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

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.