Hi. I’m Brian Bumbarger, an investigator at the Penn State Clearinghouse for Military Family Readiness. My background is in translational research, which is taking programs that has been proven effective and disseminating them in many communities. I’d like to thank you today for joining us for this presentation. Now let's begin.
In this webinar, we're going to be discussing the importance of high quality program delivery when offering programs to support families.
Improvements in our understanding about what creates strong families has lead to the development of a growing number of family strengthening programs that have demonstrated effectiveness in well-designed research studies. However, when these programs are delivered in a non-research setting we often find that they're rarely implemented the way they were meant to be. In very few communities are measuring or monitoring implementation quality or fidelity. Quality assurance typically isn’t seen as a good use of resources. Some argue that it is important to allow for the adaptation of program to meet the specific needs of a community, while others argue that absolute fidelity is important to achieve the best outcomes from programs. Regardless, the fact remains that it takes intentional effort and careful planning to ensure the programs are implemented as they were intended.
Why does fidelity matter? First and foremost, it matters because quality implementation is clearly related to positive outcomes which is what we're all after: Improving outcomes for children and families. A growing number of research studies have found the strong relationship between better quality implementation and better outcomes. Measuring and monitoring fidelity provides important information about the feasibility of programs. In other words, whether these programs can be delivered effectively under real-world conditions. Most importantly, fidelity enables us to attribute outcomes to the program. Without information about how well a program is delivered, we can’t answer the most basic question: Is what we're doing making any difference?
Poor quality or adaptation can occur. Sometimes there isn't enough time to deliver all of the programs' content, or there may be insufficient resources, or difficulty recruiting families or youth. The staff delivering the program may not have had sufficient training or they may be a very good at the mechanics of delivering the program, but don't fully understand the program’s underlining theory of behavior change. If staff don’t believe in the program’s effectiveness or relevance, they may just be going through the motions or may not deliver the program in an engaging way, which is another important aspect of implementation quality. Sometimes even effective programs aren’t user friendly. An effective delivery might require a real effort on the part of program staff.
Finally, the lack of organizational or administrative support can undermine the importance of the program, and staff won't feel motivated to ensure high quality is maintained. Here are some practical strategies to ensure high quality implementation. First, adequate planning is essential, beginning well before program delivery begins. All staff involved should participate in planning sessions to anticipate the potential barriers of good quality program delivery and to take steps to reduce those barriers. Make sure all staff responsible for delivering the program are adequately trained. This includes training in the mechanics of delivering the program, but also ensuring staff have a good understanding of the program's theory of change, or how the program's lessons and activities are tied to the desired program outcomes.
When staff have a clear understanding of the program's underlying theory, they are are better able to respond when barriers arrive, and to make adaptations that don’t reduce the program's effectiveness. Whenever possible, use peer coaching and observation to give program staff the opportunity to watch others delivering the program and to get constructive feedback from their colleagues or from experienced trainers or mentors. Make sure that there are also structured opportunities to debrief after these observations. Likewise, create specific processes and structures for maintaining and assessing program implementation quality. This communicates to everyone involved that this is a valued program and that maintaining high standards of quality is important. Finally, give staff the resources to know how well they're doing, and the resources to improve in areas where they may be struggling. This creates a desire among staff to strive for excellence in program delivery and program outcomes.
This concludes our webinar on improving implementation quality and fidelity.