Article  |  Evidence-Informed Practices

Implementation Science in Criminal Justice: How Implementation of Evidence-based Programs and Practices Affects Outcomes

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Introduction

Criminal and juvenile justice systems are increasingly training staff in evidence-based practices and programs (EBPs) to enhance public safety.[1] EBPs incorporate objective and reliable research and data to guide policy and practice decisions, with the aim of improving outcomes.[2] State and federal legislatures continue to expand their support for integrating EBPs through the provision of funding.[3] While EBPs can contribute to increased public safety, reduced recidivism, and increased accountability, they must be implemented with fidelity—adherence to their core components with regular training—and make plans to ensure sustainability.

Despite the promise of EBPs, their success is varied, limited by a lack of organizational capacity to effectively implement and sustain them. An evidence-based approach is needed not only on the selection of the EBP, but also on successful implementation with both short- and long-term sustainability plans. Implementation science examines how EBPs can be best implemented and how implementation affects immediate and future outcomes.

Policymakers, researchers and practitioners must also focus on maintaining fidelity to the core components of EBPs and how, aside from training, the practicing agency intends to move forward with full implementation and long-term sustainability. When translating research into practice, real-world outcomes and benefits are significantly shaped by program quality, organizational development, policy alignment, and quality of implementation, or how the new policy, program, or practice is integrated into an organization, funded, executed, and evaluated.[4]

What are Evidence-Based Practices?

EBPs, while newer to the field of criminal justice and social science in general, have been used in other fields of study. EBPs originated in the medical field, applied to distinguish between effective and ineffective medical practices through scientific methods, statistical analysis, research, and patient outcomes.[5] Businesses, production and manufacturing sectors, education, public health, mental health, foster care and child well-being services, to name a few, have all moved towards utilizing EBPs.

Beginning around the late 1970s, criminal justice researchers sought to develop a systematic process to identify effective and ineffective criminal justice programs and practices; assess study quality of the current literature; and analyze how the current literature’s methodological quality supports, or does not support, its outcomes (i.e., the strength and accuracy of outcomes). [6]

Although the terms evidence-based practices and evidence-based programs are frequently used interchangeably, they have slightly different meanings. Evidence-based practices are skills, techniques, strategies, policy initiatives, or core intervention components that have accumulated a significant amount of supporting research through high-quality process and outcome evaluations. [7] Evidence-based programs consist of structured, multi-faceted interventions, comprised of coordinated services or practices, designed to target complex client/consumer problems. [8] Essentially, evidence-based programs help provide the framework for evidence-based practices. For example, Aggression Replacement Training (ART) is an evidence-based program that helps increase prosocial behavior in chronically violent and aggressive youth and adolescents. [9] Evidence-based practices are incorporated within ART’s three components: social skills training, anger control, and moral reasoning. [10]

To determine whether a program or practice is effective, ideally, evaluations employ a randomized experiment design, which involves the use of random assignment of participants into either the experimental group (in the program) or the control group not in the program). A comparison is then made of the impact of that program or practice on similarly situated individuals. [11] Although these randomized control trials (RCT) are the “gold standard,” they can be difficult to employ in social science; it is important to always abide by ethical and methodological design considerations when employing an RCT design. [12] When an RCT is not an option, a quasi-experimental design can be employed, utilizing a comparison group that was not randomly assigned. [13] Ultimately, these studies must demonstrate causal evidence linking the practice or program with the desired outcomes, while ruling out factors other than the program or practice that may contribute to or influence outcomes or factors that may contribute to differences between groups prior to treatment. [14]

Though there is no specific, agreed upon number of studies that must be reached in order for a program or practice to be considered evidence-based, the Centers for Disease Control and Prevention (CDC) developed a guide to facilitate a common understanding of the continuum of evidence of effectiveness, which can help guide practitioners, policymakers, researchers, and other decision-makers in criminal justice. [15] Another guide, Standards of Evidence, developed by the Society for Prevention Research—provides criteria for efficacy and dissemination of evidence. [16] Generally, for something to be deemed evidence-based, the research and its outcomes should be rigorous, replicable, generalizable, and objective (Figure 1). [17]

FIGURE 1

Defining Evidence-Based Practices

Overall Effect Requirements Terminology
No Effect Little or no evidence exists through the use of reliable, rigorous, replicable, and generalizable research indicating the programs achieve what they are intended to achieve.[18] Not Evidence-Informed or Evidence-Based
Promising Some evidence exists through the use of reliable, rigorous, replicable, and generalizable research indicating the programs achieve what they are set out to achieve.[19] Evidence-Informed
Effective Strong evidence exists through use of reliable, rigorous, replicable, and generalizable research indicating programs achieve what they are set out to achieve.[20] Evidence-Based

National Resources

Once an evidence-based program or practice is identified, planning for implementation and sustainability prior to training is fundamental for the success of the organization, its staff, and its clients. It is important to consider that even the most empirically sound programs and practices can produce outcomes that are inconsistent, unsustainable, harmful, or generally undesirable when poorly implemented.[21] Research supports the necessity for fidelity and high quality implementation in order to most successfully implement and sustain EBPs.[22]

Implementation Science and Evidence-Based Programs and Practices

Before implementing an EBP, it is important to gauge an organization’s development and capacity to implement a new program.[23] This helps provide insight on organizational culture, including shared values or beliefs that govern staff within an organization, climate or how staff experience organizational culture; leadership; communication and decision-making within an organization; alignment of policies and practices with the potential adoption of a new EBP; alignment of policies and practices with the mission of the organization; and goals and strategic plan.[24]

Measuring Readiness: How Ready is your Organization to Make a Change?

Assessment is one way to measure an organization’s readiness for change, which can impact the implementation of EBPs and their success.[25] Readiness includes preparing staff at every level for the implementation and sustainability of the program or practice, as well as aligning policies and practices to support the staff and the organization in using the EBP. [26] Organizational readiness is an imperative precursor to successful implementation and sustainability—without it, change is more difficult to make and may ultimately result in a failed program.[27] Successfully implementing change can be difficult, however, with many organizational barriers impeding the process.[28]

Several factors are associated with readiness for change, including motivational readiness, institutional resources, staff attributes, and organizational climate (Figure 2). Lower levels of staff cynicism toward change, favorable perceptions of leadership, a supportive environment within the organization, and an increase in interagency networks can influence an organization’s readiness for change.[29]


FIGURE 2

Organizational Readiness Factors

”figure

Source: Texas Christian University’s Organizational Readiness for Change Tool; Lehman, W. E. K., Greener, J. M., & Simpson, D. D. (2002). Assessing organizational readiness for change. Journal of Substance Abuse Treatment, 22, 197-209.

Organizations can measure their readiness for change by using one of the following tools:

Are Your Staff Sufficiently Informed of the Change?

In order for organizations to prepare for implementation, all staff should have a clear understanding of

  • Who is in charge of managing the implementation and the EBP itself.
  • What the program or practice is —requiring the education staff and stakeholders with regard to the why and how of the program or practice.
  • The essential functions of the program or practice and how those functions are operationalized.
  • What the strategic plan looks like for short- and long-term implementation and the sustainability of the program or practice.
  • To the process for communicating questions, comments, or concerns about the program or practice.
  • The quality assurance process—or tracking of program process and outcomes on a continual basis—that assesses fidelity to the program or practice. This also helps identify any obstacles or barriers, areas that may need modification, and any gaps in information or services.[31]

Does your Organization have an Implementation team?

A cross-section of staff and stakeholders should comprise an organization’s implementation team to most successfully implement and sustain an EBP.[32] The implementation team can support implementation, sustainability, and the process of scaling-up (i.e., increasing in capacity or use of) the EBP.[33] Stakeholders and all organization staff should understand that implementation and sustainability is an ongoing, multi-stage process that often includes barriers and resistance to change. Further, support from organization leaders and upper-level staff and management, including involvement in the training process and experience or practice with line staff in the use of the program or practice, helps support broader acceptance of organizational change.[34] In particular, the implementation process can be significantly less stressful to all levels of staff when implementation efforts focus on the individual staff, agency, and system levels of implementation, making the process more inclusive and transparent from the bottom-up and the top-down.[35] One way to do this is by using NIRN’s Hexagon Tool [36], which helps organizations appropriately select and assess elements of a program or practice.

