Assessing Facilitators and Challenges to Implementation of Early Interventions from Multiple Perspectives

Overview: This presentation will discuss results from an implementation evaluation of an evidence-based early childhood intervention. Methods include interviews and review of meetings, communications, and notes. Results identify implementation facilitators and barriers and emphasize the importance of including diverse stakeholders in both the implementation and evaluation of new interventions.Proposal text: Rationale: Attachment and Bio-Behavioral Catchup (ABC) is an evidence-based early childhood home visiting intervention promoting strong relationships between caregivers and children to mitigate the effects of childhood adversity that can lead to toxic stress. ABC focuses on positive and sensitive parenting to promote resilience and enhance coping and self-regulation skills in young children. The purpose of the ABC Early Childhood Initiative was to test the replicability and efficacy of ABC when integrated into the service array of various child and family serving programs throughout one midwestern state. When implementing an intervention in new contexts and with different populations, evaluation of outcomes as well as the implementation process itself becomes necessary. Triangulating data from various sources, this presentation focuses on implementation of the ABC across five geographically diverse sites, utilizing the Consolidated Framework for Implementation Research (CFIR; Damschroder et al, 2009) to identify facilitators and barriers to successful implementation.

Methods: To analyze implementation of the ABC intervention in this study, the researchers apply the CFIR’s five broad constructs with associated sub-items to ABC implementation processes and data. These constructs include: Intervention Characteristics, Outer Setting; Inner Setting; Characteristics of Individuals; and Process. We collected data for from fifteen interviews with stakeholders; project communications; content from trainings and meetings; and process notes kept by the team. Data from across sources was analyzed using thematic analysis. The coding process was not based on CFIR concepts but rather post-hoc mapping onto the framework occurred to improve understanding of implications.

Results: Findings from this implementation evaluation include facilitators and challenges to implementation that must be considered in terms of future implementation and sustainability of this or similar child and family evidence-based interventions. Facilitators and challenges were identified across all five of the CFIR domains. Major facilitators identified include extensive training and supervision from program developers and the community of stakeholders that have come together around the project. Additional facilitators included a strong agency commitment to serving families with young children as well as responsive, committed, and passionate funders. Major challenges included incomplete knowledge of the intervention and time commitment during early implementation, referral of families, and graduating families in the prescribed length of time. Though some implementation themes emerged across data sources, other themes emerged from specific sources, emphasizing individuals have unique perspectives and experiences with implementation depending on their role.

Conclusions: While the implementation evaluation highlights barriers, it also showcases facilitators that made this initiative successful. These findings are informative for ABC, but also other evidence-based interventions, as it reveals features of the program and fit within the context that must be aligned to support successful implementation and sustainability. The findings emphasize the importance of engaging diverse stakeholders in both implementation processes as well as in evaluation to fully understand the context. In social work education, programs should ensure graduates not only learn how to deliver evidence-based interventions, but also “engage with clients and constituencies to critically choose and implement culturally responsive, evidenced-informed interventions” to maximize client, organization, and community goal achievement (CSWE, 2022).