4 - (SYM 69) Using Periodic Reflections and Rapid Analysis to Evaluate Implementation Progress

Background: Child Advocacy Centers (CACs) use multidisciplinary teams to provide coordinated interagency responses to child abuse allegations. Effective teamwork is critical. In a prior study, we adapted and piloted a team training intervention for CACs (TeamTRACS). Participants described a need for more structured follow-up after the training workshop to support the team in taking actions to improve teamwork. The goal of this study was to evaluate use of a self-guided implementation approach that requires few resources and is designed to build local capacity for change in teams serving high-need/low-resource areas.

Method: We conducted a cluster-randomized RCT with 6 rural CACs in the southern US. CACs randomized to the intervention condition (n = 4) were offered a TeamTRACS workshop and a companion implementation guide. The guide includes multiple discrete implementation strategies (e.g., organize implementation teams, develop an implementation blueprint). Each specific step includes key actions, tools and resources, tips for success, and questions to answer before moving to the next step. Activities are designed to be completed by “change team” members at each CAC. We conducted monthly periodic reflections with key informants in each CAC throughout implementation to obtain detailed information on the implementation process as it occurred, feedback on the implementation guide, and suggestions for improvement. We used rapid analysis to create interview summaries using a spreadsheet template. The template listed multiple domains (e.g., implementation progress, positive feedback, suggestions for change) and provided space for key points and exemplar quotes in each domain.
 

Results: We completed 5-6 periodic reflections in each CAC over 6 months of implementation. Participants were comfortable reflecting on their progress and provided substantial feedback. Participants appreciated the structure of the guide. Only 1 of 4 teams completed all steps by study end. Across teams, early engagement of a “change team” appeared to be a key facilitator of implementation progress.

Conclusions: A structured, self-guided implementation strategy is a feasible approach to support implementation and build local capacity for change in low-resource settings. Periodic reflections and rapid analysis are useful, flexible methods for evaluating progress in (near) real-time. Results were used to make iterative improvements during implementation and will inform ongoing refinement of the implementation guide.