Table 1 Description of FFE intervention using the TIDieR Checklist

Service names and elements

Community-based service-integration practice models using two vehicles (Family Healthy Lifestyle and Family Recreation); four practice principles (the practice principles of family-centeredness, cultural sensitivity, capacity building, and reflection); and a direct-service dose with low intensity (1.4 to 4.6 hours) and long duration (18 months). The vehicles and practice principles are well described in the Families First Edmonton Toolkit [35] on pages 5–6. In summary, Family Recreation focused on developing awareness, knowledge, skills, attitudes and material resources for linking to existing recreation services, and Family Healthy Lifestyle focused on developing awareness, knowledge, skills, attitudes and material resources for linking to existing social, primary health, and child/education services.

Goal and rationale

Goal was to increase use of existing service programming by low-income families with children.

Vehicle selection was influenced by two interventions used in the comprehensive intervention of WTBB, namely health promotion and recreation. These vehicles were the health and/or recreation backgrounds against which family workers were to inform and model the problem solving, communication and resource management required to access the services needed by the families.

Practice principles were based on a systematic review of effective interventions for school-aged children. An analysis of the 29 reviews of 1102 intervention studies [37] showed that successful programs have seven characteristics:

1. They were holistic and integrated. The complexity of the life of the child, parent, and family is addressed.

2. Successful programs resulted from collaborations that are multilevel and multisectoral.

3. Successful programs were capacity building, rather than focusing exclusively on eliminating undesirable problems and behaviors.

4. Successful programs were client-centered.

5. Successful programs were community-based in what is available and situated in families’ neighborhoods.

6. Successful programs were long-term, engaging long enough to show effects and enabling relationships between staff and participants to develop.

7. Successful programs were well staffed with supportive personnel who are culturally similar to the population served.

The amount of direct service was constrained by two items: a) the desire to evaluate the effect of a small service-integration intervention on the use of existing service and b) financial considerations, since the community partners were funding the intervention (e.g., what would be reasonably fundable for long-term implementation should positive outcomes be found). For these reasons, Family Recreation was funded for 1.4 hours per month per participant family, Family Healthy Lifestyle was funded for 3.5 hours per month, and Comprehensive (Family Recreation plus Family Healthy Lifestyle) was funded for 4.6 hours per month.

Service-delivery vehicles, principles, and dose elements were described in a logic model and transformed into a Request for Proposals that was issued to community agencies that provided family programming. Community-based practice delivery for FFE was competitively awarded to a collaboration of four community service agencies that called their involvement in the trial “Families Matter.”

Materials and practices

Service-delivery practices and the Families Matter program support practices are fully described in the Families First Edmonton Toolkit [38].

Methods used to describe and monitor the practices

Community-based intervention, when delivered through a research project, risks losing intervention fidelity for at least two reasons: (a) use of general practice principles and very broadly identified content area within which to practice and (b) intervention drift [39]. In addition, a culturally based reluctance by service providers to submit to rigorous oversight of community-developed practices exists.

For these reasons, action research methods were used to record and monitor the development and delivery of the service integration. An administrative database was jointly developed to include qualitative and quantitative methods of recording practice to be used to calculate dose and to audit practices.

In addition, the administrative and supervisory staff of Families Matter met weekly with the researchers to review and apply the elements of the FFE service-delivery logic model, which built the relationship and internalized the need for intervention fidelity.

At the same time, a researcher spent half a day each week with the supervisors and family workers, focusing on trouble-shooting the practices associated with recording the practices in the database and on the need for fidelity to the three service-integration groups.

Families Matter also assigned family workers and supervisors to only one service-integration approach in order to support intervention fidelity.

Lastly, focus groups and individual interviews were held, with supervisors and family workers, over the course of the 18 months of service delivery in order to specify the practices used in service integration.

Providers

Three types of providers were funded. The one manager was a professionally educated social worker. The three supervisors of the vehicles (Family Healthy Lifestyle, Family Recreation and Comprehensive) were nonprofessional and baccalaureate-educated. All of the family workers were college-educated paraprofessionals or gifted graduates of service programs delivered by the collaborating service agencies.

The Families Matter collaborative used an in-house, ongoing schedule of training. Supervisors used reflective practice approaches with family workers. All are described on pages 20–22 of the Families First Edmonton Toolkit.

Modes and location of service delivery

Family workers used three ways to contact and work with families: face-to-face meetings in homes or other safe locations, telephone conversations, and email communication. Occasionally, family workers accompanied families to selected service visits that were counted as face-to-face meetings.

How much service and tailoring

To distribute the intensity and duration of the dose for each intervention, Families Matter used case management by the supervisors as supervised by the manager. The case management practices and protocols are described on page 17 of the Families First Edmonton Toolkit.

Modifications

As described above, action research methods were used to describe the practices developed by Families Matter to deliver service integration using four principles: family-centeredness, cultural sensitivity, capacity building, and reflection. The action research observations lead to the production of a practice model called Service-integration Flow that had eight practices and four pillars. They are described on pages 6–10 of the Families First Edmonton Toolkit.

Intervention fidelity

The interventions as delivered were different from the interventions as planned. Six families received a different intervention than the one assigned: five families received the Comprehensive intervention rather than Family Recreation (n = 2), Family Healthy Lifestyle (n = 1), and Self-Directed interventions (n = 1), and one family received the Family Healthy Lifestyle rather than the Self-Directed intervention. The monthly hours per family of direct FFE intervention was low (ranging from 5 to 32 % of the assigned hours) and had little variability across groups (Table 3). In addition, the Comprehensive group received about a third of the Family Healthy Lifestyle intervention contacts compared to the Family Healthy Lifestyle group (Table 3).