Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems

Abstract

Background: Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice.

Methods: Semi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions.

Results: Of those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network.

Conclusion: Although the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies.

Trial registration: NCT00880126.

Figures

Figure 1

Social network members by county treatment condition and implementation stage. Legend: Color: green = high implementation, yellow = moderate implementation, red = low implementatinon; Shape: triangle = CDT intervention, circle = standard, square = non-county organiztion.

Figure 2

Network by Randomization Category and Implementation Stage. Legend: Color: green = high implementation, yellow = moderate implementation, red = low implementatinon; Shape: triangle = CDT intervention, circle = standard, square = non-county organiztion. Note: Three cross-condition paths exist between participants from 6 organizations.

Figure 3

Network of CDT Condition w/ Actors from Non-County Organizations. Note: Nodes 62 and 92 are CiMH representatives.

Figure 4

Standard Condition w/ Actors from Non-County Organizations. Note: Nodes 62 and 92 are CiMH representatives.