Implementing Evidence-Based Practices in Child Welfare Settings: Lessons Learned

Introduction: Despite a federal mandate and flexible funding to support implementation of evidence-based practices (EBPs) in child welfare systems (CWS), agencies still face challenges in embedding EBPs into their service array. How to mitigate these challenges and successfully implement EBPs in the CWS is unknown due to the fact that: (1) most efforts have been devoted to implementing EBPs for psychiatric disorders in mental health settings, (2) those efforts have been largely disappointing, and (3) the question of whether and how the disproportionate number of minority youth and families in child welfare access and utilize EBPs remains unanswered. Thus, the current study seeks to fill these knowledge gaps by (1) understanding what strategies purveyors are using to implement EBPs, (2) illuminating unique implementation challenges for high-risk minority youth and families in the CWS, and (3) determining whether and how implementation strategies need to be modified to address these challenges.

Methods: Seven 30-minute semi-structured telephone interviews were conducted with seven investigators who either developed EBPs or who conducted EBP effectiveness studies in child welfare settings. The EBPs chosen for this study were those classified as well-supported by research evidence by the California Evidence-Based Clearinghouse.. Participants were asked to reflect upon inner (intra-organizational and individual adopter characteristics) and outer (funding, inter-organizational process) contextual factors that are hypothesized by Aaron and colleagues (2011) to influence the implementation process. Content analysis was used to generate emerging themes from participant experiences and final themes were selected by consensus.

Results: Implementation barriers were identified at the micro level (e.g. lack of transportation, stigma, cultural incongruence), mezzo level (e.g. lack of caseworker and provider buy-in, multiple service plans to juggle, lack of training), and macro level (e.g. community skepticism of researchers, overhead expenses, provider reimbursement structures). Participants promoted implementation of EBPs and mitigated barriers by using evidence-based engagement strategies to increase recruitment and retention, using psychoeducation and agency presence to increase caseworker knowledge and awareness, and engaging the community to promote trust. Interventions were typically not modified but were tailored to meet the concrete needs and cultural nuances of the population.

Conclusion: To successfully implement EBPs in the CWS, efforts should focus on increasing caseworker, provider, and organizational readiness to engage clients and communities. Policies must ensure adequate funding structures for agency and system EBP implementation and sustainability. With proper implementation support, researchers can then determine the EBPs that are effective in preventing and treating child maltreatment.