A Mixed Methods Approach for Optimization of an Implementation and Consultation Model for Scaling up a Family-Centered Evidence-Based Intervention

Despite the emergence of many evidence-based interventions (EBIs), the uptake of EBIs in community agencies has been poor (Fixsen et al., 2009). Effective and efficient provider consultation is one challenge contributing to the poor uptake of EBIs (Fixsen et al.). Resource-intensive consultation used in efficacy and effectiveness research does not translate to real world settings (August et al., 2004). Providers are encumbered with overwhelming caseloads and administrative responsibilities, such that resource-intensive consultation is neither acceptable nor feasible (Elliott & Mihalic, 2004). Alternatively, the ‘‘train and hope’’ approach, involving minimal or no post-training consultation, is ineffective in developing provider knowledge, skill, and competence (Herschell et al., 2010). The current study integrates focus group data, survey data assessing provider readiness to implement, and observational assessments of provider fidelity scored using an empirically validated fidelity coding system (Smith, Dishion et al, 2013) from 40 providers in community agencies to optimize the Family Check-Up (FCU) provider consultation model for real-world service delivery systems. The FCU is a brief, family centered intervention that is implemented in service settings such as public schools, early childhood home visiting and community mental health and improves child and family adjustment from early childhood through adolescence (e.g., Dishion & Stormshak, 2007; Dishion et al., 2008; Shaw et al., 2006; Stormshak et al., 2009). Given the demand for brief, cost efficient, evidence-based programs, the FCU model transitioned quickly from efficacy and effectiveness to the “going to scale” phase (Kellam & Langevin, 2003). In this transition, the FCU implementation model integrated “bottom-up” and “top-down” approaches to adapt provider consultation for real-world delivery (Ogden et al., 2009). The bottom-up approach increased feasibility and acceptability at the cost of creating site-specific variations that challenged standardization and compromised rigor. Alternatively, the top-down approach imposed requirements (e.g., videotaping sessions) that were often beyond the capacity of the implementation agency. Clinic-specific challenges (e.g., high turnover) posed additional difficulties. Drawing on lessons learned, this study applies a systems-contextual perspective (Beidas and Kendall, 2010) and focus group, survey data, and observational fidelity data from 40 providers to optimize feasibility and acceptability of provider consultation as FCU continues scale-up. Provider readiness assessments and observational data will specifically inform provider variables (e.g., attitudes toward EBIs) that influence intensity and frequency of consultation to maintain fidelity.