Let’s talk about adaptation! How individuals discuss adaptation during evidence-based practice implementation
| Date | 28 November 2019 |
| DOI | https://doi.org/10.1108/JCS-05-2018-0010 |
| Pages | 266-277 |
| Published date | 28 November 2019 |
| Author | Rebecca Lengnick-Hall,Karissa Fenwick,Michael S. Hurlburt,Amy Green,Rachel A. Askew,Gregory A. Aarons |
| Subject Matter | Health & social care,Vulnerable groups,Children's services,Sociology,Sociology of the family,Children/youth,Parents,Education,Early childhood education,Home culture,Social/physical development |
Let’s talk about adaptation! How
individuals discuss adaptation during
evidence-based practice implementation
Rebecca Lengnick-Hall, Karissa Fenwick, Michael S. Hurlburt, Amy Green,
Rachel A. Askew and Gregory A. Aarons
Abstract
Purpose –Researchers suggest that adaptation should be a planned process, with practitioners actively
consulting with program developers or academic partners, but few studies have examined how adaptation
unfolds during evidence-based practice (EBP) implementation. The purpose of this paper is to describe
real-world adaptation discussions and the conditions under which they occurred during the implementation
of a new practice across multiple county child welfare systems.
Design/methodology/approach –This study qualitatively examines 127 meeting notes to understand how
implementers and researchers talk about adaptation during the implementation of SafeCare, an EBP aimed
at reducing child maltreatment and neglect.
Findings –Several types of adaptation discussions emerged. First, because it appeared difficult to get staff
to talk about adaptation in group settings, meeting participants discussed factors that hindered adaptation
conversations. Next, they discussed types of adaptations that they made or would like to make. Finally, they
discussed adaptation as a normal part of SafeCare implementation.
Research limitations/implications –Limitations include data collection by a single research team member
and focus on a particular EBP. However, this study provides new insight into how stakeholders naturally
discuss adaptation needs, ideas and concerns.
Practical implications –Understanding adaptation discussions can help managers engage frontline staff
who are using newly implemented EBPs, identify adaptation needs and solutions, and proactively support
individuals who are balancing adaptation and fidelity during implementation.
Originality/value –This study’s unique data captured in vivo interactions that occurred at various time
points during the implementation of an EBP rather than drawing upon data collected from more scripted and
cross-sectional formats. Multiple child welfare and implementation stakeholders and types of interactions
were examined.
Keywords Implementation, Qualitative, Adaptation, EBP, SafeCare, Home visiting program
Paper type Research paper
Introduction
Effective implementation of interventions to reduce child maltreatment and neglect requires
balancing fidelity to the intervention as designed by researchers with adaptation by the providers
delivering the intervention (Aarons et al., 2017; Lau et al., 2017; Lutzker and Casillas, 2016;
Paulsell et al., 2014). Adaptation is often needed to successfully translate new interventions into
non-research settings and ensure the practice fits the organization, client population and the
local context (Brownson et al., 2017; Damschroder et al., 2009). However, core components of
evidence-based practices (EBPs) must be implemented as intended by intervention developers
to maintain fidelity, preserve the mechanisms that made the original intervention effective, and
ensure that interventions achieve their intended client benefits (Brownson et al., 2017;
Schoenwald et al., 2011). Given the tension between fidelity and local fit, adaptations may have
positive or negative impacts on implementation, depending on the type and context of the
Received 9 May 2018
Revised 15 November 2018
27 March 2019
Accepted 3 June 2019
Rebecca Lengnick-Hall is
based at the School of Social
Work, University of Southern
California, Los Angeles,
California, USA.
Karissa Fenwick is based at the
University of Southern
California, Los Angeles,
California, USA.
Michael S. Hurlburt is based at
the School of Social Work,
University of Southern
California, Los Angeles,
California, USA.
Amy Green is based at the
Department of Psychiatry,
University of California –
San Diego, San Diego,
California, USA.
Rachel A. Askew is based at
the Student Assessment and
Research, Broward County
Public Schools, Fort
Lauderdale, Florida, USA.
Gregory A. Aarons is based at
the Department of Psychiatry,
University of California –
San Diego, San Diego,
California, USA and Child and
Adolescent Services Research
Center, San Diego,
California, USA.
PAGE266
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JOURNAL OF CHILDREN'S SERVICES
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VOL. 14 NO. 4 2019, pp. 266-277, © Emerald Publishing Limited, ISSN 1746-6660 DOI 10.1108/JCS-05-2018-0010
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