Academic journal article Generations

Challenges Implementing Evidence-Based Programs

Academic journal article Generations

Challenges Implementing Evidence-Based Programs

Article excerpt

There are six characteristics that impact successful implementation.

Few scientific research investigations focus on lactors that affect the implementation of evidence-based programs (EBPs). Most current thinking is based on anecdotal observations and personal experiences. For the field of aging services, this lack of research is partially a byproduct of EBPs only recently being developed and no widely accepted definition of what constitutes such a program. The dearth of implementation research also reflects the absence of empirical studies in service organizations that deliver these programs and a lack of experience, training, or interest in implementation by most universities and university-based researchers who have a bias toward basic, rather than applied research. A similar bias exists in the priorities of many federal funding agencies.

Organizations that house both service and research divisions, such as the Benjamin Rose Institute on Aging, are well positioned to study the implementation process. While few in number, these hybrid organizations can function as learning organizations that examine the intricacies of developing, delivering, marketing, and sustaining EBPs.

Encouraged by recent initiatives of a few funding organizations, such as the Administration on Aging, the next few years will generate important new information about the science of implementation. This growing body of evidence will benefit from several recently developed conceptual frameworks, such as the Chronic Care Model (Bodenheimer, Wagner, and Grumbach, 2002), RE-AIM (Dzewaltowski, et al., 2004), and the National Implementation Research Network (Fixsen, et al., 2005).

The success of implementing EBPs is distinct from the beneficial outcomes in efficacy and effectiveness studies. There is no guarantee that programs which achieve laudable consumer outcomes can be successfully implemented (Fixsen, et al., 2001). Further, a key but elusive measure of successful implementation is sustainability over an extended timeframe.

This article inventories six characteristics that impact successful implementation. These characteristics are identified in the formative existing literature, as well as from experiences at the Benjamin Rose Institute on Aging, such as Care Consultation, a telephone coaching and support service (Bass, et al., 2003). The six characteristics include: 1) Community Characteristics, 3) Intra- Organizational Characteristics, 4) Evidence-Based Program Characteristics, 4) Fidelity, 5) Staffing and Training, and 6) Marketing, Cost, and Payment Sources.

This inventory provides a useful starting point, but much about implementation remains unknown. For example, are certain of the six characteristics more or less important? Can one strong characteristic substitute for weaker characteristics? Do influential factors differ across substantive areas? And how macro- (i.e., community characteristics) and micro - level features (i.e., evidencebased program characteristics) interface. Some of the characteristics are important when implementing any new service or intervention and are not unique to EBPs. Others are particular to the evidence-base that justifies broader implementation.

Community Characteristics

"Community" refers to contextual factors outside of the organization delivering the evidence-based program. It includes features of the local environment, as well as regional, state, and national characteristics. It also includes social norms and values that impact consumer preferences and behaviors.

Characteristics of the community arguably are the most important influences on implementation. Despite their importance, these macro-level contextual features frequently are overlooked because most professionals who initiate and implement EBPs focus on characteristics of consumers and providers.

The availability of a source to pay for an evidence-based program is an essential community characteristic. …

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