Strategies for Sustaining Efforts

From the NRI survey of strategies used by states to implement evidence-based practices (2005), it was learned that states, which had clear goals of “going to scale” with their evidence-based and promising practices included many of the following strategies:

  • Strong consensus development processes up front to get buy-in from all stakeholders
  • Inclusive advisory boards
  • Collaboration with other agencies and Medicaid to establish funding mechanisms
  • Contractual relationships between the state and providers to use evidence-based and promising practices
  • Establishment of collaborative relationships with universities to develop Centers of Excellence for on-going training and technical assistance

Although research on the effectiveness of specific strategies for implementing and disseminating evidence-based interventions is scant, Rohrbach and colleagues (2006, p. 315-319) recently summarized factors considered to be important in taking evidence-based programs “to scale,” these include:

  • Packaging program materials so that they are attractive and user friendly
    • Program implementation manuals should be easy to follow, explicit about the requirements for implementation, and presented in a language and format that is familiar to implementers
    • Materials to be presented to program participants should be attractively packaged, appropriate for all cultural groups that will use them, and reproducible on a large scale, yet not too costly

  • Establishing a diffusion system
    • The system for disseminating program information should have the capacity needed to respond to inquiries about the program, distribute materials widely, provide training and technical assistance, and link program users to developers for questions about implementation, adaptation, and evaluation.
    • Many developers of evidence-based practices have developed their own diffusion system with the requisite capacity. Most of the websites listed in the section “What are the Evidence-Based Practices?” contain information on developers or purveyors which can be contacted to find out whether they have existing dissemination systems.

  • Helping sites build their organizational capacity
    • Ensure that adopting sites have established a clear need for the evidence-based practice and that it fits with the agencies’ mission
    • Establish initial and sustainable funding, strong administrative support, a local program champion, adequate supply of receptive and skilled program implementers, and strong levels of community support
    • The capacity building process requires a detailed implementation plan
    • Expect that the capacity-building process may take up to 9 months, may require on-site visits and telephone contacts with developers or dissemination organizations

  • Providing training and technical assistance to program implementers
    • Mechanisms must be put in place for the developer or dissemination organizations to do the training and on-going technical assistance
    • Some large-scale prevention programs have used self -instruction modalities such as websites, and teleconferencing.  For an example, visit the Medical University of South Carolina’s Website dedicated to Trauma-Focused Cognitive Behavior Therapy.
    • Requests for technical assistance may include peer support, coaching, consultation, trouble-shooting implementation problems, and ongoing efforts to help the agencies build capacity for sustainability

  • Establishing a system for collecting and reporting data on program delivery
    • Routine reporting data on fidelity and outcomes can guide program efforts to improve on-going implementation and can foster sustainability
    • Some diffusion systems have centralized information systems with built-in measurement instruments, reporting schedules, and feedback loops.
    • Technical assistance can be used to develop program specific evaluation plans and methods

References

Rohrbach, L.A., Grana, R., Sussman, S. & Valente T.W. (2006). Type II translation:
Transporting prevention interventions from research to real-world settings. Evaluation and the Health Professions, 29 (3), 302-333.

NASMHPD Research Institute, Inc.. (2005, August). Results of a Survey of State Directors of Adult and Child Mental Health Services on Implementation of Evidence-Based Practices. Alexandria, VA: Author.