What are your Organization’s Strengths and Weaknesses?

In addition, an organization should examine its current capacity, assessing both strengths and weaknesses to understand the organization’s landscape for implementation. One way to do this is through a SWOT analysis—a group process to compile and analyze the organizations strengths, weaknesses, opportunities, and threats.[37] Such analysis can help inform strategic planning by identifying potential strategies for implementation.

During the planning process, an organization should think “big picture” on the program or practice goal to account for how change may impact the organization as a whole. Implementing change may require a holistic look at organizational policies, regulations, guidelines, procedures, and practices, and how they may align with the new change.[38] In particular, organizations should consider how:

  • The EBP connects to other parts of the organization as well as to organizational and systemic goals.
  • Current policies (organizational, local, county, state, federal) may support or conflict with the EBP—consider new policies to support EBPs while discontinuing ineffective or conflicting policies in order to align policy and practice.
  • Communication will occur within the organization and external to the organization, promoting honest and open discussion.
  • The use of data can drive decision-making. This allows for continual assessments of the organization and its goals, policies, practices, and outcomes.[39]

Strategic Planning

Assessing Implementation Drivers for Change

In addition to organizational readiness assessments, strategic planning requires assessing key “drivers” for organizational change prior to implementation and on an ongoing basis.

Organizations should assess the components that drive change within an organization, or drivers. Drivers are categorized as competency drivers, organization drivers, and leadership drivers (Figure 3).[40] These implementation drivers support organizational capacity for creating “program, practice, and systems level changes needed to achieve improved population outcomes.”[41] These drivers are compensatory and integrated in nature, working together to enhance quality, fidelity, and consistency in program implementation to improve outcomes.[42]


FIGURE 3

Implementation Drivers of Organizational Change

”figure

Figure Source: Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes: Implementation frameworks and organization change. Research on Social Work Practice, 25(4), 477-487.

Competency Drivers

Competency drivers assist in the development and enhancement of competency and confidence among staff.[43] These drivers are vital for selecting, teaching, understanding, supporting, and assessing the use of the EBP.

Staff selection refers to hiring qualified staff at all levels within the organization to train, coach, assess, and execute EBPs. Research suggests that individuals who are open to learning, obtaining, and honing in on new or previously learned skills may be more willing to learn and integrate new ways of working within their current responsibilities.[44] Further, findings from an evaluation of staff quality and program effectiveness of 64 community-based correctional facilities and halfway houses in Ohio indicated that 28 percent of program variation was explained by staff characteristics, training, and supervision; positive staff characteristics and training were associated with substantial recidivism reduction.[45]

Training, both pre-service (beginning) and in-service (continued), is the impetus for staff behavioral change in implementing and assessing a new EBP. Training is the first step in assisting the transfer of knowledge from research to practice. Training should incorporate information on EBP theory, philosophy, values, and rationales of key components and for the organization’s adoption of the EBP, and the ability to listen, watch, practice, and receive feedback on new skills. [46]

Ongoing coaching and consultation integrates newly learned concepts into practice. This can greatly increase staff competency and confidence in using the new program or practice.[47] For example, in a meta-analysis of 21 studies on motivational interviewing, skills eroded for staff who were not provided coaching and feedback post-training compared to those who were.[48] An estimated 10 percent of information is ultimately transferred from training to practice.[49] Further, in a study of probation and parole officers trained in an evidence-based supervision model, officers who were trained and coached monthly engaged in more proficient use of practices than those who were not coached after the initial training.[50]

