As a further example of our approach, we offer a detailed post-hoc case study of the implementation of the Signs of Safety practice approach in child protection. This is chosen because it has been deployed in multiple places but evidence suggests it is often only partially implemented. Our case study is of a child protection agency M which evidence shows achieved a high standard of implementation. In this case study we had a rich evidence base to work with, both of background research on child protection implementations able to provide evidence from afar of systemic factors that might be causally important and of local evidence available from extensive contemporaneous documentation in M. Our method helps to illustrate and explain the range of changes needed to support Signs of Safety as the organisational practice approach in M.