Implementation during a time of crisis: The critical role of trusting relationships

Trust

Allison Metz

Are there lessons we can learn from the current response of service systems which have galvanized into action to meet the needs of children and families during the COVID-19 pandemic?  How does the response of service systems affect our hypotheses about how change happens at scale?

In my professional role providing implementation support to public service systems, I’ve observed these systems responding to the COVID-19 pandemic with urgency and agility.  The urgency is to be expected, but the agility has inspired me. 

The agility runs counter to accepted wisdom in implementation science that implementation takes time. Depending on the scope and complexity of the change effort, it can take up to five years for initiatives to reach full implementation.  Implementation science cites common barriers to implementation including stakeholder buy-in, available resources, contextual factors, and competing demands. 

Child welfare is one example of a public system that needed to quickly pivot to perform mission critical work with children and families during the pandemic. Many of the functions performed by child welfare systems – investigating child maltreatment, addressing food insecurity, providing in-home services, appearing in family court, protecting children and youth with pre-existing conditions, providing visitation and reunification services – are now more challenging than ever to implement.  The impact of the pandemic on children and families, including an increased risk of child abuse and neglect, cannot be understated.

However, these systems have also rapidly responded to these new demands.  For example:

  • technology has been developed to support visitation
  • protocols have been enacted to assess the health of case planners and families
  • public-private partnerships have been leveraged to ensure service availability
  • emergency plans have been developed and implemented.

Did the crisis necessitate implementation, thereby bypassing all of the commonly cited barriers?

I had a chance to ask leaders from child welfare systems in two major cities in the U.S. this exact question, and their response was that a shared sense of humanity and concern for children’s safety has facilitated rapid adaptations to their current ways of work

Child welfare leaders noted that relationships were at the center of the fast paced changes they were making to respond to the crisis: “Everyone is in this together…when I make a call people ask immediately how they can help.”  

While the crisis itself does not appear to be driving this rapid implementation, it has elevated the role of relationships, which may be the more critical mechanism for implementation. Surprisingly, relationship building has received less attention in the field of implementation science than behaviorally-based and top-down leadership strategies. Few studies have explored the role of relationships in depth, limiting our understanding of how trusting relationships can effectively be built and why they are important.

Trust plays a critical role in how agency leaders and practitioners vet and interpret information needed to make decisions. When trust exists, individuals engage in the risk-taking, learning and change required to support implementation efforts. 

There are several ingredients in the relationship building process that have been described as both a contributor to and an outcome of trust.  It seems the development of these ingredients has been accelerated during the COVID-19 pandemic.  For example:

  • Collaborative decision-making is happening daily as stakeholders seek quick solutions to support families. 
  • Communication is taking place at a high frequency and involves information exchange that is leading to shared understanding across diverse perspectives on how to solve rapidly emerging problems. 
  • Stakeholders are demonstrating a heightened sensitivity to each other’s priorities to keep children and families safe.

The question is whether these active ingredients for building trusting relationships can be accelerated and sustained in a post-pandemic world.  We know from clinical psychology that individuals feel more motivated by relationship-based support than they do by general support, such as financial resources.  If this is the case, the field of implementation should focus on the strategies we can use to facilitate communication, collaboration and sensitivity in order to build the trusting relationships that seem to be at the heart of successful and rapid change efforts. 

Existing research has demonstrated in both early childhood and child welfare service settings that trusting relationships can be built through specific co-creative implementation strategies including:

  • supporting co-learning rather than top-down or outside expert models
  • brokering relationships among disconnected stakeholders
  • co-designing implementation strategies with those who will deliver and experience these strategies
  • explicitly addressing power differentials so that families have a choice in how they respond to emergencies.

These strategies seem more important now than ever before.  This crisis has highlighted the importance of relationships for successful implementation.

How can we avoid losing sight of the key role of trusting relationships in our post-pandemic world?  What’s your experience been?  Have you also found other factors to be critical?

To find out more  on the importance of building relationships for implementation:

Co-creative Technical Assistance

Co-Creating the Conditions to Sustain the Use of Research Evidence in Public Child Welfare

Principles and Competencies for Implementation Support Practitioners


By Allison Metz, Director, National Implementation Research Network

Image credit: The word trust on wooden cubes, on a dark background, symbols signs by Elena via Adobe Stock

This blog was originally posted on the Integration and Implementation Insights blog, on 12th May 2020 and the original version is available here: https://i2insights.org/2020/05/12/trusting-relationships-for-change/ The broader iS2 blog has lots of other material that might be of interest to Evidence & Policy readers.


If you enjoyed this blog post, you may also be interested to read:

Building trust and sharing power for co-creation in Aboriginal health research: a stakeholder interview study [Open Access]

Risk, uncertainty and medical practice: changes in the medical professions following disaster [Open Access]

Co-creative approaches to knowledge production: what next for bridging the research to practice gap? [Open Access]

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