Staff performance assessments can evaluate staff use of and fidelity to the EBP, as well as outcomes related to those processes.[51] Staff performance assessments should incorporate staff use of, competency in, and fidelity to program or practice components.[52] This helps practitioners gain better understanding of their strengths and areas for improvement and organizations gain better understanding of implementation progress and efforts.[53]

Organization Drivers

Organization drivers help create supportive environments that increase the accessibility and efficacy of staff selection, training, coaching, and performance via a supportive and welcoming administration, as well as access to funding and resources. [54] In a study of EBPs in substance use treatment, researchers found that a supportive environment for new programs and practices, training, resources, and interagency networks was related to increased use of EBPs.[55]

Decision support data systems are central in identifying and assessing key aspects of organizational performance, such as fidelity, outcomes, and quality improvement information, to support the continued improvement and efficacy of EBP implementation and sustainability.[56] This includes continuous quality improvement or CQI [57] as a way to monitor organizational processes and outcomes in order to ensure that the EBPs are delivered as intended. CQI ultimately helps organizations improve performance of current and/or new practices.[58] In addition, a quality assurance process is instrumental, as the audit helps to best identify and rectify staff deviation from EBP policy or protocol.[59]

Facilitative administrative supports are an organization’s policies, protocols, structures, culture, and climate that act to enhance, support, and facilitate organizational changes to align with staff needs.[60] To do this, leadership provides support to the organization as a whole, making use of organizational data to inform decision-making, keep staff on track, and remain focused on the successful development of skills in order to implement and successfully use a new EBP (or enhance other attempted EBP previously implemented) EBP.[61]

Systems intervention are strategies to help analyze system-level factors that support outcomes, such as the ever-changing context of federal, state, organizational, funding resources and availability, human resources, and community-level policies and practices.[62]

Leadership Drivers

Implementation of any EBP requires effective leadership to support the staff as well as the organization as a whole in obtaining desired outcomes. Leadership drivers help identify appropriate leadership skills, capabilities, and strategies in order to institute, repurpose, modify/adjust, and monitor both competency and organization drivers throughout implementation and further sustainability.[63]

Technical leadership is most common with traditional management styles that identify, clearly and precisely, strategies, problems, and solutions.[64] Technical leadership is most synonymous with effective management. It primarily deals with problems for which there is an agreed upon understanding of the nature of the problem and how to resolve it.[65]

Adaptive leadership tends to occur when the problems arise from more complex organizational conditions in which organizational actors are not all in agreement with the problem and solution. Generally, adaptive leadership styles incorporate the use of a group of people who work collaboratively to identify the problem and possible solutions.[66] The importance of leadership drivers is knowing when each type of leadership is most appropriate.[67]

The use of implementation frameworks and implementation drivers throughout the process of implementation and future sustainability is vital to the quality and effective delivery of an EBP.[68] These implementation drivers are integrated in nature; a change or adjustment in one implementation driver might necessitate change in other implementation drivers.[69] These drivers also are compensatory in nature; where there is less of one driver, another may be used to supplement. However, this should be done only after careful consideration of each implementation driver.[70]

The Challange of Adapting an EBP to Meet Local Needs and Capabilities

One challenge in implementing EBPs is knowing when or how to adapt the EBP to reflect local differences. While an EBP is the ideal, not every local, county, or state operates the same; this may result in potential barriers to implementing an EBP with fidelity, for example, for differing local policies, capacity, target population, and staff skill level.[71] Adaptations may be necessary, but it is recommended to first implement with fidelity to the original EBP. Research indicates that adaptations made after implementation were more successful than those made prior to implementation.[72] Further, adaptations must be structured around the essential functions (or core components) of the EBP in order to prevent compromising the effectiveness of the program or practice.[73] Adaptations can be done with high or low fidelity, aligning or drifting from the essential functions of the EBP.[74] Further, adaptation may be appropriate only up to a certain point; too much and the changes may result in program “drift,” transforming the EBP into something that is not an EBP.[75]

In a 2013 study of the sustainability of evidence-based school, community/family-focused, and family treatment programs, researchers noted that sustainability suffered when many changes were made to fit the program to the population, setting, and needs. [76] Most frequently, programs identified adaptations to program procedures, dose, and content.[77] The top five reasons for these adaptations were:

