A mixed-methods process evaluation of Family Navigation implementation for autism spectrum disorder.
Sarabeth Broder-Fingert, Sarah Qin, Julia Goupil and 9 others
PMID 30404548WHAT IT FOUND
Navigators often struggle to set up community services and engage families, while training and fidelity monitoring are easily overlooked.
Implementation fails when systems are complex, requiring better resource inventories and consistent supervision rather than just adding more steps.
Key findings
01The highest risk step in Family Navigation implementation was setting up community-based services, followed by attending intake/testing appointments and initial meetings with families.
02Stakeholders identified insufficient monitoring and training, and challenges in engaging families, as the primary causes of implementation failure.
03Suggested solutions included creating inventories of community resources, establishing contacts at agencies for waitlist updates, and using mentored navigation for training.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study did not include perspectives from the families receiving the intervention, focusing only on provider and system views. The FMEA method is new to behavioral health, and there are no established cut-off values for interpreting risk scores, making comparisons across different studies difficult. Only seven of the 66 mapped steps were analyzed in depth, so other potentially high-risk steps may have been missed. The risk ratings were generated by a small group of nine investigators via an online survey, which may lack the consensus of in-person discussion.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the National Institute of Mental Health.
The easy way to misread this
Do not interpret these findings as evidence that Family Navigation improves clinical outcomes for children with autism. This study evaluates the implementation process and potential points of failure, not the effectiveness of the intervention itself.