Site-Level Evidence-Based Practice Accreditation: A Qualitative Exploration Using Institutional Theory

ABSTRACT

Accreditation is gaining ground in human services as leaders find ways to demonstrate the quality and legitimacy of services. This study examined site-level accreditation for SafeCare®, an evidence-based practice designed to prevent and reduce child maltreatment. We leveraged two waves of qualitative data to explore the perspectives of trainers, organizational and system leaders, and program developers who participated in an initial rollout of a site-level accreditation process for SafeCare. Institutional theory was used to frame accreditation’s potential benefits, burden, and impact. Findings highlight specific considerations for the human service environment, including the inherent resource scarcity, interdependence among organizations, and the impact of cost and slow-moving bureaucratic processes.

PRACTICE POINTS

• Current institutional pressures – such as large funding streams coming out of federal initiatives that rely on program developers to report which sites are accredited when financing evidence-based programs – may force human service organization (HSO) leaders to consider participation in site-level accreditation specific to a particular evidence-based practice (EBP) or model.

• Although accreditation may not meaningfully change day-to-day service delivery of an EBP, HSO leaders may gain other benefits, including cross-site communication and the ability to demonstrate legitimacy and competence within their organizational field.

• Accreditation cost is an essential and unavoidable consideration for program developers and purveyors who plan to use accreditation to support EBP sustainment and scale-up in HSOs.

KEYWORDS:

• Accreditation
• EBP implementation
• institutional theory

Acknowledgments

We thank Dr. Lara Gunderson for her contributions to collecting data for this study. We also thank Drs. Whitaker and Self-Brown with the National SafeCare Training and Research Center for their review of this manuscript and helpful feedback.

Disclosure statement

This work was funded by National Institute of Mental Health (R01MH072961, PI: Aarons, T32MH019960; PI: Cabassa, P50MH113662; PI: Hoagwood, R25MH080916; PI: Proctor).The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. The second author is on the Editorial Advisory Board for the Human Service Organizations: Management, Leadership & Governance journal.

Additional information

Funding

The work was supported by the National Institute of Mental Health [R01MH072961].