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The Implementation Corner

NREPP contains information about evidence-based programs and practices that have been rigorously evaluated. However, in addition to their grounding in rigorous science, these programs and practices did not remain as ideas on a page or in a laboratory. They were successfully implemented in service settings and communities. Such implementation often required extensive time and commitment on the part of the program developers themselves, who had to generate funding and other forms of support from communities and funding agencies.

The evidence-based programs and practices in NREPP can also be implemented in other service settings and communities, either with strict fidelity to the original models or with adaptations that are required by the cultural and other needs in these other communities.

However, implementation is not always easy, and many individuals and communities can benefit from information and guidance about how to go about effective implementation. The Implementation Corner discusses best practices in implementation in behavioral health.

Click on the links below for additional discussion and resource materials relevant to best practices in the implementation of evidence-based programs and practices in behavioral health: What is implementation?
Implementation can be simply defined as a set of activities taken to put a program or policy into practice. Most often, programs and policies are implemented to achieve desired outcomes—whether that is to increase seatbelt use, decrease drug use, or maintain clean water.

Let’s assume you have already identified a program that could help you address the needs of your community and have decided to implement it. You’ll likely discover what many before you have: that is, defining implementation may be simply, but doing it is not! Selecting the activities to undertakes, choosing the staff to carry out those activities, and ensuring funding for ongoing activities can be very complicated in a local context.

So how do you best go about implementing your program?

Implementation science
Implementation science is about finding ways to integrate research evidence into decisions made in real-world settings. Integrating research into practice can be a complicated and arduous task. For example, within the public health field, research found that it took an average of 17 years for 14 percent of original clinical research to be integrated into a physician’s practices (Brownson et al. 2006). Similarly, Ringwalt and colleagues (2008) found that, in 2005, only 10.3 percent of surveyed school districts across the country administered a universal substance use prevention curriculum recognized as “evidence-based” on a federal registry, despite efforts by legislation, such as No Child Left Behind, that requires schools to implement prevention programs with evidence that demonstrates effectiveness.

Terms of Implementation Science
There are many terms used in this field, many of which are used interchangeably, and many of which have multiple meanings. For instance, the meanings of “research” and “research use” can vary across fields and disciplines. Research use for one individual might mean reading about evaluations and studies such that their thinking about an issue or problem is changed. For another, it might mean making direct changes to policy and practices based on evidence (Walter, Nutley, and Davis 2005; National Research Council 2012; Tseng 2012).

In addition, many of these interrelated terms are used interchangeably within discussions of implementation science, such as research, evidence, knowledge, data-driven, evidence-informed, and evidence-based. Although each term has a specific meaning, the use of this type of language essentially strengthens the idea of creating policies and practices that are grounded in science and research, as opposed to politics, ideologies, or beliefs (Tseng 2012). These terms, however, may have different meanings to practitioners and researchers. For instance, in the education field, Tseng (2012) reported that researchers often used the terms “evidence” and “research” to mean empirical findings derived from scientific methods (for example, results from randomized controlled trials or quasi-experimental designs), whereas practitioners and policymakers viewed evidence as including not only empirical work, but also information obtained from individuals’ experiences, testimonies, examples or case studies, and laws/policies.

Models and Frameworks to Guide Implementation
Researchers have developed a variety models and frameworks to help guide practitioners as they implement their program of choice. It is worth noting that while these frameworks draw on research evidence, most have themselves not been evaluated for effectiveness (Chinman et al. 2014). Most suggest a set of steps to guide a sequential implementation process, although most also acknowledge the non-linear nature of implementation in a real-world setting. Examples of such frameworks include
  • The National Implementation Research Network (NIRN), which describes the six stages of the Implementation Process (Fixsen et al. 2005)
  • RAND’s Getting to Outcomes (GTO) series that presents 10 steps to address issues before and after the implementation of a program has begun (Mattox et al. 2013)
  • The Quality of Implementation Framework (QIF) that was developed from a literature synthesis focused on 25 frameworks of implementation from myriad fields, including health care, substance use prevention and treatment; and community-based prevention services (Durlak and Wandersman 2012)
Resources on Implementation
Numerous resources are available that can help guide your thinking about the various facets of implementation. Whether you are still trying to identify a program of interest, or whether you have already started implementing an intervention, these kinds of resources may provide important guidance.
  • Overviews of the development of implementation science and training efforts to develop knowledge in the field (Glasgow et al. 2012; Irwin and Supplee 2012; Meissner et al. 2013)
  • Current collaborations of researchers/practitioners to promote and understand implementation (e.g., Lehman et al. 2011; NIRN; QUERI)
  • Syntheses of the literature and/or a consolidating framework (e.g., Century et al. 2012; Damschroder et al. 2009; Fixsen et al. 2005; Greenhalgh et al. 2004)
  • Tools for use in implementation (e.g., A Road Map, 2012; Brach et al. 2008; The Active Implementation Hub)
  • Field specific discussions of implementation science (e.g., Baum et al 2103; Lehman et al. 2011; Metz & Bartley 2012)
  • Empirical studies of implementation (e.g., Hanbury et al. 2013; Pas & Bradshaw 2012)
These resources are not meant to be a comprehensive review of materials about implementation, but rather to provide some suggestions. Click here to access an annotated bibliography of selected resources.

Additional Implementation Resources
Using Evidence-Based Constructs to Assess Extent of Implementation of Evidence-Based Interventions

The Importance of Contextual Fit When Implementing Evidence-Based Interventions

The GTO intervention helps practitioners permanently incorporate newly learned capacities into routine operations, closing the gap between research and practice

For more implementation resources, see Resources page