The role of leadership and environmental context in the implementation of an evidence based programme: a qualitative analysis of three local government services which implemented multi systemic therapy in 2008

This is a qualitative study examining three of the ten English Local Authorities who implemented the intervention Multi Systemic Therapy (MST) in their Children’s Services Department in 2008. The research considers the implementation of MST and the consequent organisational impact as the services mobilised and then matured. One service closed at two years, another at five years and a third service was sustained and expanded. The research explores the concept of ‘evidence based practice’ in contemporary social work before considering and applying implementation science theory to understand the implementation process in the three sites. A grounded theory methodological approach (Charmaz, 2006, 2014) was taken to analyse twelve participant interviews across the three Authorities, including one with the national programme lead for MST. The findings propose new theoretical categories which extend understanding of implementation: The high collaborative environment and The hostile environment. These two environmental categories are especially relevant when linked to leadership. Both categories demonstrate the importance of the contextual setting within which implementation takes place. The high collaborative environment enabled the facilitation of the strategic and operational space for the intervention to successfully embed and sustain itself in the Authority continuing to provide MST. Taking a values based approach connecting to both operational practice and desired strategic outcomes significantly assisted in the implementation. A hostile environment is conceptualised as a context of threat, strategic change and uncertainty where the intervention is poorly placed. In the first setting this led to early closure as the service could not find a fit within the Authority. In the second setting, a successful mobilisation followed by a period of positive performance, could not sustain MST in the long term as the strategic and operational context changed negatively. The findings support and contribute to the understanding of the category of Leadership for implementation (Aarons 2016). Leadership which is attentive, relational, collaborative and perseverant appears most conducive to the successful implementation outcomes. Consistent leadership at the MST steering group is identified as vital as it is in this forum where the high collaborative environment and leadership for implementation were evident. In conclusion the research considers the implications of the findings and what these mean for practice and for the implementation of evidence based interventions in new settings as well as for the sustainability of interventions post mobilisation.