Child & Family Well-Being

An implementation framework answers the questions of what needs to be done, how to establish what needs to be done in practice, who will do the work to accomplish positive outcomes and where will effective interventions and implementation thrive. The adoption of the NIRN framework counters passive approaches for sharing knowledge or depending on basic training programs.

Implementation support builds local ownership that is not reliant on external partners. 

Child and Family Well-Being considers applications from a variety of public and private agencies willing to use an implementation framework to adopt and sustain evidence-based programs. Individual nonprofits, provider associations, county and state public agencies are typical applicants. 

In 2016, Child and Family Well-Being began funding efforts to create statewide intermediary agencies. Intermediaries are centers or partnerships that support state, regional or local agencies’ efforts to design, adopt, scale and sustain evidence-based programs. Typically, intermediary functions include: 

1. Partnership engagement and communications to ensure that the right partners are at the table;
2. Proactive and responsive implementation supports to ensure that systems are in place, such as an outcomes monitoring method;
3. Research, evaluation and data linking to ensure continuous improvement;
4. Workforce development that ensures practitioners competently and confidently deliver the program; and
5. Policy and finance that focuses on legislative and administrative environments to ensure those environments support and sustain the adoption of evidence-based programs.

Currently, Child and Family Well-Being is working with Prevent Child Abuse NC, Children’s Trust of SC and the Impact Center at the Frank Porter Graham Institute, part of the University of North Carolina at Chapel Hill, to build their capacity, either individually or in partnership, to serve as intermediaries.

Lessons Learned

Insights

The allure of evidence-based practices is compelling but implementing them successfully in new locations requires the right infrastructure to assure appropriate service delivery and results. New sites must have the financial means and human resources to provide ongoing quality assurance, training, monitoring and data collection to remain true to the fundamental tenets of an evidence-based program.

The Duke Endowment determined that its support would be best used to create or strengthen infrastructure for implementing a program, rather than simply supporting service delivery. This approach allowed the Endowment to complement the existing efforts of public funders and expand their effectiveness.

Impact

Former U.S. Surgeon General David Satcher said that it takes roughly 17 years for a proven intervention strategy to take root in mainstream practice. With this initiative, the Endowment is accelerating the adoption rate of some evidence-based interventions in North Carolina and South Carolina.

For the past 11 years, the Endowment has provided more than $11 million for implementation support for the evidence-based programs noted above; it was matched by more than $25 million in federal and state funds.

More than 10,000 children and families have benefited from the supported programs. External evaluations of the evidence-based programs, executed with proper implementation support, find positive outcomes. For example, external evaluators of the Incredible Years and Strengthening Families Program tracked 21 outcomes. Each year since 2010, every outcome was statistically significant, and in the case of the Strengthening Families Program, the outcomes exceeded those of a national comparison group. The Duke Endowment’s investment in implementation averages $2,500 per family, as compared to traditional foster care costs of $35,000 per child, per year.