  • Lack of time (80 percent).
  • Limited resources (72 percent).
  • Participant retention difficulty (71 percent).
  • Resistance from implementers (64 percent).
  • Difficulty recruiting participants (61 percent).[78]

Most adaptations were reactive in nature, related to logistical fit (i.e., compatibility issues related to implementers’ or target populations’ capacity—resources, time, skills, knowledge, and schedules),[79] and were negatively aligned with—or had drifted from—the program goals and theory.[80] Another study of school-based substance use prevention programs found that, on average, teachers had more than three adaptations to the program—63 percent of which were negatively adapted (i.e., drifted from the original program theory and goals), increasing the likelihood of null or harmful effects on the youth served.[81]

In a study of an evidence-based adolescent and family programs in several sites, a majority of program modifications were related to philosophical issues—misalignment of organizational or participant values or philosophy (58 percent) —while the deletion of program components was most likely due to logistical issues—misalignment of organizational and program capacity or context (77 percent).[82] Forty-two percent of additions and changes to the program were as likely to be aligned with the program’s theory or logic model ( positively aligned) as they were to be misaligned with the program’s theory or logic model ( negatively aligned), whereas deletion of program components and functions was most likely negatively aligned with the program’s theory and goals (82 percent).[83] This suggests that program modifications involving the removal of parts of the program are more likely to misalign with the original program theory and logic model—or the components that are most effective within a program. This research suggests that adaptation to EBPs should be done in an objective manner, based on technical, theoretical, and rigorous evidence of such adaptations rather than subjective stances or individual beliefs.[84]

Conclusion

Implementation is a complex, continuous process; EBPs should be continually monitored and evaluated for efficacy and fidelity as they relate to process and outcomes. Adopting a comprehensive, multifaceted program or practice within an organizational setting must be strategically translated into a complex, ever-changing system, interplaying between EBP characteristics, providers, and organizational and service delivery settings.[85] Because criminal justice organizations are dynamic, influenced by internal and external political, social, moral, and economic pressures, it is important for organizations to build an internal capacity to deliver the program or practice and adapt or modify with the ebb and flow of the organization. This upfront planning can greatly improve not only the outcomes of the EBP, but also how staff receive these changes and ultimately use them in their day-to-day activities.

This project was supported by Award No. 13-DJ-BX-0012 awarded by the Bureau of Justice Assistance, Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author and do not necessarily reflect the views of the Department of Justice or the Illinois Criminal Justice Information Authority.

References


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  36. While the tool is framed for use in schools, it is appropriate for criminal and juvenile justice with the modification of the language in the tool to reflect criminal and juvenile justice. ↩︎
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  57. This is just one resource an organization can use to develop CQI in order to integrate frequent reporting and information related to organizational and programmatic functioning. The Plan-Do-Study-Act (PDSA) is also a great resource for implementing quality assurance planning and processes. ↩︎
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Lily Gleicher

Lily Gleicher joined ICJIA as a research analyst in the Center for Justice Research and Evaluation in July 2016. Her research interests include implementation and sustainability of evidence-based practices, correctional treatment and rehabilitation, mental and behavioral health, and criminal justice and correctional policy. Prior to joining the Authority, Lily was a research assistant at the University of Cincinnati Corrections Institute, where she trained others on the Effective Practices in Community Supervision (EPICS) model and co-authored an article for Federal Probation entitled “Creating a Supervision Tool Kit: How to Improve Probation and Parole.” The article described three similar models for effective supervision meetings between probation/parole officers and their clients supported by research findings. Lily also completed professional internships with the Lake County Therapeutic Intensive Monitoring Courts and the Probation Sex Offender Unit in Hartford, Conn. Lily received a bachelor’s degree in political science from University of Connecticut and a master’s degree in criminal justice from the University of Cincinnati. She is a University of Cincinnati Ph.D. candidate with a concentration in corrections and criminal justice systems.