Making it Happen: Understanding Factors Related to Worker and Organizational Fidelity to Family Connections, a Child Maltreatment Prevention Program

Abstract

It has been well documented that the degree to which interventions are implemented as intended, or with fidelity, in typical service settings has varied. Frequently, interventions are developed or tested in highly controlled or early adopter settings. Less attention has been given to what implementation looks like in the real world, and which factors promote a worker's ability to implement an intervention with fidelity. Individuals and organizations implementing intervention receive varying levels of support from external sources and little information from established research, and are often left to persevere through implementation efforts. It is necessary to pay attention to these factors in child maltreatment prevention to ensure that vulnerable children and families have access to, and receive when necessary, interventions as intended in agencies in their home communities. In the quantitative phase of this study, 32 case planners implementing FC, a child maltreatment preventive intervention, completed a survey about their perceptions of individual and organizational factors related to fidelity. These factors were identified through prior research and theory to be important in supporting the implementation of interventions. This survey data was connected to case level fidelity scores to understand the relationship between these variables. The qualitative phase of this study involved further exploration with nine case planner interviews and two separate focus groups with supervisors and agency leadership. The results of this study suggest that supervision is a key contributor to a worker's ability to implement an intervention in the real world. The quantitative and qualitative results suggest that various aspects of supervision, including supervisors' perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of efforts to support a worker's ability to learn and use FC. The quantitative results suggest that level of education and the perceptions of the intervention's limitations may be negatively related to implementation. Additional components also emerged from the qualitative phase that are worthy of future exploration, related to system expectations and policies, individual worker attributes, and characteristics of the intervention. Implications for practice, policy, and future research are discussed as they relate to the main findings of this study.