Over the last decade, there has been an increased effort to implement evidence-based practices (EBPs) into real-world community settings. Accordingly, researchers have sought to understand what steps in the implementation process are essential to effectively transport EBPs to a diverse range of settings, and how to best measure if these steps have occurred well. This proposal maps onto NIH PAR-10-038 by targeting the development of outcome measures and suitable methodologies for dissemination and implementation approaches that accurately assess the success of an approach to move evidence into practice. The Stages of Implementation Completion (SIC) is an 8-stage measure that was developed to evaluate the implementation of the Multidimensional Treatment Foster Care (MTFC) model. Each of the stages maps onto the three phases of implementation: pre-implementation, implementation, and sustainability. The SIC measures adopting sites' implementation performance, as indicated by activity completion and duration, in each of the implementation stages. Early stage implementation performance (i.e., pre-implementation) has been shown to predict successful implementation outcomes for MTFC. In the proposed project, the SIC will be adapted and extended to three new EBPs serving children and families with mental health problems, Multisystemic Therapy, Multidimensional Family Therapy, and a computer-assisted version of Coping Cat, through collaborations with each of the EBP developers. Both retrospective data (from previous site implementation efforts) and prospective data (from newly adopting sites) will be analyzed. The influence of pre-implementation performance on implementation outcomes will be examined (Aim1). In addition, mixed method procedures will focus on increasing understanding of the underlying processes that lead to implementation success or failure in order to determine if the SIC can provide early detection of sites' likelihood of success (Aim 2). Study activities also will include cost mapping of SIC stages and an examination of the relationship between implementation costs and performance (Aim 3). This project, therefore, fills a void in the field of implementation science by addressing the measurement gap in both the implementation process and the associated costs. In collaboration with an Advisory Board comprised of child mental health implementation science experts and end users, study outcomes, including the key elements of implementation and associated costs, will be disseminated to the participating EBPs and to the broader field to inform decision makers. The development of a tool that predicts implementation outcomes by assessing implementation performance will help identify areas in need of intervention (e.g., through additional support/consultation). Further, the ability to reliably measure implementation processes will facilitate future evaluations of implementation strategies. The overarching goal of this project is to provide tools that will help increase the uptake of EBPs in communities, thereby increasing the availability of services to youth and decreasing wasted resources from failed implementation efforts.
Current research lacks data regarding 'what it takes' to install evidence-based practices (EBPs) into usual care settings, leading to costly public health consequences including wasted efforts and resources on failed implementation attempts and a lack of availability of the most beneficial services to clients. Attempts to examine implementation outcomes and develop implementation interventions are hindered by the absence of tools to measure key processes and stages of implementation across EBPs. This project aims to address this deficit by extending a measure of implementation process to three EBPs in child and family mental health service sectors and to advance the abilities of researchers, developers, and end users to support more successful implementation efforts in real-world settings.
