Community-Based Dissemination of ABC: Successes and Challenges of Implementation and Sustainability

Introduction: Evidence-based prevention programs with young children at risk for child maltreatment are needed to enhance children’s developmental and mental health outcomes. Yet access to evidence-based treatments (EBTs) focused on early maltreatment is limited. Barriers to the adoption of EBTs (e.g., inadequate training/supervision, limited resources, wariness of change, challenges in transforming policies and procedures) prevent widespread dissemination. A focus on supports for implementation (competency, organizational supports, leadership capacity) is needed for effective, sustained innovations. To address these issues, the current project integrated established quality improvement and implementation science methods with fidelity-grounded clinical training, utilizing the Learning Collaborative Model on Adoption & Implementation of EBTs. The goals were to examine the feasibility of this model for the dissemination of ABC in a variety of community settings (child welfare, early intervention, community mental health) with respect to the effectiveness of training community providers to fidelity, changing client/family outcomes, and creating sustainable ABC programs.

Methods: Over the course of 12 months, service providers and agency administrators from two cohorts attended three face-to-face learning sessions and received on-going intensive clinical and implementation consultation. Provider fidelity was measured by quality and quantity of “in the moment” comments. Parenting behavior was assessed at pre- and post-intervention via semi-structured play assessments (NICHD Early Child Care Research Network, 1996).

Results: 27 providers and 11 administrators participated. Consultation and data collection are on going, but preliminary findings are available. Providers demonstrated increasing and appropriate model fidelity. From 33 cases with complete pre- and post-intervention assessment data, significant increases were found in parent sensitivity (F(1,32) = 35.18, p < .0001, h²_p = 0.52), along with significant reductions in parent intrusiveness (F(1,32) = 24.81, p < .0001, h² _p = 0.44) with large effect sizes. 

Conclusions: This project offers an innovative training approach to disseminating an EBT designed to intervene with young children at risk for maltreatment. Results demonstrate the feasibility of the approach, including provider fidelity to the model and significant targeted parenting behavior enhancement. Successes with and challenges to implementing and sustaining practice in various settings also will be addressed. Results are expected to have an important positive impact by improving the quality of training for community providers and increasing their use of evidence-based practices with model fidelity, which, in turn, will promote positive developmental and mental health outcomes in young high-risk children.