Adaptation happens: a qualitative case study of implementation of The Incredible Years evidence‐based parent training programme in a residential substance abuse treatment programme

Publication Date30 Nov 2012
Pages233-245
DOIhttps://doi.org/10.1108/17466661211286463
AuthorGregory A. Aarons,Elizabeth A. Miller,Amy E. Green,Jennifer A. Perrott,Richard Bradway
SubjectEducation,Health & social care,Sociology
Adaptation happens: a qualitative case
study of implementation of The Incredible
Years evidence-based parent training
programme in a residential substance
abuse treatment programme
Gregory A. Aarons, Elizabeth A. Miller, Amy E. Green, Jennifer A. Perrott and Richard Bradway
Abstract
Purpose – Evidence-based practices (EBPs) are increasingly being implemented in real-world
settings. While intervention effectiveness is dependent on fidelity, interventions are often adapted to
service settings according to the needs of stakeholders at multiplelevels. This study aims to examine the
naturalistic implementation of The Incredible Years(IY) parenting programme in a residential substance
abuse treatment programme for pregnant and parenting women.
Design/methodology/approach – The study took place in a residential substance abuse treatment
programme serving pregnant and parentingwomen and their children. Participants included 120 female
clients. The primary IY facilitator was a master’slevel counselling psychologist. In person observations of
IY sessions were completed by a trained bachelor’slevel anthropologist. Ethnographic field notes were
collected and then coded in keeping with a priori themes and to identify emergent themes. The Parent
Group Leader Checklist was used to evaluate quality and integrity of the IY basic parent programme.
Findings – Quantitative analyses indicate that fidelity varied by type of checklist activity. Specifically,
adherenceto the IY programme was highest in beginning topic activities, setup, and home activity review,
and lowest in role play, vignettes, and wrap-up activities. Qualitative analyses revealed a number of
adaptations in implementationof IY. Adaptations fit into two broad categories: modificationof programme
delivery and modification of programme content. Within each of these categories modifications included
organisation-driven adaptations, provider-drivenadaptations, and consumer-driven adaptations.
Practical implications – Changes to evidence-basedpractice generally take two forms – adaptations
consistent with model intent and theoretical approach and changes that represent drift from core
elements of the EBP. The challenge for implementation science is to develop frameworks in which
models can be adapted enough to make them viable for the service context (or the service context
adapted to fit the model), yet avoid drift and maintain fidelity.Attending to the complexities of adaptation
prior to and during implementation in a planned way is likely to help organisations better utilise EBPs to
meet their unique needs while maintaining fidelity.
Originality/value – The paper shows that identification of types of intervention adaptations and drift
allows for consideration of systematic approaches, frameworks, and processes to increase adherence
during EBP implementation in community mental health and substance abuse treatment settings.
Keywords Evidence-based practice, Implementation, Adaptation, Parent training, Substance abuse,
United States of America, Addiction, Women, Children (kinship), Social care
Paper type Case study
Introduction
There is increasing impetus to implement evidence-based practices (EBPs) in community
mental health and substance abuse treatment settings (Aarons et al., 2011). However,
DOI 10.1108/17466661211286463 VOL. 7 NO. 4 2012, pp. 233-245, QEmerald Group Publishing Limited, ISSN 1746-6660
j
JOURNAL OF CHILDREN’S SERVICES
j
PAGE 233
Gregory A. Aarons,
Elizabeth A. Miller,
Amy E. Green and
Jennifer A. Perrott are
based in the Department of
Psychiatry, Child and
Adolescent Services
Research Center,University
of California, San Diego,
California, USA.
Richard Bradway is based
in the Alcohol and Drug
Services Division, Mental
Health Systems, Inc.,
San Diego, California, USA.
This work was supported by
grants from the United States
Substance Abuse and Mental
Health Services Administration
(TI018361), the National
Institute of Mental Health
(MH072961) and the Centers
for Disease Control and
Prevention (CE001556). The
authors thank Amanda
Zimmerman, BA for her
ethnographic work, Mark
Chaffin, PhD for his guidance
on issues of fidelity and drift,
and the staff and residents of
the substance abuse treatment
center for their participation in
this project. Parts of this paper
were presented at the 118th
annual convention of the
American Psychological
Association (2010).

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