Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM, 87106, USA.
Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA.
BMC Health Serv Res. 2023 Jan 26;23(1):88. doi: 10.1186/s12913-023-09079-2.
Evidence-based interventions, which are typically supported by data from randomized controlled trials (RCTs), are highly valued by providers of human services like child welfare. However, implementing such interventions in the context of a randomized clinical trial is a complex process, as conducting an RCT adds extra tasks for providers and complicating factors for provider organizations. Utilizing the Exploration, Preparation, Implementation, and Sustainment Framework, this study examines factors that facilitate or impede success in the implementation of evidence-based interventions in the context of a largescale trial of SafeCare,® a child maltreatment intervention.
Qualitative data were obtained as part of a larger mixed-methods study involving a cluster randomized trial comparing SafeCare to usual services for caregivers within nine child welfare agencies across four states. Between May and October 2017, individual interviews were conducted with a purposive sample of 21 child welfare administrators and 24 supervisors, and 19 focus groups were conducted with 84 providers. Data were coded iteratively and grouped into themes.
Several interconnected themes centered on facilitators and barriers to SafeCare implementation in the context of a randomized clinical trial. Facilitators included: (1) Benefits afforded through RCT participation; (2) Shared vision and sustained buy-in across system and organizational levels; and (3) Ongoing leadership support for SafeCare and the RCT. Barriers that hindered SafeCare were: (1) Insufficient preparation to incorporate SafeCare into services; (2) Perceived lack of fit, leading to mixed support for SafeCare and the RCT; and (3) Requirements of RCT participation at the provider level.
These data yield insight into an array of stakeholder perspectives on the experience of implementing a new intervention in the context of a largescale trial. This research also sheds light on how the dynamics of conducting an RCT may affect efforts to implement interventions in complex and high-pressure contexts. Findings highlight the importance of aligning knowledge and expectations among researchers, administrators of organizations, and supervisors and providers. Researchers should work to alleviate the burdens of study involvement and promote buy-in among frontline staff not only for the program but also for the research itself.
循证干预措施通常以随机对照试验 (RCT) 的数据为支撑，受到儿童福利等人类服务提供者的高度重视。然而，在随机临床试验的背景下实施此类干预措施是一个复杂的过程，因为进行 RCT 会为提供者增加额外的任务，并为提供者组织增加复杂因素。本研究利用探索、准备、实施和维持框架，考察了在 SafeCare®大规模试验背景下，促进或阻碍循证干预措施实施成功的因素，SafeCare®是一种虐待儿童干预措施。
定性数据是作为一项更大的混合方法研究的一部分获得的，该研究涉及一项群组随机试验，比较了 SafeCare 与四个州的九个儿童福利机构内的常规服务对照顾者的影响。2017 年 5 月至 10 月期间，对 21 名儿童福利管理人员和 24 名主管进行了有针对性的个人访谈，并对 84 名提供者进行了 19 次焦点小组讨论。数据经过迭代编码并分为主题。
几个相互关联的主题集中在 RCT 背景下实施 SafeCare 的促进因素和障碍。促进因素包括：（1）通过 RCT 参与获得的收益；（2）系统和组织各级的共同愿景和持续支持；（3）对 SafeCare 和 RCT 的持续领导力支持。阻碍 SafeCare 的障碍包括：（1）准备不足，难以将 SafeCare 纳入服务；（2）感知不匹配，导致对 SafeCare 和 RCT 的支持不一；（3）提供者层面参与 RCT 的要求。
这些数据深入了解了一系列利益相关者对在大规模试验背景下实施新干预措施的体验。这项研究还揭示了 RCT 开展的动态如何影响在复杂和高压环境下实施干预措施的努力。研究结果强调了在研究人员、组织管理人员和主管以及提供者之间协调知识和期望的重要性。研究人员应努力减轻研究参与的负担，并促进一线工作人员对计划和研究本身的支持。
