Scaling Out: Efficiency, Adaptation, and Harmonization Rigor, - - PowerPoint PPT Presentation
Scaling Out: Efficiency, Adaptation, and Harmonization Rigor, Relevance, Rapidity PRESENTER: GREGORY A. AARONS Presented at the 12 th Annual Conference on the Science of Dissemination and Implementation in Health. 5 December, 2019. Arlington,
PRESENTER: GREGORY A. AARONS
Presented at the 12th Annual Conference on the Science
5 December, 2019. Arlington, VA.
Funding
National Institute on Drug Abuse
Swedish Research Council
FORTE Sweden
National Institute on Drug Abuse
National Institute of Mental Health
Norwegian Ministry of Health and Care Services
Contributors
Ulrica von Thiele Schwarz (Mälardalen University and Karolinska Institutet)
Henna Hasson (Karolinska Institutet)
Karina Egeland, Ane-Marthe Solheim Skar, Erlend Laukvik (Norwegian Center for Violence and Traumatic
Stress Studies – NKVTS)
Marisa Sklar, Lauren Brookman-Frazee (UC San Diego)
Aubyn Stahmer (UC Davis)
Aarons, G. A., Sklar, M., Mustanski, B., & Benbow, N., & Brown, C. H., (2017). “Scaling-out” evidence-based interventions to new populations or new health care delivery systems. Implementation Science, 12(1), 111.
Can interventions be expected to produce effects similar to those found in previous studies?
Scaling-out is an approach to adapting and delivering EBIs across health and allied health service systems and organizations and/or across different target populations.
Scaling-out is the deliberate use of strategies to implement, test, improve, and sustain EBIs as they are delivered in novel circumstances distinct from previous implementations.
EBI implementation in a moderately different setting, or with a different population, can “borrow strength” from evidence of impact from prior trials.
Every EBI implementation raises (at least) three questions:
1.
Is there sufficient evidence that this EBI would impact health as expected with a different population or in a new setting?
2.
Are system, organization, and/or EBI adaptations necessary, sufficient, and culturally appropriate to make the EBI feasible, practical, acceptable, and effective in the new context?
3.
Will proposed mechanisms (e.g., mediational pathways) hold as in prior trials?
EBI is delivered through different
EBI delivered to a different
1) The end product of implementation efforts should emphasize overall
value rather than only the intervention effects
2) Implementation strategies can be construed as a method to create
fit between EBIs and context, and
3) Transparency is vital; not only for the intervention but for all of the four
terms of the equation.
von Thiele Schwarz, U., Aarons, G. A., & Hasson, H. (2019). The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation. BMC health services research, 19(1), 868.
ADAPTATION What is Modified Level REASON
Content Context Process System Agency Clinic Provider
Switch from mental health to substance abuse X X X X X Funding source Extension of timeline and added booster session X X X X Results of pilot study showing increased effects starting at six months Switch from general EBP to MI focus (content of training, measures) X X X X X Goal of linking LOCI to specific implementation outcomes Integration of fidelity monitoring and feedback into LOCI components X X X X Alignment of LOCI with the implementation Expansion of organizational strategy meetings (more regular meetings, climate development plan, etc.) X X Results of pilot study and recognition of importance of alignment of leadership across levels Updated content around findings of dimensions
X X X X Alignment of LOCI with updated measure development
Adapted and overly simplified from: Stirman, S. W., Baumann, A. A., & Miller, C. J. (2019). The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Science, 14(1), 58.
Mechanisms LOCI Norway to Implement PTSD treatment
Scaling-out can improve efficiency and examine generalizability in
Clearly identify core elements of the EBI and what can be adapted
Also applies to implementation strategies
Reconciling fidelity and adaptation should consider perspectives
Documenting mechanisms and harmonization of measures are
Gregory Aarons, Ph.D.
UC San Diego, Department of Psychiatry UCSD Dissemination and Implementation Science Center (UCSD-DISC) Child and Adolescent Services Research Center (CASRC)
e-mail: gaarons@health.ucsd.edu