Successful Implementation of Safecare: Operationalizing and Assessing Organizational Implementation Completion

Introduction: While successfully implementing evidence-based practice (EBP) continues to plague the field, much has been learned about the strategies and processes that promote program start-up and sustainment. The Stages of Implementation Completion (SIC) is a tool to measure implementation process and milestones. Organizational activities are tracked during the three phases of implementation: Pre-implementation, implementation, and sustainment. The SIC was adapted for SafeCare as it is implemented in the real-world, to assess organizational implementation behavior compared to established benchmarks of other non-SafeCare EBPs.

Methods: Each SIC stage was populated with SafeCare activities applying the standardized SIC adaptation method. In addition to 14 organizational demographic items, a total of 55 activities were defined: Stage 1 Engagement = 6; Stage 2 Feasibility Assessment = 8; Stage 3 Readiness Planning = 8; Stage 4 Hiring and Training = 7; Stage 5 Fidelity Monitoring Established = 4; Stage 6 Service Delivery and Consultation Begin = 5; Stage 7 Ongoing Program Delivery and Fidelity Monitoring = 8; and Stage 8 Competency = 9. The adapted SafeCare-SIC was utilized to track all organizations who expressed interest in the model beginning in August 2014.

Results: A total of 94 sites expressed interest in implementing SafeCare during the study period. Of those, 76% discontinued during Stage 1 (Engagement). Another 9% discontinued in Stage 2 (Feasibility Assessment). However, of the 15% that completed pre-implementation, all but one successfully launched a SafeCare program, and the majority successfully achieved Competency in program delivery, with 86% achieving Stage 8 (13% of total). Discontinuing during pre-implementation by the majority of sites is consistent with implementation efforts of other EBPs. However, organizations that successfully launched a SafeCare program completed a greater number of implementation activities in all three phases, and did so significantly more quickly than organizations implementing other EBPs.

Discussion: Although organizations considering the adoption of SafeCare followed a similar pattern of discontinuation during pre-implementation to other EBPs, this poses a recruitment challenge for implementation research operating on limited study time-lines. Yet, findings from recruited organizations meeting feasibility criteria suggest that implementation activities defined by SafeCare to guide organizations with technical assistance have the potential to yield sustainable programs. This study provides a significant example of a process that promotes reduction of wasted resources and improvement in obtaining sustainment, offering both a significant implementation outcome and an important method for retaining eligible sites in study observation.