The good coach: implementation and sustainment factors that affect coaching as evidence-based intervention fidelity support

Date19 March 2018
Published date19 March 2018
DOIhttps://doi.org/10.1108/JCS-09-2017-0043
Pages1-17
AuthorLara M. Gunderson,Cathleen E. Willging,Elise M. Trott Jaramillo,Amy E. Green,Danielle L. Fettes,Debra B. Hecht,Gregory A. Aarons
Subject MatterHealth & social care,Vulnerable groups,Children's services,Sociology,Sociology of the family,Children/youth,Parents,Education,Early childhood education,Home culture,Social/physical development
The good coach: implementation
and sustainment factors that affect
coaching as evidence-based
intervention fidelity support
Lara M. Gunderson, Cathleen E. Willging, Elise M. Trott Jaramillo, Amy E. Green,
Danielle L. Fettes, Debra B. Hecht and Gregory A. Aarons
Abstract
Purpose Evidence-based interventions (EBIs) for human services unfold within complicated social
and organizational circumstances and are influenced by the attitudes and behaviors of diverse stakeholders
situated within these environments. Coaching is commonly regarded as an effective strategy to
support service providers in delivering EBIs and attaining high levels of fidelity over time. The purpose of
this paper is to address a lacuna in research examining the factors influencing coaching, an important EBI
support component.
Design/methodology/approach The authors use the Exploration, Preparation, Implementation, and
Sustainment framework to consider inner- and outer-context factors that affect coaching over time. This case
study of coaching draws from a larger qualitative data set from three iterative investigations of implementation
and sustainment of a home visitation program, SafeCare®. SafeCare is an EBI designed to reduce
child neglect.
Findings The authors elaborate on six major categories of findings derived from an iterative data coding
and analysis process: perceptions of goodand badcoaches by system sustainment status; coach as
peer; in-house coaching capacity; intervention developer requirements vs other outer-context needs; outer-
context support; and inner-context support.
Practical implications Coaching is considered a key component for effective implementation of EBIs in
public-sector systems, yet is under-studied. Understanding inner- and outer-context factors illuminates the
ways they affect the capacity of coaches to support service delivery.
Originality/value This paper demonstrates that coaching can accomplish more than provision of EBI
fidelity support. Stakeholders characterized coaches as operating as boundary spanners who link inner and
outer contexts to enable EBI implementation and sustainment.
Keywords Coaching, Consulting, Implementation science, Child neglect, Evidence-based intervention,
Home visitation
Paper type Research paper
1. Introduction
Implementation of evidence-based interventions (EBIs) health or human service interventions
supported by rigorous scientific research represents an increasingly accepted strategy for
improving the wellbeing of families at risk for child maltreatment (Novins et al., 2013). However, it
has long been known that the implementation of EBIs within day-to-day service delivery milieus is
often inconsistent and ineffective, underscoring the challenges of transferring science to service
(Horwitz et al., 2010; Novins et al., 2013). Researchers consider the implementation of innovative
human service technologies, such as EBIs, to be more complicated than other types of
technology, because they are delivered by individuals and organizations within complex,
Received 11 September 2017
Revised 22 December 2017
Accepted 20 March 2018
Lara M. Gunderson,
Cathleen E. Willging and
Elise M. Trott Jaramillo are
based at Behavioral Health
Research Center of the
Southwest, Pacific Institute
for Research and Evaluation,
Albuquerque, New Mexico,
USA.
Amy E. Green and Danielle L.
Fettes are based at theChild
and Adolescent Services
Research Center, University of
California, San Diego,
California, USA.
Debra B. Hecht is based at the
Section of Developmental and
Behavioral Pediatrics,
University of Oklahoma Health
Sciences Center, Oklahoma
City, Oklahoma, USA.
Gregory A. Aarons is based at
the Child and Adolescent
Services Research Center,
University of California, San
Diego, California, USA.
DOI 10.1108/JCS-09-2017-0043 VOL. 13 NO. 1 2018, pp. 1-17, © Emerald Publishing Limited, ISSN 1746-6660
j
JOURNAL OF CHILDREN'S SERVICES
j
PAG E 1
multi-layered social contexts (Aarons et al., 2011; Fixsen et al., 2009). In this paper, we consider
how systematic consultation,or coaching,can assist providers and organizations in
implementing and sustaining EBIs.
