Maximizing Pilot Phase Measures to Inform Quality Improvement: Using a Sequential Mixed-Methods Design With Interrupted Time Series to Examine Feasibility, Uptake, and Drivers of an Evidence-Based Practice in Part C/Early Intervention Systems
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Date
2019-09-18
Authors
Stegenga, Sondra
Journal Title
Journal ISSN
Volume Title
Publisher
University of Oregon
Abstract
Reviews of published research indicate only a 33% median success rate of complex systems change initiatives. This lack of uptake is becoming known as implementation failure. Social emotional interventions with infants and young children and their caregivers also have a history of high attrition rates, putting efforts focused on this area at high risk of implementation failure. This failure rate is especially pertinent because 28 of 55 states and jurisdictions providing Part C early intervention services are focusing improvement efforts on social emotional development as part of the State Systemic Improvement Planning processes. Although policy-mandated quality improvement is occurring in local, state, and federal systems, published research is lacking on quality improvement measures and implementation-focused outcomes within this population. The pilot phase of implementation holds immense potential for identifying quality improvement needs before scale-up, ultimately resulting in large potential savings of money and time by avoiding implementation failure. However, focused objective measures are often missing or underutilized within these cycles. The goal of this study was to examine factors with potential impact on implementation and uptake of an evidence-based practice (EBP) in a quality improvement project. The study focus was on the feasibility, acceptability, and appropriateness of a policy-related EBP implemented in a Part C early intervention system. Potential determinants (barriers and supports), uptake rates, and driver influence relative to the uptake were analyzed. The efficacy of these elements for improving measurement accuracy and for understanding quality improvement needs in the pilot phase of initial implementation was evaluated. Two specific research questions were addressed: “What are the feasibility, acceptability, and appropriateness of the use of an EBP (i.e., electronic social emotional assessment) used in Part C/early intervention pilot sites?” and “What is the relationship between the identified key drivers and uptake rates for the use of electronic social emotional assessments?” Key drivers identified were initial training, leadership coaching, and implementation completion rates.
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Keywords
Early Childhood Education, Early Intervention, Implementation Science, Mixed Methods, Program Evaluation, Short Interrupted Time Series