Abstract
Providers of youth care encounter problems with the implementation of interventions. This dissertation aimed to gain insight into factors that lead to successful and sustainable implementation of interventions in youth care. The first part of the dissertation provides a definition and a theoretical model that incorporates the main concepts related
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to implementation. Implementation is considered to be a systematic approach with the aim of a successful and sustainable implementation of an intervention. Regarding the success of implementation, specific attention is paid to the distinction between (1) implementation in the narrow sense – to carry out the intervention as intended, designated as program integrity - and (2) implementation in a broad sense - to achieve the intended outcomes. Through the following four steps a planned and phased approach is guaranteed: (1) define the desired outcome in a narrow and broad sense, (2) analyze the determinants (3) select strategies and (4) monitor, evaluate and adjust the process. Interviews with experts show that although various implementation activities were used in practice, these activities do not seem to be selected very systematically. The second part of the dissertation shows the ‘implementation monitor’, a schematic representation of an implementation process of a particular intervention in a specific organization. The monitor can be used to design, conduct, analyze and present research on implementation. This part also focuses on psychometric quality of two research instruments, the Decision Determinants Questionnaire (DDQ) and the questionnaire ‘Vragenlijst Kerncomponenten’. The DDQ measures readiness to change of employees in an organization. The ‘Vragenlijst Kerncomponenten’ is designed to gain insight into skills of youth care professionals and as a tool to discuss these skills between the professionals and their supervisors. In the third part of the dissertation contains two empirical studies on implementation. Firstly, the implementation of the intervention ‘Methodiek Ambulante Hulp’ within Jeugdformaat. Data were collected using questionnaires and structured interviews with 253 clients, 59 professionals and their supervisors. This study gave insight into the process of implementing an intervention. Furthermore, it shows relevant correlations between determinants of that implementation process and implementation in the narrow sense (program integrity) and in the broad sense (child outcomes). Secondly, a study on the implementation in the narrow sense of the intervention ‘Deltamethode Gezinsvoogdij’, a method for family guardianship at Bureau Jeugdzorg. The dissertation ends with a discussion, containing conclusions regarding the research questions, a summary of main findings for research and practice, limitations of the study and implications for further research and for the practice of youth care in the Netherlands. Amongst other findings, it is argued that the evidence for determinants of successful implementation is scarce, that this dissertation shows that implementation is a complex process in which various characteristics influence how the process proceeds and that an intervention can only help children and parents if it fits the needs of the client and if providers of the intervention are properly supervised. To conclude: implementation of an intervention should be well-thought
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