An Exploratory Study of a Training Team-Coordinated Approach to Implementation

Abstract

It is now widely understood that successful implementation of evidence-based treatments is facilitated by several favorable conditions (e.g., community buy-in, invested agency leadership). However, strategies for supporting agencies in promoting these conditions have been examined to a lesser extent. In this exploratory study, the implementation support procedures of Parenting with Love and Limits (PLL), an evidence-informed family treatment for child/adolescent behavior problems in which the training team follows structured procedures to help coordinate implementation support activities, are illustrated, and their preliminary effectiveness examined. PLL documents and communication records between PLL and n = 23 sites across the U.S. that initiated PLL pre-implementation activities were reviewed. In addition, implementation activities completed for each agency were entered into the Stages of Implementation Completion (SIC) dashboard. The prescriptive nature of the PLL implementation support protocol was illustrated through descriptions of procedural documents and case examples. Quantitative analyses revealed that, among the 23 sites that began pre-implementation, 9 discontinued, with a trend toward sites in metropolitan areas being more likely to discontinue than those in less populous areas. In addition, the 14 sites that launched PLL demonstrated a high amount of consistency in activities, with sites in the sustainability phase completing an average of 86% of implementation behaviors. Training team coordination of implementation activities may be one promising approach for supporting agencies in completing tasks to facilitate successful uptake of evidence-supported interventions. In turn, sustained implementation of evidence-supported treatments could allow communities to benefit from practice innovations to a greater extent.

The relative value of Pre-Implementation stages for successful implementation of evidence-informed programs

“…Each of the three Pre-Implementation stages are positively, significantly, and independently associated with program start-up. Although the Pre-Implementation phase (across all of the first three stages) typically stands alone (e.g., [ 16 , 21 ]) and was shown in the current study to be predictive of program start-up, the relative importance of each stage was remarkable. This provides further evidence that each of the three stages measures different aspects of Pre-Implementation fidelity [ 25 ].…”

“…This is supported by multiple studies, which have found that sites with higher implementation process fidelity early-on were more likely to make it to the point of delivering services to clients [ 12 – 15 ]. Additionally, in a descriptive study of 23 implementation attempts [ 16 ], sites that eventually became competent in delivering the intervention program were those that—early-on—had 100% implementation process fidelity. In contrast, of sites that did not reach competency in program delivery, the average level of implementation process fidelity during Pre-Implementation was only 47%.…”

Stepped implementation-to-target: a study protocol of an adaptive trial to expand access to addiction medications

“…A third Final Stage score indicates the final stage achieved in the implementation process (Stages 1-8). The SIC has been adapted or customized for multiple evidence-based practices (EBPs) [70][71][72][73][74][75] and evaluated across different system settings [51,76,77].…”

Adapting the stages of implementation completion to an evidence-based implementation strategy: The development of the NIATx stages of implementation completion

“…The SIC has been adapted or customized for multiple EBPs, through a clearly defined adaptation process ( Dubowitz et al, 2020 ; Nadeem et al, 2018 ; Saldana et al, 2012 , 2020 ; Sterrett-Hong et al, 2021 ; Watson et al, 2020 ). Several applications of the SIC have or are being evaluated in system settings focused on improving child or youth services ( Aalsma et al, 2019 ; Brown et al, 2014 ; Palinkas et al, 2017 ).…”