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Scaling Up: Replicating Promising Interventions with Fidelity

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Advances in Child Abuse Prevention Knowledge

Part of the book series: Child Maltreatment ((MALT,volume 5))

Abstract

To retain the demonstrated effects of any tested program, interventions must maintain model fidelity at the individual and organizational levels and faithfully replicate the content and process of the intervention’s delivery system. While most agree on the importance of accurate and consistent replication, achieving a high level of fidelity and measuring the degree to which a replication meets model standards is a complex undertaking. Although many interventions share similar components, capturing the unique aspects of a model may require an individualized fidelity monitoring system. This chapter provides an overview of how program fidelity has been addressed in the child welfare system and assesses the current status of such efforts, details the development and monitoring of fidelity in two model interventions (Attachment and Biobehavioral Catch-Up and SafeCare®), and discusses the major questions facing practitioners, administrators, policy makers, and researchers as promising interventions are scaled-up.

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Authors and Affiliations

  1. College of Social Work, DeSaussure College, University of South Carolina, Columbia, SC, 29208, USA

    Kristen D. Seay

  2. School of Social Welfare, University of Kansas, Lawrence, KS, 66045, USA

    Kaela Byers

  3. Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA

    Megan Feely

  4. School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB # 3550, Chapel Hill, NC, 27599, USA

    Paul Lanier

  5. College of Social Work, The Ohio State University, 1947 College Rd., Columbus, OH, 43210, USA

    Kathryn Maguire-Jack

  6. School of Public Health, Center for Healthy Development, Georgia State University, 34 Peachtree Street, Suite 1700, Atlanta, GA, 30303, USA

    Tia McGill

Authors
  1. Kristen D. Seay
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  2. Kaela Byers
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  3. Megan Feely
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  4. Paul Lanier
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  5. Kathryn Maguire-Jack
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  6. Tia McGill
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Correspondence to Kristen D. Seay .

Editor information

Editors and Affiliations

  1. Chapin Hall, University of Chicago, Chicago, Illinois, USA

    Deborah Daro

  2. Northwestern University, Evanston, Illinois, USA

    Anne Cohn Donnelly

  3. Chapin Hall, University of Chicago, Chicago, Illinois, USA

    Lee Ann Huang

  4. Center for Mental Health Policy and Services Research Department of Psychiatry, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Byron J. Powell

Reflections: Scaling Up Evidence-Based Programs with Fidelity

Reflections: Scaling Up Evidence-Based Programs with Fidelity

  • Lucy Berliner 

  1. Harborview Center for Sexual Assault and Traumatic Stress, University of Washington, , Seattle, , WA,, USA

    Lucy Berliner

In recent years, a science of dissemination and implementation of evidence-based programs (EBPs) has come into its own. Frameworks have been developed, relevant factors identified, and research conducted that has confirmed organizational variables associated with the successful adoption of these efforts. Among the key factors driving successful implementation are organizational leadership and commitment, training and expert consultation from the model developers, ongoing supervision, and ongoing monitoring. Various studies have now shown that under favorable organizational circumstances and with external financial support, real world organizations can deliver EBPs and achieve strong outcomes.

While this all is very good news, it is also clear that outcomes in typical real world environments tend not to be as good as those in the more structured contexts, except when organizations can replicate the conditions of the controlled research. It is no coincidence that the best results occur in funded research studies or for proprietary programs where external funding is maintained and ongoing monitoring is required. However, in our work in public mental health the biggest question put to us is how to sustain EBPs with fidelity when community programs are expected to cover the associated costs out of their usual operating budgets. The research has shed little light on this question so far.

Another consideration is that the extant research has focused almost exclusively on programs that target a single outcome (recidivism, parenting skills, or abuse prevention). The typical community-based programs, however, serve a diverse clientele seeking help for multiple problems. In our experience, individual brand name programs do an excellent job of providing support and resources that can be purchased for their specific program addressing their specific outcome. They are not concerned, understandably, with helping organizations manage the problem of delivering multiple EBPs with fidelity. It is unrealistic to expect that community-based organizations can manage multiple intervention-specific supervision structures or separate quality assurance methods. The research needs to identify practical strategies that can be integrated into usual care contexts offering EBPs to all of their clients, not just a few subgroups.

The science is clear that fidelity, monitored in some way, is important to get the desired outcomes. But it turns out that fidelity is defined and measured in many different ways. For example, an important distinction is between adherence to program characteristics versus competent delivery of specific clinical content. From the perspective of real world organizations, the methods have to be feasible to implement because fidelity monitoring consumes organizational resources. For example, if adherence to organizational characteristics is connected to outcomes across different EBPs, this would be very attractive to organizations.

It is our observation, at least in public mental health, that the value of EBP is no longer challenged. What organizations are asking is how to do it within the reality of their practice settings and fiscal constraints. If the goal is to scale up and extend the reach of these programs, then the research has to begin addressing these real world exigencies.

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Seay, K.D., Byers, K., Feely, M., Lanier, P., Maguire-Jack, K., McGill, T. (2015). Scaling Up: Replicating Promising Interventions with Fidelity. In: Daro, D., Cohn Donnelly, A., Huang, L., Powell, B. (eds) Advances in Child Abuse Prevention Knowledge. Child Maltreatment, vol 5. Springer, Cham. https://doi.org/10.1007/978-3-319-16327-7_8

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