title: Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial.
abstract: BACKGROUND
  Much is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices. This paper presents outcomes from a randomized implementation trial of Multidimensional Treatment Foster Care (MTFC) in child public service systems in California and Ohio, including child welfare, juvenile justice, and mental health.
  
  
  METHODS
  Fifty-one counties were assigned randomly to one of two different implementation strategies (Community Development Teams (CDT) or independent county implementation strategy (IND)) across four cohorts after being matched on county characteristics. We compared these two strategies on implementation process, quality, and milestone achievements using the Stages of Implementation Completion (SIC) (Implement Sci 6(1):1-8, 2011).
  
  
  RESULTS
  A composite score for each county, combining the final implementation stage attained, the number of families served, and quality of implementation, was used as the primary outcome. No significant difference between CDT and IND was found for the composite measure. Additional analyses showed that there was no evidence that CDT increased the proportion of counties that started-up programs (i.e., placed at least one family in MTFC). For counties that did implement MTFC, those in the CDT condition served over twice as many youth during the study period as did IND. Of the counties that successfully achieved program start-up, those in the CDT condition completed the implementation process more thoroughly, as measured by the SIC. We found no significant differences by implementation condition on the time it took for first placement, achieving competency, or number of stages completed.
  
  
  CONCLUSIONS
  This trial did not lead to higher rates of implementation or faster implementation but did provide evidence for more robust implementation in the CDT condition compared to IND implementation once the first family received MTFC services. This trial was successful from a design perspective in that no counties dropped out, even though this study took place during an economic recession. We believe that this methodologic approach of measurement utilizing the SIC, which is comprised of the three dimensions of quality, quantity, and timing, is appropriate for a wide range of implementation and translational studies.
  
  
  BACKGROUND
  Trial ID: NCT00880126 (ClinicalTrials.gov).
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Dr, 10th Floor, Chicago, IL, 60611, USA. hendricks.brown@northwestern.edu.
authors.forename: C Hendricks
authors.initials: CH
authors.lastname: Brown
authors.affiliation: Oregon Social Learning Center, 10 Shelton Mcmurphey Blvd, Eugene, OR, 97401, USA. pattic@oslc.org.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chamberlain
authors.affiliation: Oregon Social Learning Center, 10 Shelton Mcmurphey Blvd, Eugene, OR, 97401, USA. lisas@oslc.org.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saldana
authors.affiliation: Oregon Social Learning Center, 10 Shelton Mcmurphey Blvd, Eugene, OR, 97401, USA. courtp@oslc.org.
authors.forename: Courtenay
authors.initials: C
authors.lastname: Padgett
authors.affiliation: University of South Florida, 13201 Bruce B Downs MDC 56, Office 2130, Tampa, FL, 33612, USA. wwang@health.usf.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Dr, 10th Floor, Chicago, IL, 60611, USA. gracelyn.cruden@northwestern.edu.
authors.forename: Gracelyn
authors.initials: G
authors.lastname: Cruden
mesh_terms: D002140:California; D002648:Child; D002669:Child Welfare; D002983:Clinical Competence / Q000592:standards; D016000:Cluster Analysis; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D005581:Foster Home Care / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000592:standards*; D006801:Humans; D009820:Ohio; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards