We have several recommendations as a result of our implementation experiences with these three different types of organizations that may help other programmers avoid the same issues we encountered. Before implementing an EBP, it is essential to assess potential barriers and facilitators that exist at each implementation level (core implementation components, organizational components, and external factors) and examine how these factors could enable or hinder implementation. There are several existing tools that can help lead an organization through this process [17], [29] and [30]; the 10-step PSBA-GTO [17] was developed specifically for implementing EBP TPP programs, and a number of case studies exist to help TPP programs learn from others who have used the tool [21] and [31].
After assessing the needs and characteristics of the population being served and identifying an appropriate EBP, planners should fully research and understand the core intervention and implementation components that must be in place to meet fidelity requirements. Understanding these core requirements sets the stage for identifying the essential organizational components needed in program partners to achieve quality, sustainable program implementation. As noted by other researchers [21], [27] and [28], at the organizational level, it is important to ensure that both the lead organization and all partner organizations implementing the program have, or can build, adequate administrative and logistical capacity and infrastructure to support the core implementation activities. Elliot and Mihalic [27] noted in their implementation research on the Blueprints for Violence Prevention-Replication Initiative that “The finding that most sites are initially unprepared to implement and sustain programs with fidelity presents a major obstacle to taking model programs to scale. Some commitment to developing site capacity must become a routine part of any implementation initiative and the expected time frame for successfully implementing programs must be extended to allow for developing site readiness” (p. 48). Practical tools that program planners might find useful in conducting these organizational assessments include Chapter Five of the PSBA-GTO [29]; the Center for Healthy Aging'sSelf-Assessing Readiness for Implementing Evidence-Based Health Promotion and Self-Management tool [30]; and, the Capacities Tool specified in the Getting to Outcomes 2004: Promoting Accountability Through Methods and Tools for Planning, Implementation, and Evaluation manual developed by RAND [29].
Another critical organizational consideration is to ensure that all potential partners fully understand what is expected of them prior to implementation. Developing a clear and concise checklist is a useful way to help clarify these requirements. Lead organizations should have frequent and open communications with implementation partners about program requirements and capacity needs; multiple site visits prior to implementation will help to ensure sites are adhering to requirements and serve as a good way to identify and address barriers as they arise. Memoranda of Understanding are another effective method to clearly spell out and enforce these expectations. A lead organization should monitor adherence to the Memoranda of Understanding and change or discontinue partnerships if it becomes clear that a partner lacks the organizational components necessary, or if external factors make it impossible, to implement with fidelity. Alternatively, if a partnership is fixed or integral to the project, a change in EBP should be considered.
The key partner organization characteristics that we found helped to facilitate 4Real Health's implementation are (1) strong administrative motivation and support to implement TPP programming; (2) ability to reach and recruit large numbers of the target population; (3) established programming in which you can integrate your TPP program; (4) incentives to help motivate youth participation in the program; (5) logistical capacity to implement (classrooms, chairs/tables, program time, etc.); and (6) administrative capacity to implement (staffing, office space, oversight, etc.). As we learned, it is also important to assess the political environment in which the program will be implemented to identify any external factors, such as agency regulations or local/state laws that can impact implementation.
Taking the time to identify EBP implementation requirements, assess organizational “fit” both when identifying implementation partners and on an ongoing basis, and uncover potential external factors at play can be well worth the effort, as it will improve the likelihood that a program is executed with fidelity, and thus increase the likelihood that the hypothesized participant outcomes will be realized.