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  • Implementation and Fidelity in Evidence-Based Practice

Implementation and Fidelity in Evidence-Based Practice

One of the most important considerations when implementing an evidence-based practice is fidelity (sometimes called adherence or integrity) to the original approach. Preserving the components that made the original practice effective can directly impact the success of desired outcomes. The resources on this page highlight the need to maintain model fidelity and discuss implementation strategies and challenges, including the need to balance service effectiveness with client needs, and manage resistance that may undermine the adoption of an evidence-based approach. Implementation considerations relating to the Family First Prevention Services Act are also included. 

  • Ensuring fidelity
  • Implementation challenges 

Ensuring fidelity

Evidence-Based Practice Is a Process 
Faulkner & Parrish (2018) 
The University of Texas at Austin, Texas Institute for Child & Family Wellbeing
Explains the need to look at evidence-based practice as a process to avoid implementation problems and chaos. The article discusses the need to match evidence-based practice with the needs of the client and how enacting programs with fidelity can mean modifications must be approved and/or programs may be tailored as long as the primary components of the intervention are left intact. 

The Good Coach: Implementation and Sustainment Factors That Affect Coaching as Evidence-Based Intervention Fidelity Support (PDF - 226 KB) 
Gunderson, Willging, Trott Jaramillo, Green, Fettes, Hect, & Aarons (2018)
Journal of Children's Services, 13(1)
Examines the use of coaching as an effective strategy to support child welfare service providers and organizations in implementing and delivering evidence-based interventions and attaining high levels of fidelity. 

Implementation Oversight for Evidence-Based Programs: A Policymaker's Guide to Effective Program Delivery
Pew Charitable Trusts (2016)
Focuses on the implementation of evidence-based programs, why organizations struggle with implementation, how to overcome challenges during program implementation, and more. 

Implementation Science and Fidelity Measurement: A Test of the 3-5-7 Model™ (PDF - 1,679 KB) 
Denby-Brinson, Tudor, Henry, Wolfe, Gomez, & Alford (2017)
The Lincy Institute Research Brief, 8
Examines the results of a 5-year Federal project guided by implementation science that sought to improve well-being in youths age 12–21 involved in the child welfare system. The 3-5-7 Model™, a strengths-based approach that empowers children and families to engage in grieving and integrating significant relationships, was studied and a fidelity system was created to test the model.

Towards Creating Synergy Among Policy, Procedures, and Implementation of Evidence-Based Models in Child Welfare Systems: Two Case Examples (PDF - 76 KB) 
Chamberlain (2017)
Clinical Child and Family Psychology, 20(1) 
Describes two child welfare case studies in which child welfare system leaders worked with evaluators and model developers to implement evidence-based practices and integrate research-based parenting skills into routine services provided to families. Fidelity to the original KEEP (Keeping Foster and Kin Parents Supported and Trained) parenting curriculum was monitored closely and measured to ensure adherence to the original approach and consistency. 

Watch Our Webinar: Adapting Evidence-Based Programs in Child Welfare
Annie E. Casey Foundation (2018) 
Offers a webinar for child welfare leaders and program developers on how to adapt an evidence-based intervention to their needs. The webinar describes how in order to get the best outcome, programs may need to be adjusted while remaining faithful to the original model. 

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Implementation challenges

Applying the Research and Evaluation Provisions of the Family First Prevention Services Act (PDF - 359 KB)
McKlindon (2019) 
Child Trends 
Discusses research and evaluation requirements of the Federal Family First Prevention Services Act of 2018. The law includes specific requirements around evidence-based programs and tools, expands opportunities to use research, and encourages data-driven decision-making in child welfare. 

Bringing Culture to Implementation: The Tribal REDI Pilot Study
Annie E. Casey Foundation (2017)
Discusses how cultural considerations are often overlooked during the implementation of evidence-based programs and provides an example of a program working with Native American communities that allows teachers and representatives involved to identify and enact cultural adaptations. 

Evidence-Based Practice Is a Process 
Faulkner & Parrish (2018) 
The University of Texas at Austin, Texas Institute for Child & Family Wellbeing
Explains the need to look at evidence-based practice as a process to avoid implementation problems and chaos. The article discusses the need to establish clearly who decides what is evidence, who controls access to evidence-based programming, how to ensure the practice being used matches client needs, and more. 

Funding Effective Implementation of Evidence-Based Programs in Child Welfare
Annie E. Casey Foundation (2017) 
Examines the implementation of evidence-based practices in child welfare and discusses strategies that will help overcome challenges and successfully fund and sustain these programs. 

Implementing the Family First Prevention Services Act
Children's Defense Fund (2020) 
Presents a guide to the Family First Prevention Services Act, which is designed to provide a starting point for implementation efforts of child welfare agencies, policymakers, and other stakeholders. The guide contains a section devoted to evidence-based programs starting on page 18 that reviews how the law promotes evidence-based programs, how the evidence-based standards were developed, quality improvement requirements for evidence-based services and more. 

Lessons Learned When Building the Evidence for a Child Welfare Practice Model
Rushovich & Malm (2019) 
ChildTrends
Highlights evidence-building lessons learned from the evaluation of a postreunification program, Success Coach, in North Carolina. The resource explores key challenges related to implementation of the program and evaluation, and it suggests solutions. 

Perceptions Among Child Welfare Staff When Modifying a Child Mental Health Intervention to Be Implemented in Child Welfare Services
Gopalan, Hooley, Winters, & Stephens (2019)
American Journal of Community Psychology, 63(4) 
Examines the perception of child welfare practitioners who were involved in the implementation of evidence-based programs in child welfare prevention settings. The child welfare staff reported several challenges, including difficulty engaging families, heavy workloads, and conflicting implementation initiatives. 

Special Foreword: Making Research Work in Child Welfare: Overcoming Challenges
DuMont & James-Brown (2017)
Child Welfare League of America 
Explores how to improve the use of evidence-based practices and research in the child welfare field in ways that benefit children and families. 

What's Standing in the Way of Evidence-Based Programs? (PDF - 454 KB) 
Neuhoff, Loomis, & Ahmed (2017) 
The Bridgespan Group 
Presents the results of a study that examines challenges to the success of evidence-based programs and finds that most original developers or creators of these practices are not doing enough to ensure large-scale implementation and expand their reach.  

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