Project Spotlight: Applying Implementation Science at 3 Levels: Practitioner, Organization and System
By Brian Bumbarger, Visiting Research Associate, Colorado State University Prevention Research Center, Adjunct Research Fellow, Griffith University Institute of Criminology, Consultant on Community and Public Systems Capacity Building
Figure 1: Ecological model for EBI implementation in public systems
For nearly three decades I’ve sought to bridge research, practice and policy by understanding facilitators and barriers to greater use of evidence-based interventions (EBIs). From 1998-2016 at Penn State University’s Prevention Research Center, I supported state agencies who funded many EBIs but struggled to have them delivered with quality and fidelity. These programs were often more complex and difficult to implement well than “business as usual”. This need led to the development of the Evidence-based Prevention and Intervention Support Center (www.EPISCenter.psu.edu), one of the first state-level intermediaries to support the scale-up of EBIs. The large scale of the initiative (over 200 grantees) and diversity of EBIs offered a “living laboratory” to study and support implementation. The initial focus of support was on individual practitioners who needed to understand and apply implementation science (even if we didn’t yet call it that). These EBIs often represented significant departures from the way practitioners had been trained, and they needed in-service retrofitting of their skills to deliver EBIs with quality and fidelity. We realized however that these practitioners, and the organizations they worked for, weren’t ONLY delivering EBIs, and by helping them apply Implementation Science principles only in the context of a specific program, we were unintentionally creating a disparity within their program portfolios, making programs with the strongest evidence seem the least attractive (because they required greater attention to the details of implementation). We discovered Wandersman’s Interactive Systems Framework (ISF), which emphasizes both intervention-specific support and general (i.e. organizational) support, and found it to be a helpful heuristic. We shifted our support from practitioners to organizations, generalizing the Implementation Science principals to everything a provider organization offered.
Figure 2: Wandersman’s Interactive Systems Framework (ISF)
More recently I have recognized that we must also consider how these provider organizations are embedded within, and constrained by, (public) systems. I co-chair a Task Force of the Society for Prevention Research which has recently drafted a white paper to examine the need for applying implementation science within public systems. If we hope to effectively scale EBIs while maintaining the quality and fidelity necessary to move the needle on population public health, we will need to broaden our lens to acknowledge this level of the socio-ecological model.
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