Measuring implementation fidelity in independent living programs (ILPs) for youth leaving care: a systematic review of the literature

(For the review 'Measuring implementation fidelity in independent living programs (ILPs) for youth leaving care: A systematic review of the literature' by Tara Batista-Calderbank.) Background: Youth exiting foster care experience poor outcomes across several domains in comparison to their peers from traditional family structures. ILPs are designed to help foster care youth transition to adulthood. Little is known about their implementation and effectiveness. This is an update of a Cochrane review first published in 2006. Objectives: To examine implementation fidelity of independent living programs. Search methods: The reviewer searched eight major electronic databases: Applied Social Science Index and Abstracts (ASSIA)(1980-July 2009); Cochrane Register of Controlled Trials (CENTRAL) (Jan. 1980-July 2009); CINAHL (date); Dissertation and Theses Abstracts (date); EMBASE (1980-July 2009); Medline(1950-July 2009); PsychINFO (1967 to July 2009); Sociological Abstracts (1980-July, 2009) and reference lists of articles. The reviewer also contacted experts and researchers in the field. Selection criteria: Randomised controlled trials, quasi-randomised or quasi-experimental studies of the effectiveness of ILPs for foster care youth in the U.S. using contemporaneous controls. Outcomes were restricted to mental and physical health, criminality, housing, employment, and education. Data collection: The author assessed trial quality, risk of bias and implementation fidelity and extracted data. Main results: Seven studies involving 1,430 participants. Two studies were randomized control trials and five were quasi-experimental. The randomised control trials found no significant outcomes. The quasi-experimental studies found significant results for criminality, housing, employment and education. The risk of bias ranged from low to high. The methodological quality of the studies ranged from moderate to low. Four of the seven studies included information on implementation fidelity and three did not. Two studies demonstrated poor implementation fidelity, two demonstrated unclear-poor implementation fidelity and three studies demonstrated unclear implementation fidelity. The most substantial flaw was that in six of the seven studies, services available to controls were virtually indistinguishable from the intervention. Authors' conclusions: The effectiveness and implementation fidelity of ILPs is impossible to assess if the intervention is indistinguishable from services as usual. The programs are not well defined. Before further evaluations are conducted, researchers and service providers need to clearly define the core components of the programs and re-develop the services incorporating theory, empirical evidence and client perspectives.