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      Dynamic adaptation process to implement an evidence-based child maltreatment intervention

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          Abstract

          Background

          Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.

          Methods

          This project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.

          Discussion

          The DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

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          Most cited references26

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          Issues in disseminating and replicating effective prevention programs.

          The new frontier for prevention research involves building a scientific knowledge base on how to disseminate and implement effective prevention programs with fidelity. Toward this end, a brief overview of findings from the Blueprints for Violence Prevention-Replication Initiative is presented, identifying factors that enhance or impede a successful implementation of these programs. Findings are organized around five implementation tasks: site selection, training, technical assistance, fidelity, and sustainability. Overall, careful attention to each of these tasks, together with an independent monitoring of fidelity, produced a successful implementation with high fidelity and sustainability. A discussion of how these findings inform the present local adaptation-fidelity debate follows.
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            Implementing computerized technology: an organizational analysis.

            Why do some organizations succeed and others fail in implementing the innovations they adopt? To begin to answer this question, the authors studied the implementation of manufacturing resource planning, an advanced computerized manufacturing technology, in 39 manufacturing plants (number of individual respondents = 1,219). The results of the plant-level analyses suggest that financial resource availability and management support for technology implementation engender high-quality implementation policies and practices and a strong climate for implementation, which in turn foster implementation effectiveness--that is, consistent and skilled technology use. Further research is needed to replicate and extend the findings.
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              The cross-level effects of culture and climate in human service teams

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                Author and article information

                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central
                1748-5908
                2012
                18 April 2012
                : 7
                : 32
                Affiliations
                [1 ]Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
                [2 ]Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, CA, USA
                [3 ]School of Social Work, University of Southern California, Los Angeles, CA, USA
                [4 ]Center for Healthy Development, Georgia State University, Institute of Public Health, Atlanta, GA, USA
                [5 ]Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
                Article
                1748-5908-7-32
                10.1186/1748-5908-7-32
                3436717
                22512914
                9dade350-635d-4033-9d75-93fe34c07c5c
                Copyright ©2012 Aarons et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 October 2011
                : 18 April 2012
                Categories
                Study Protocol

                Medicine
                adaptation,fidelity,public sector,evidence-based practice,child maltreatment,implementation
                Medicine
                adaptation, fidelity, public sector, evidence-based practice, child maltreatment, implementation

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