Social Work - Theses

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    Implementation frameworks – their usability and limitations within child, youth and family services
    Albers, Bianca ( 2020)
    Purpose This thesis is located at the nexus of research-supported interventions (RSIs) in child and family services, evidence-based practice and implementation science. Within the context of Australian child and family services, it focuses on the implementation problem, i.e. the sector’s persistent problems with integrating evidence in routine practice. Its overarching goal is to examine how implementation frameworks have been and can be used to understand efforts to implement RSIs in this sector, and how these frameworks, and potentially any other implementation science concept, may be more effectively moved into routine child and family services in the future. Methods This research builds on a mixed-methods design and was conducted in three phases. During phase one, the scoping review method was used to identify studies conducted within child and family services and explore how implementation frameworks were used in the sector. In phase two, one particular implementation framework, the Consolidated Framework for Implementation Research, was applied to understand the barriers to the Australian implementation of multiple RSIs developed in the United States. The examination of the failed implementation of Multisystemic Therapy-Emerging Adults in New South Wales built on a case study design, whereas the early implementation of multiple US-based RSIs in Victoria was evaluated using mixed methods. Finally, during phase three, in developing a proposal for how to better bridge the implementation research-practice divide, the systematic integrative review method was instrumental for the development of a program logic for the role of implementation support practitioners. Results The use of implementation frameworks in child and family services studies has been cursory, and limited guidance is available on how to operationalize them in contexts of routine practice. The Australian experience with implementing US-based RSIs reflects that implementation frameworks insufficiently mirror the implementation challenges these interventions impose on stakeholders. While frameworks map implementation as a tidy and linear collection of determinants, real-world implementation occurs as a dynamic, both concurrent and recurrent interaction between multiple implementation factors. Particularly limited are the insights that frameworks provide to understand the role of the outer setting, containing, for example, policy dynamics, in an implementation. The role of implementation support practitioners may be a relevant strategy for integrating implementation research in routine child and family services, but the evidence surrounding their work and effectiveness is scarce and will require further consolidation. A first program logic outlining how ISPs may build implementation capacity in child and family services is presented. Conclusion To solve the implementation problem, strategies are needed that can help to create a new normal. One in which research-minded decisionmakers, operating in the child and family services sector, constantly request and use evidence in their daily routines, and practice-minded scientists work to spur this use in all areas of policy and practice. Implementation support practitioners may be one such strategy. To better understand the characteristics, activities, and contexts required for this role to be effective will be a key task for the decade ahead – both for the child and family services sector and the field of implementation science.