Background Many organizations in health and social services lack strong implementation and QI capacity, that is, the capability to effectively align practice with changing evidence and contexts and thereby continuously improve services and outcomes without external expert assistance. This study maps the characteristics of capacity building interventions (CBIs) aimed at developing generic implementation or quality improvement (QI) capacity, examines how their content aligns with implementation practice competencies, and how they are evaluated. Method We followed the Joanna Briggs Institute scoping review methodology. Two searches (most recent 19/4/2024) were conducted in three databases. Empirical articles describing the development and implementation and/or evaluation of generic implementation or QI CBIs delivered to individuals, teams, and/or organizations in healthcare, public health, and social services were included. Data were analyzed using quantitative description and content analysis. Results Data were extracted from 160 articles. Most CBIs were delivered in high-income countries ( n = 145, 91%), in healthcare settings ( n = 121, 76%), and to clinicians ( n = 74, 46%). CBIs usually target the individual level ( n = 63, 39%) or the individual and team levels ( n = 45, 28%). A combination of capacity-building strategies was generally used rather than a single strategy. Most content and activities aligned with analytical and planning competencies, with only a few emphasizing relational and emotional competencies, planning for sustainability, and knowledge brokering skills. Evaluations captured primarily self-reported reaction ( n = 98, 61%) and learning outcomes ( n = 83, 52%), with few assessing behaviors after active support ended ( n = 37, 23%) or results ( n = 45, 28%). Conclusion CBIs aiming to build implementation or QI capacity vary substantially in their development, evaluation, and reporting, making knowledge synthesis and reproducibility difficult. Greater emphasis on relational, emotional, and sustainability competencies may help participants develop a more balanced skill set. Strategies to create organizational conditions and rigorous longitudinal evaluations are required to support and assess CBIs' long-term impact and skill sustainability.
Background Strategies that improve integration of evidence-based substance use disorder (SUD) innovations within HIV service organizations (HSOs) are needed. Building on research supporting the effectiveness of facilitation to improve HSOs’ implementation of a motivational interviewing-based brief intervention (MIBI) for SUDs, this dissemination research sought to test the effectiveness of brief exploration facilitation to improve organization-level MIBI adoption/preparation (primary outcome) and exploration (secondary outcome) after an initial distributing educational materials strategy. Methods HSOs that did not transition to adoption/preparation within one week of the initial distributing educational materials strategy were randomized to either (a) continue in the distributing educational materials condition or (b) receive exploration facilitation. Outcomes were assessed four months post-dissemination. The primary dissemination outcome was organizational-level adoption/preparation, defined as 1+ HSO staff downloading the manual and/or enrolling in online asynchronous training. The secondary dissemination outcome was organization-level exploration of the intervention (i.e., 1+ HSO staff opened the dissemination email). Results At the end of week 1 after the initial distributing educational materials strategy, 327 (46.7%) of 700 HSOs had transitioned to exploration and an additional 15 HSOs (2.1%) had transitioned to adoption/preparation. After randomization, no additional HSOs achieved adoption as a function of being in either study condition. Of 341 HSOs randomized to exploration facilitation, only 11 HSOs (3.2%) received the single facilitation session delivered by our team of facilitators. Conclusion The project’s initial distributing educational materials dissemination strategy led to minimal MIBI adoption by HSOs. Despite several phone attempts per HSO, the project’s facilitators were generally unsuccessful in engaging HSOs and unable to deliver the exploration facilitation strategy; thus, the exploration facilitation strategy was not effective. Future research should consider testing alternative dissemination strategies, such as incentivization, which has demonstrated effectiveness as an implementation strategy.
