The past two decades have seen an explosion in the development and evaluation of parenting programs and other preventive and early interventions. As service providers have begun to take on the challenge of delivering these evidence-based programs in the community, new questions are being asked. Does it matter whether programs are chosen from the “top down” or “bottom up”? How well do service providers adhere to program protocols – and why do they deviate?

A recent study takes some steps toward answering these questions by exploring agency administrators and service providers’ perspectives about the adoption of a well-known evidence-based parenting program in Ontario, Canada.

The goal, say two psychologists from the University of Ottowa, is to find better information on implementation that will help prevention scientists take the crucial next steps – to adapt evidence-based programs developed in the lab so that they are more effective in the real world.

The researchers surveyed 63 administrators and 215 service providers from 69 agencies. Agency administrators were asked who chose the program: was it initiated “top down” by a government body, or chosen “bottom up” by the agency itself? They were also asked about the agency’s readiness and resistance to adopting the intervention, and about how tightly they adhered to program protocols.

Does it matter, then, whether programs are initiated by government funders, or chosen by local agencies themselves? The analysis found no significant difference in openness or readiness between those agencies that took a “bottom up” approach – some two-thirds of the agencies surveyed – and those who were asked by government to implement it.

In addition, regardless of how the intervention was initiated, the study reported a measure of resistance from key stakeholders. “Even when staff are open to discussing new ideas, when the time comes to actually implement behavioral change, they may express resistance,” the authors say. Moreover, almost half of the agencies described themselves as “not being ready before implementation.”

Encouragingly, service providers often reported very high levels of adherence (that is, delivering the program according to the program protocols). The average adherence rate was 86%, and more than a third of the participants reported adherence scores of 100% - although some reported scores as low as 33%. When service providers didn’t follow program protocols, why did they deviate? The most common reasons for lower rates of adherence were a lack of time in the session to complete all of the components, and a decision that a component was not relevant for particular participants.

This study raises a number of crucial questions about why programs are chosen and how implementation actually occurs. While more research will be needed, the researchers encourage psychologists and others involved in the implementation process to provide practical preparation such as securing funding, materials, space, supervision and peer support, and evaluating frameworks. In addition, they urge implementers to “expect some resistance and be ready to address concerns… Anticipating, acknowledging, and allowing for resistance may be valuable strategies in helping agencies to persist in their implementation efforts.”

Source
Asgary-Eden, V., & Lee, C.M. (2011). So now we’ve picked an evidence-based program, what’s next? Perspectives of service providers and administrators. Professional Psychology: Research and Practice, 42(2), 169-175.