183855 Adaptations of evidence-based practices in child welfare: A qualitative perspective

Tuesday, October 28, 2008

Kristen Honda, BS , Department of Psychiatry, University of California, San Diego, San Diego, CA
Tabitha Kirkland, BA , Department of Psychiatry, University of California, San Diego, San Diego, CA
Gregory Aarons, PhD , Department of Psychiatry, University of California, San Diego, San Diego, CA
Introduction: It is important to enhance our understanding of factors that support the use of evidence-based practices (EBPs) in real-world settings. Specifically, there is concern about the balance between delivering EBPs with fidelity and making adaptations necessary for specific contexts. The present study examines this issue in a statewide implementation of an intervention to reduce child maltreatment.

Methods: We interviewed 17 home-based service providers implementing SafeCareŽ, an EBP to reduce the incidence and prevalence of child neglect. Interview guides focused on provider experiences working with families and their perceived need for adaptation of SafeCareŽ. Grounded theory methods were used to identify factors associated with intervention adaptation.

Results: Adaptations were based on service providers' clinical judgment and identification of fit with client needs. The most common themes were: Forestalling (addressing urgent concerns before focusing on the EBP); Module reordering within the EBP; Emphasizing certain aspects of the EBP more than others; and Adding information to model materials. These four types of adaptations occurred when warranted by individual family considerations such as health or safety issues in the home, developmental disabilities or mental impairment, age of the children, and the presence of urgent situations such as parental incarceration or job loss.

Discussion: The data presented here suggest that EBPs may be more effective and better fit the needs of clients if designed to be flexible. A flexible EBP will better accommodate these types of practical considerations. These results are congruent with definitions of EBP issued by both the IOM and APA.

Learning Objectives:
1. The most common adaptations of evidence-based practices in child welfare are: Forestalling, Module Reordering, Selective Emphasis, and Adding Information. 2. Adaptations of evidence-based practices in child welfare occur when warranted by individual family considerations such as health or safety issues in the home, developmental disabilities or mental impairment, age of the children, and the presence of urgent situations.

Keywords: Evidence Based Practice, Community-Based Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary research assistant on this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.