Background Scaling evidence-based practices (EBPs) to address youth behavioral health needs is a key public health goal. Community mental health settings face challenges in measuring and reporting EBPs used with model fidelity due to resource constraints and complex reporting requirements, particularly when individual providers deliver multiple, distinct EBPs. This practical implementation report describes the development and evaluation of three implementation strategies to support the reporting of EBPs in a community mental health outpatient program in the state of Washington. Method Using a pragmatic pre–post study design, we measured clinician EBP use via progress notes and billing claims data. After baseline data collection, we deployed three brief, low-effort implementation strategies, including developing educational materials, conducting an educational visit, and auditing and providing feedback. We compared internally calculated EBP use rates in our program to publicly available data from a state-affiliated reporting and implementation partner, and we characterized attempts to use EBP elements by providers who were not yet eligible to officially report EBP use at the state level. Results The overall program EBP use rate was 32.7% in the baseline phase, and 48.9% after the implementation strategies were deployed. Paired pre–post analyses of eligible providers showed significant individual increases in EBP reporting post-deployment. The program's contribution to county-wide EBP services increased from 11.8% to 27.1% (with no change in relative proportion of total county services). Analysis of provider behavior that included all providers in the program supported the view that providers replaced informal use of EBP with formal EBP when possible and not simply a “report more EBP” response pattern. Conclusions This report highlighted the potential benefits of deploying brief, low-effort implementation strategies to improve implementation outcomes, including self-reported reach and provider behavior. Characterizing EBP use among diverse provider types has practical utility for implementation research and practice.
Background Teamwork influences implementation processes and outcomes, but knowledge of how specific dimensions of teamwork affect implementation is limited. We used explanatory sequential mixed methods to examine how teamwork influenced implementation outcomes in rural Children's Advocacy Center (CAC) multidisciplinary teams. Method CACs across a single state implemented the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a mental health screening/referral protocol. We purposively sampled six rural/frontier CACs with variability in reach and interviewed team members in each CAC ( N = 24). Interview data were coded for potential influencing factors, which were then categorized as general teamwork or innovation-specific teamwork. Influencing factors at each CAC were rated as negative, mixed, or low/moderate/high positive. Ratings and implementation outcomes were organized into a sortable matrix and color-coded to identify patterns. Qualitative and quantitative findings were integrated in a joint display. Results Both general and innovation-specific teamwork were related to implementation outcomes. Problems in affective/behavioral functioning (e.g., trust, conflict management) impaired implementation efforts. Shared goals facilitated faster time to adoption, especially when the CPM-PTS was viewed as advancing the team's goals. Teams with better overall performance achieved better reach. Team members were generally supportive of the CPM-PTS despite limited knowledge, but their knowledge and beliefs had little influence on implementation outcomes. Sites where screening results were intentionally and consistently shared with team members had better reach and a quicker time to adoption than sites where results were intentionally or passively withheld from team members. Conclusions In team-based service settings, team performance and shared goals facilitate better implementation outcomes. Positive affective/behavioral functioning may be a necessary precondition for successful implementation but insufficient on its own to improve outcomes. Teams that already work closely together may seek more active involvement in new practices, and their involvement can enhance implementation outcomes.
Background Community violence interventions (CVIs) aim to reduce firearm-related harm through strategies that center community engagement, credible messengers, and tailored outreach. Despite increasing adoption, few studies use implementation science methods to assess the implementation of adapted CVI models in new contexts. This pilot evaluation describes the implementation of the University of Pennsylvania Community Violence Prevention (PCVP) program, an adaptation of Cure Violence (CV) implementation strategies co-developed with community stakeholders. We assessed implementation outcomes and short-term participant-level impacts to inform future scale-up. Method Using a type 3 hybrid implementation-focused design, we conducted a mixed-methods evaluation over an 18-week pilot period. Guided by the RE-AIM framework and Proctor's implementation outcomes, we examined reach, fidelity, acceptability, and appropriateness. Administrative data, staff-reported checklists, and geospatial outreach analyses were triangulated with survey data from 18 high-risk participants, informed by the COM-B model. Quantitative data were analyzed descriptively and using Pearson correlations; qualitative responses underwent rapid thematic analysis. Results The PCVP team (two full-time, two part-time outreach workers, and one manager) engaged 38 participants, reaching 75% of target caseloads and covering 70% of shooting incidents within two blocks and two weeks. Fidelity was high for case management and community engagement, but low for violence detection/interruption due to staffing limitations. Participants reported high acceptability and appropriateness of the intervention (M = 4.39, SD = 0.98), with COM-B scores indicating strong engagement across capability, opportunity, and motivation domains (M = 25.64/30). Correlations revealed significant links between social/physical opportunity and motivation (r > .70, p < .01). Conclusions This study demonstrates the feasibility and acceptability of a community-adapted CVI model. High acceptability and engagement support continued implementation, though limitations in fidelity to violence interruption underscore the need for targeted staffing and funding. Context-sensitive adaptation, robust community partnerships, and longer-term implementation research are essential for sustaining and scaling CVI efforts.
