Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

Abstract

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653–1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274–1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739–749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

Commentary on Scaling-Up Evidence-Based Interventions in Public Systems

“…(3) public awareness and support for EBIs; (4) local engagement and capacity to implement EBIs; (5) the degree to which public system leadership supports EBIs; (6) availability of a skilled workforce to implement EBIs; and (7) data monitoring and evaluation capacity. In their paper, the MAPS IVauthors used an ecological model to visualize the influence of these factors, where public policies and funding represent the most influential macro factor that envelopes all other scale-up factors (see Fagan et al 2019). Alternatively, the MAPS IV Task Force authors note that this ecological model can also be interpreted from the micro level outward, with an initial focus on a specific EBI.…”

“…The MAPS IV paper (Fagan et al 2019) builds on the previous findings of the SPR MAPS II Translational Research Task Force, which operated from 2008 to 2014 and recommended a two-pronged research agenda to address barriers to adopting, implementing, and sustaining EBIs. The first MAPS II recommendation focused on building local infrastructure to support EBIs.…”

“…The degree to which systems enact public policies that require, recommend, or provide funding for EBIs in the USA can be conceptualized as a macro federal or state-level infrastructure factor affecting scale-up (Fagan et al 2019), and perhaps more importantly, sustainability. Statutory language at federal levels requiring use of EBIs is the most difficult to change and as a result is a scale-up factor with the greatest potential to foster sustainability.…”

“…Equitable implementation partnerships between community stakeholders and residents, policy makers, practitioners, and scientists are integral to promoting public support for EBIs and sustainability of EBIs within public systems. The MAPS IV authors recommended the development and evaluation of new frameworks that foster EBI scale-up (Fagan et al 2019). Although we are hesitant to endorse development of even more implementation frameworks than already exist, we simply include a request that any new frameworks for EBI scale-up include capacity drivers relevant to the five equitable implementation actions recommended by a group of researchers, practitioners, and funders at Academy Health's recent conference (DuMont et al 2019).…”

Transferring a Community-Based Participatory Research Project to Promote Physical Activity Among Socially Disadvantaged Women—Experiences From 15 Years of BIG

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