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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.

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.

The authors elaborate on six major categories of findings derived from an iterative data coding and analysis process: perceptions of “good” and “bad” coaches 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.

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.

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.

The purpose of this paper is twofold: first, to identify the types of adaptations made by service providers (i.e. practitioners) during a large-scale US statewide implementation of SafeCare®, an evidence-based intervention to reduce child neglect; and second, to place adaptations within a taxonomy of types of adaptations.

Semi-structured interviews and focus groups were conducted with 138 SafeCare providers and supervisors. Grounded theory methods were used to identify themes, specific types of adaptations and factors associated with adaptation.

Adaptations were made to both peripheral and core elements of the evidence-based practice (EBP). The taxonomy of adaptations included two broad categories of process and content. Process adaptations included presentation of materials, dosage/intensity of sessions, order of presentation, addressing urgent concerns before focusing on the EBP and supplementing information to model materials. Content adaptations included excluding parts of the EBP and overemphasizing certain aspects of the EBP. Adaptations were motivated by client factors such as the age of the target child, provider factors such as a providers’ level of self-efficacy with the EBP and concerns over client/provider rapport. Client factors were paramount in motivating adaptations of all kinds.

The present findings highlight the need to examine ways in which adaptations affect EBP implementation and sustainment, client engagement in treatment, and client outcomes.

Implementers and EBP developers and trainers should build flexibility into their models while safeguarding core intervention elements that drive positive client outcomes.

This study is unique in examining and enumerating both process and content types of adaptations in a large-scale child neglect implementation study. In addition, such adaptations may be generalizable to other types of EBPs.

Clinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.

Survey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader–member exchange with organizational climate and turnover intentions.

Lower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.

This study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader–follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor–supervisee relationships.

Researchers suggest that adaptation should be a planned process, with practitioners actively consulting with program developers or academic partners, but few studies have examined how adaptation unfolds during evidence-based practice (EBP) implementation. The purpose of this paper is to describe real-world adaptation discussions and the conditions under which they occurred during the implementation of a new practice across multiple county child welfare systems.

This study qualitatively examines 127 meeting notes to understand how implementers and researchers talk about adaptation during the implementation of SafeCare, an EBP aimed at reducing child maltreatment and neglect.

Several types of adaptation discussions emerged. First, because it appeared difficult to get staff to talk about adaptation in group settings, meeting participants discussed factors that hindered adaptation conversations. Next, they discussed types of adaptations that they made or would like to make. Finally, they discussed adaptation as a normal part of SafeCare implementation.

Limitations include data collection by a single research team member and focus on a particular EBP. However, this study provides new insight into how stakeholders naturally discuss adaptation needs, ideas and concerns.

Understanding adaptation discussions can help managers engage frontline staff who are using newly implemented EBPs, identify adaptation needs and solutions, and proactively support individuals who are balancing adaptation and fidelity during implementation.

This study’s unique data captured in vivo interactions that occurred at various time points during the implementation of an EBP rather than drawing upon data collected from more scripted and cross-sectional formats. Multiple child welfare and implementation stakeholders and types of interactions were examined.

The purpose of this paper is to examine the experiences of Latino clients following a naturalistic cultural adaptation made to SafeCare, an evidence-based home visiting intervention designed to address specific linguistic and cultural issues affecting the Latino community during implementation in San Diego County, California.

Hierarchical linear models examined whether Latino clients experienced differences in perceptions of SafeCare delivery, working relationship with the home visitor and satisfaction with services when compared with non-Latino clients and whether language of service delivery and provider-client ethnic match were related to Latino clients’ experiences of the intervention.

Overall, across several different dimensions, there was no decrement in experience with SafeCare for Latino clients compared to non-Latino ones, implying that adaptations made locally adequately engaged Latino and Spanish-speaking clients in services without compromising perceived adherence to the programme model.

Because this was a non-experimental study, conclusions could not be drawn as to whether the locally adapted SafeCare would fare better in Latino client ratings than SafeCare unadapted. However, the findings are important because they contradict concerns that EBPs may not be relevant to diverse client groups, and support the idea that when adaptations are made, it is possible to maintain adherence at the same level of adherence as when the programme is delivered in its non-adapted form.