Our case study of coaching, defined here as ongoing support, or technical assistance, from a
specialistto improve EBI implementationafter training (Beidas et al., 2013; Dudaand Barrett, 2013;
Kucharczyket al., 2012), draws from a larger qualitativedata set documenting implementationand
sustainment of a home visitation program, SafeCare®, an EBI to reduce child neglect (Chaffin,
Hecht, Bard, Silovsky and Beasley, 2012; Gershater-Molko et al., 2003; Whitaker et al.,2012).
Interviews and focus groups were conducted with government administrators and staff of
community-basedorganizations (CBOs)contracted to deliver SafeCarein 11 United States human
service (e.g. childwelfare) systems. We examine how stakeholder perceptionsand experiences of
coaching changed during different phases of implementation, describe the significance of these
changes, and discuss factors influencing coaching support.
Studies show that while training alone (i.e. one-shot workshops) is unlikely to result in practice
change, let alone fidelity to an EBI (Odom, 2009), there are strategies to improve adherence to
EBIs that range from didactic methods (Perepletchikova et al., 2007) to systematic review of care
such as audit and feedback (Foy et al., 2005; Ivers et al., 2012) to observations performed in vivo
or through recordings or one-way mirrors (Forgatch et al., 2005; Sheidow et al., 2008). Such
strategies vary in effectiveness (Forgatch et al., 2005; Ivers et al., 2012). Studies of audit and
feedback suggest limited evidence on reliability and how to best employ this approach, although
intensive feedback appears to enhance effectiveness (Jamtvedt et al., 2006; Foy et al., 2005).
Observation can better assess fidelity than self-report; continuous supervision, role plays, and
periodic booster trainings may also reduce deviation from intervention protocols (Perepletchikova
et al., 2007). Although potentially more costly, labor intensive, and intrusive to practitioner and
client than other strategies, observation as part of fidelity monitoring can contribute to greater
adherence to and positive outcomes for home visitation interventions (Forgatch et al., 2005;
Weiss et al., 2006).
Coaching is an implementation strategy that may involve in vivo observation, intensive feedback,
and other methods described above to support use of and fidelity to EBIs, including SafeCare
(Chaffin, Bard, Bigfoot and Maher, 2012). Researchers point to the critical role that coaching can
play in implementing and sustaining EBIs with fidelity by ensuring ongoing support after initial
training (Duda and Barrett, 2013; Edmunds et al., 2013; Fixsen et al., 2009). Coaches supply
implementation support, for example, with therapists delivering cognitive-behavioral therapy to
youth (Beidas et al., 2013), by the National Professional Development Center on Autism
Spectrum Disorders for improved EBI provision to students with autism (Kucharczyk et al., 2012),
and for preschool teachers to promote school readiness for at risk students with the Childrens
School Success Project (Odom, 2009; Odom et al., 2010). Recognized characteristics of
effective coaches include abilities to negotiate diverse stakeholder needs in hierarchically
structured organizations and service systems (Duda and Barrett, 2013), and to cultivate the
attitudes and behaviors among frontline workers that are most likely to result in successful
implementation (Kucharczyk et al., 2012). Adequately trained and supported coaches can build
trust, develop productive relationships, and create accountability for EBI implementation
outcomes (Duda and Barrett, 2013).
Although researchers suggest that coaching improves fidelity to EBIs, the specific strategies and
interactions by which coaching contributes to desired outcomes is unclear (Beidas et al., 2013).
EBIs are only as good as the support systems in place to ensure their integration into practice
(Odom, 2009), and more research is needed to shed light on the nuances of implementing these
systems (Fixsen et al., 2005, 2009). Our study offers a unique opportunity to examine coaching
as a support system by exploring the situated pe rspectives of multiple stakeholders
implementing the same EBI in varied service systems.
1.1 Conceptual framework
Several frameworks define implementation as a complicated process involving a series of stages
and factors at multiple levels, i.e., system, organization, provider, and client (Aarons et al., 2011;
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