagues [15, 30]. The elements align with the definitions of implementation fidelity (e.g., [31, 32]) in that they included measurement of treatment dose, quality (as measured by staff knowledge, certification, access to high-quality training, and supervision), and penetration (i.e., proportion of staff trained and youth treated in A-CRA).…”

Sustaining alcohol and opioid use disorder treatment in primary care: a mixed methods study

“…These findings are consistent with the studies in behavioral health (i.e., mental health and/or substance use) care settings which have found that multiple factors appear critical to the sustainment of evidence-based practice use [ 21 , 23 – 25 ]. These studies indicate that a confluence of leadership and staff support are important, along with access to continued resources to maintain the practice under study.…”

“…Many studies also suggest that while elements of an evidence-based practice may be sustained, it is typical for some adaptation to occur whereby “partial” rather than “full” sustainment is more likely. For example, Aarons and colleagues [ 15 , 23 ] found that many community-based sites continued to deliver a child neglect intervention following an initial implementation support period showing “operational” sustainment. However, the “structural” elements that help ensure quality delivery, such as ongoing coaching and supervision, were discontinued.…”

Measuring sustainment of an evidence based treatment for adolescent substance use

“…Operationalizing EBT sustainment in this way is consistent with recommendations from a recent systematic review (Wiltsey Stirman et al, 2012) and was recently employed by Aarons and colleagues (Aarons et al, 2016; Green et al, 2015). More specifically, Wiltsey Stirman et al (2012) recommended that the operationalization of program sustainment include the capacity elements needed to function at the required level to maintain program benefit.…”