Responding to Adaptative Issues in the Practice Profile Development Process

July 5, 2019

Practice Profiles are a participant-driven methodology to operationalize the values and core components of an innovation. The iterative and developmental approach includes a variety of stakeholder and consumer perspectives at multiple steps in the process. The opportunity for stakeholders and consumers to share their perspectives can sometimes uncover additional aspects of an innovation in need of further clarity or reveal aspects of the organizations or system that may hinder successful implementation of the innovation once it is defined. This blog post will detail an example in which this occurred and how we responded to the stakeholder and consumer-based inquiries. 

The purpose of the Practice Profile development process in this project was to detail the values and core components of a community-based program that was being implemented throughout one state by their child welfare system. Seen as a child maltreatment prevention effort, these community-based programs were situated in neighborhood centers and worked within the community to forge connections and link families with supports and resources. The state leadership had a strong interest in prevention and supported the rapid replication of the community-based program throughout the state. As new centers developed, a lack of consistency in the programs became more apparent. Staff at some sites felt as though they were unsure of what they were supposed to be doing within the community and where to go if they needed additional support. 

The state decided to invest in developing a Practice Profile for the community-based centers in hopes of creating consistency and equity in the center efforts across the state. They wanted the opportunity for all families to experience the benefits of the centers.  A teaming structure was developed to support the work, which included a Leadership Team and Implementation Team. They included representation from key partners in the organization, as well as community-based center leaders and stakeholders. We worked with the teams to identify key stakeholders to include in the profile development process, particularly through the semi-structured interviews and vetting and consensus phases. The goal was to have full participation from all of the centers (n > 50) throughout the state. 

As we began to carry-out the steps in the practice profile methodology, inquiries about other aspects of the approach began to surface. For example, during semi-structured interviews, several participants shared that they were unclear who the centers were supposed to be serving in the community: were they supposed to serve the entire family, or was it okay to just serve particular family members? Others shared a lack of clarity around the purpose of the centers and where they were supposed to be located. Some were in communities and buildings that weren’t directly in a neighborhood; was that okay? Often times, there was uncertainty from interview participants about who to go to or how to share questions or concerns. These questions were reiterated by participants in the vetting and consensus process. The concerns and inquiries were outside of the goal of defining the values and core components of the Practice Profile, yet they were fundamental to understanding the approach. The answers to these questions seemed adaptive; there seemed to be multiple perspectives on who the centers served and how they work and at times there seemed to be competing ideas on how best to respond to the network of centers. 

We shared these revelations with the Implementation Team and agreed that the Leadership Team had the knowledge and authority to respond to these questions. The Leadership Team agreed to grapple with these questions and develop concise responses. They knew that it would require a series of discussions to reach consensus. Together, we went through a facilitated process to first individually process responses to these questions, then share our individual ideas, look for commonalities, and draft formal responses together. At times, there were differing perspectives on how to answer some of the questions. For example, the centers are supposed to be stand-alone entities within a community; the goal is for them to be separate from other service providers such as a hospital or child welfare organization. Yet, some communities have limited existing stand-alone space to house the centers. Therefore, the team had to come to consensus on how best to respond. Responses to the questions were drafted and confirmed, then shared with the network through a series of meetings and discussions to reiterate the shared communication within the effort. They have also been integrated into the published Practice Profile. 

This case example exemplifies how inclusion of multiple perspectives, particularly stakeholders and consumers, can strengthen the overall process of defining an approach, and bring clarity to aspects needed in implementation. Elevating these perspectives is one of the major strengths of the Practice Profile methodology. The methodology’s flexibility and ability to gather and respond to various perspectives is an opportunity to further define aspects of the approach that are needed for successful implementation.