The Brown School, Washington University, St. Louis, MO, USA.
Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM, USA.
Implement Sci. 2020 Sep 10;15(1):74. doi: 10.1186/s13012-020-01031-w.
The majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP. This study explores the process of organizational-rather than EBP-adaptation during implementation and sustainment. To the authors' knowledge, there are no previous implementation studies that focus on organizational adaptation in this way.
This analysis utilizes a case study approach to examine longitudinal qualitative data from 17 community-based organizations (CBOs) in one state and seven county-based child welfare systems. The CBOs had sustained a child-neglect intervention EBP (SafeCare®) for 2 to 10 years. The unit of analysis was the organization, and each CBO represented a case. Organizational-level profiles were created to describe the organizational adaptation process.
Three organizational-level adaptation profiles were identified as follows: incorporators (n = 7), early investors (n = 6), and learners (n = 4). Incorporators adapted by integrating SafeCare into existing operations to meet contractual or EBP fidelity requirements. Early Investors made substantial organizational adaptations during the early implementation period, then operated relatively consistently as the EBP became embedded in the organization and service system. Learners were characterized by steady and continuous attention to new ways that the organization could adapt to support the EBP.
The profiles demonstrated that there can be multiple effective paths to EBP sustainment. Organizational adaptation was calibrated to fit a CBO's operations (e.g., size of the program) and immediate environmental constraints (e.g., funding levels). Additionally, organizations fulfilled different functional roles in the network of entities involved in EBP implementation. Knowing organizational roles and adaptation profiles can guide implementation planning and help to structure contract designs that bridge the outer (system) and inner (organizational) contexts. Adaptation profiles can also inform the intensity of the implementation strategy tailoring process and the way that strategies are marketed to organizations.
大多数关于循证实践（EBP）适应的文献都侧重于临床实践的改变，而没有明确解决组织如何适应新的 EBP。本研究探讨了实施和维持过程中组织而非 EBP 适应的过程。据作者所知，以前没有任何实施研究以这种方式关注组织适应。
本分析采用案例研究方法，从一个州的 17 个基于社区的组织（CBO）和七个基于县的儿童福利系统中检查了纵向定性数据。CBO 持续实施了 2 至 10 年的儿童忽视干预 EBP（SafeCare®）。分析单位是组织，每个 CBO 代表一个案例。创建了组织层面的概况来描述组织适应过程。
确定了三种组织层面的适应概况如下：整合者（n = 7）、早期投资者（n = 6）和学习者（n = 4）。整合者通过将 SafeCare 整合到现有运营中以满足合同或 EBP 保真度要求来适应。早期投资者在早期实施阶段进行了大量的组织调整，然后随着 EBP 嵌入组织和服务系统，运作相对稳定。学习者的特点是持续关注组织适应支持 EBP 的新方法。
这些概况表明，EBP 的维持可能有多种有效途径。组织适应是根据 CBO 的运营（例如，项目规模）和当前环境限制（例如，资金水平）进行校准的。此外，组织在参与 EBP 实施的实体网络中发挥了不同的功能作用。了解组织角色和适应概况可以指导实施计划，并有助于构建连接外部（系统）和内部（组织）环境的合同设计。适应概况还可以为实施策略定制过程的强度以及向组织推销策略的方式提供信息。