The study explicitly documents and generates knowledge around an organic adaptation made in a community to an evidence-based intervention for a client group about whom there has been documented concern regarding the relevance of and engagement in services.

Evidence‐based practices (EBPs) are increasingly being implemented in real‐world settings. While intervention effectiveness is dependent on fidelity, interventions are often adapted to service settings according to the needs of stakeholders at multiple levels. This study aims to examine the naturalistic implementation of The Incredible Years (IY) parenting programme in a residential substance abuse treatment programme for pregnant and parenting women.

The study took place in a residential substance abuse treatment programme serving pregnant and parenting women and their children. Participants included 120 female clients. The primary IY facilitator was a master's level counselling psychologist. In person observations of IY sessions were completed by a trained bachelor's level anthropologist. Ethnographic field notes were collected and then coded in keeping with a priori themes and to identify emergent themes. The Parent Group Leader Checklist was used to evaluate quality and integrity of the IY basic parent programme.

Quantitative analyses indicate that fidelity varied by type of checklist activity. Specifically, adherence to the IY programme was highest in beginning topic activities, setup, and home activity review, and lowest in role play, vignettes, and wrap‐up activities. Qualitative analyses revealed a number of adaptations in implementation of IY. Adaptations fit into two broad categories: modification of programme delivery and modification of programme content. Within each of these categories modifications included organisation‐driven adaptations, provider‐driven adaptations, and consumer‐driven adaptations.

Changes to evidence‐based practice generally take two forms – adaptations consistent with model intent and theoretical approach and changes that represent drift from core elements of the EBP. The challenge for implementation science is to develop frameworks in which models can be adapted enough to make them viable for the service context (or the service context adapted to fit the model), yet avoid drift and maintain fidelity. Attending to the complexities of adaptation prior to and during implementation in a planned way is likely to help organisations better utilise EBPs to meet their unique needs while maintaining fidelity.

The paper shows that identification of types of intervention adaptations and drift allows for consideration of systematic approaches, frameworks, and processes to increase adherence during EBP implementation in community mental health and substance abuse treatment settings.

The purpose of this paper is to examine the implementation and adaptation of group Triple P, an evidence-based parenting intervention developed in Australia, for a Latina population living in the USA.

Mothers with pre-school age children participated in the programme, which was offered by a community mental health agency. The final study sample consisted of 174 Latina mothers.

Participation in group Triple P was associated with clinically significant improvements in maternal mental health, parenting styles, and child behaviour problems. Additionally, mothers reported high levels of satisfaction with the programme.

Triple P is a promising intervention for Latina caregivers who are concerned about the behaviour of their young children. It can be implemented successfully into community-based mental health care systems.

This is the first study to examine the applicability of Triple P to Latina caregivers.

The concerns that implementing a new structured innovation with increased oversight may lead to reduced job autonomy and poorer work attitudes. These concerns have been cited as a barrier to evidence-based treatment (EBT) implementation. However, previous research found lower turnover among child welfare providers implementing an EBT with fidelity monitoring compared to those administering services as usual (SAU). The authors hypothesized that changes in job autonomy, job satisfaction, and organizational commitment would be no worse among providers in EBT conditions and fidelity monitoring conditions compared to SAU and no monitoring conditions.

Survey data were collected from 208 service providers over four waves at six month intervals as part of a 2 (EBT vs SAU) by 2 (fidelity monitoring vs no monitoring) hybrid effectiveness-implementation trial. Superiority testing was conducted to determine whether there were significant differences over time on the outcomes as a function of experimental condition. Non-inferiority testing examined whether the EBT condition is not inferior to SAU and monitoring not inferior to no monitoring on the outcomes.

No evidence of superiority was found for any conditions over time on the outcomes. Non-inferiority testing indicates EBT is not inferior to SAU and monitoring is not inferior to no monitoring on the outcomes.

This study provide empirical quantitative data regarding job attitudes and job autonomy perceptions over time following EBT implementation. In light of the current findings, concerns regarding the impact of EBT implementation on provider job perceptions should be minimized.