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Background Workforce development for implementation practice has been identified as a grand challenge in health services. This is due to the embryonic nature of the existing research in this area, few available training programs and a general shortage of frontline service staff trained and prepared for practicing implementation in the field. The interest in the role of “implementation support” as a way to effectively build the implementation capacities of the human service sector has therefore increased. However, while frequently used, little is known about the skills and competencies required to effectively provide such support. Main body To progress the debate and the research agenda on implementation support competencies, we propose the role of the “implementation support practitioner” as a concept unifying the multiple streams of research focused on e.g. consultation, facilitation, or knowledge brokering. Implementation support practitioners are professionals supporting others in implementing evidence-informed practices, policies and programs, and in sustaining and scaling evidence for population impact. They are not involved in direct service delivery or management and work closely with the leadership and staff needed to effectively deliver direct clinical, therapeutic or educational services to individuals, families and communities. They may be specialists or generalists and be located within and/or outside the delivery system they serve. To effectively support the implementation practice of others, implementation support practitioners require an ability to activate implementation-relevant knowledge, skills and attitudes, and to operationalize and apply these in the context of their support activities. In doing so, they aim to trigger both relational and behavioral outcomes. This thinking is reflected in an overarching logic outlined in this article. Conclusion The development of implementation support practitioners as a profession necessitates improved conceptual thinking about their role and work and how they enable the uptake and integration of evidence in real world settings. This article introduces a preliminary logic conceptualizing the role of implementation support practitioners informing research in progress aimed at increasing our knowledge about implementation support and the competencies needed to provide this support.

Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021–2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained “very important” during times of crisis. Greater self-efficacy and supports increased implementation fidelity.

Background Disseminating care guidelines into clinical practice remains challenging, partly due to inadequate evidence on how best to help clinics incorporate new guidelines into routine care. This is particularly true in safety net community health centers (CHCs). Methods This pragmatic comparative effectiveness trial used a parallel mixed methods design. Twenty-nine CHC clinics were randomized to receive increasingly intensive implementation support (implementation toolkit (arm 1); toolkit + in-person training + training webinars (arm 2); toolkit + training + webinars + offered practice facilitation (arm 3)) targeting uptake of electronic health record (EHR) tools focused on guideline-concordant cardioprotective prescribing for patients with diabetes. Outcomes were compared across study arms, to test whether increased support yielded additive improvements, and with 137 non-study CHCs that share the same EHR as the study clinics. Quantitative data from the CHCs’ EHR were used to compare the magnitude of change in guideline-concordant ACE/ARB and statin prescribing, using adjusted Poisson regressions. Qualitative data collected using diverse methods (e.g., interviews, observations) identified factors influencing the quantitative outcomes. Results Outcomes at CHCs receiving higher-intensity support did not improve in an additive pattern. ACE/ARB prescribing did not improve in any CHC group. Statin prescribing improved overall and was significantly greater only in the arm 1 and arm 2 CHCs compared with the non-study CHCs. Factors influencing the finding of no additive impact included: aspects of the EHR tools that reduced their utility, barriers to providing the intended implementation support, and study design elements, e.g., inability to adapt the provided support. Factors influencing overall improvements in statin outcomes likely included a secular trend in awareness of statin prescribing guidelines, selection bias where motivated clinics volunteered for the study, and study participation focusing clinic staff on the targeted outcomes. Conclusions Efforts to implement care guidelines should: ensure adaptability when providing implementation support and conduct formative evaluations to determine the optimal form of such support for a given clinic; consider how study data collection influences adoption; and consider barriers to clinics’ ability to use/accept implementation support as planned. More research is needed on supporting change implementation in under-resourced settings like CHCs. Trial registration ClinicalTrials.gov , NCT02325531. Registered 15 December 2014.

Although high levels of intervention implementation are more likely to lead to improved student outcomes, educators struggle to maintain high implementation levels over time. School psychologists might provide research-supported, consequence-oriented supports (e.g., performance feedback) to promote educators' implementation, yet these are reactive and potentially time intensive. This study evaluated whether a proactive, ­antecedent-oriented support (i.e., daily, preprogrammed e-mailed prompts) could effectively promote educators' implementation. Findings indicate that for 3 of 4 teachers who participated in this multiple baseline single case design study, implementation of the class-wide behavior intervention improved upon receiving e-mailed prompts. In addition, increases in praise, decreases in corrective statements, and corresponding improvements in student outcomes were noted. This initial study suggests that prompts may be a feasible and effective Tier 1 implementation support that can be incorporated by school psychologists to support educators responsible for delivering interventions in the classroom. Additional implications for future research and school-based practice are discussed.

Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial called Preparing to Run Effective Programs (PREP) showed that an implementation support intervention called Getting To Outcomes (GTO) improved implementation of an evidence-based substance use prevention program (CHOICE) run in community-based settings. However, more information is needed on how these interventions affect organizational barriers and facilitators of implementation. This paper aims to identify differences in implementation facilitators and barriers in sites conducting a substance use prevention program with and without GTO. PREP is a cluster-randomized controlled trial testing GTO, a two-year implementation support intervention, in Boys & Girls Clubs. The trial compares 15 Boys & Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 Boys & Girls Club sites implementing CHOICE supported by GTO (intervention group). All sites received CHOICE training. Intervention sites also received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE, and then evaluate and make quality improvements to CHOICE implementation using feedback reports summarizing their data. Following the second year of CHOICE and GTO implementation, all sites participated in semi-structured interviews to identify barriers and facilitators to CHOICE implementation using the Consolidated Framework for Implementation Research (CFIR). This paper assesses the extent to which these facilitators and barriers differed between intervention and control group. Intervention sites had significantly higher average ratings than control sites for two constructs from the CFIR process domain: planning and reflecting and evaluating. At the same time, intervention sites had significantly lower ratings on the culture and available resources constructs. Findings suggest that strong planning, evaluation, and reflection—likely improved with GTO support—can facilitate implementation even in the face of perceptions of a less desirable implementation climate. These findings highlight that implementation support, such as GTO, is likely to help low-resourced community-based organizations improve program delivery through a focus on implementation processes.Trial RegistrationThis project is registered at ClinicalTrials.gov with number NCT02135991 (URL: https://clinicaltrials.gov/show/NCT02135991). The trial was first registered May 12, 2014.

Problematic rates of alcohol, e-cigarette, and other drug use among US adolescents highlight the need for effective implementation of evidence-based programs (EBPs), yet schools and community organizations have great difficulty implementing and sustaining EBPs. Although a growing number of studies show that implementation support interventions can improve EBP implementation, the literature on how to improve sustainability through implementation support is limited. This randomized controlled trial advances the literature by testing the effects of one such implementation intervention—Getting To Outcomes (GTO)—on sustainability of CHOICE, an after-school EBP for preventing substance use among middle-school students. CHOICE implementation was tracked for 2 years after GTO support ended across 29 Boys and Girls Club sites in the greater Los Angeles area. Predictors of sustainability were identified for a set of key tasks targeted by the GTO approach (e.g., goal setting, evaluation, collectively called “GTO performance”) and for CHOICE fidelity using a series of path models. One year after GTO support ended, we found no differences between GTO and control sites on CHOICE fidelity. GTO performance was also similar between groups; however, GTO sites were superior in conducting evaluation. Better GTO performance predicted better CHOICE fidelity. Two years after GTO support ended, GTO sites were significantly more likely to sustain CHOICE implementation when compared with control sites. This study suggests that using an implementation support intervention like GTO can help low-resource settings continue to sustain their EBP implementation to help them get the most out of their investment. ClinicalTrials.gov Identifier: NCT02135991.

Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs. Methods The study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation. Discussion Optimizing cardiac rehabilitation centres’ delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI. Trial registration ClinicalTrials.gov. Identifier: NCT05889416 . Registered 2023-03-23.

Background This study uses the Practical, Robust, Implementation, and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to describe how features of jail contexts are associated with the number of people linked to medication for opioid use disorder (MOUD) and sustainment of jail linkage programs implemented in Wave 1 of the HEALing Communities Study in Kentucky (HCS-KY) from 2021 to 22. The HCS-KY is part of a parallel-group, cluster-randomized wait-list controlled trial examining the effects of supporting wide-scale implementation of evidence-based practices to reduce opioid overdose deaths. One strategy involved implementation of MOUD linkage programs within five Kentucky county jails. Minutes from program planning and maintenance meetings led by HCS-KY implementation facilitators with linkage staff/supervisors and jail liaisons/partners (average of five participants/meeting) were coded following PRISM-RE-AIM using template analysis to understand variations in participation across sites as well as barriers to and facilitators of MOUD linkage implementation. Results Across the five jails, 277 participants met with linkage staff during and/or post-incarceration for 1,119 visits conducted in-person or via phone/video conference. Twenty-six participants linked to community-based MOUD treatment during the implementation period. Participation differed across sites based on jail and linkage staff utilization of implementation support strategies but did not affect program sustainment, which all jails pursued in some form. Qualitative analysis yielded four overarching themes characterizing jail linkage program implementation. First, program integration into jail infrastructure entailed navigation of jail facilities and technologies as well as legal factors surrounding linkage staff backgrounds and information-sharing. Second, adapting the intervention to site-specific needs required providing training and implementation support to jail and linkage staff tailored to each jail context. Third, facilitating inter-organizational and cross-system coordination was related to collaboration successes and challenges among the HCS-KY team, linkage staff, the courts, and other provider partners. Finally, staffing and legal factors influenced sustainment. Conclusions Only ~ 10% of participants linked to community-based MOUD despite intensive implementation support, yet jails highly valued the program and planned for sustainment. Given the complexities in postponing treatment initiation until reentry, we call for simultaneous efforts to integrate MOUD screening and treatment into jail booking processes.

BackgroundGuided by the Interactive Systems Framework and the Evidence-Based System for Implementation Support, the current study examines how County Offices of Education can advance systemic SEL in districts and schools to bolster the well-being and mental health of educators and students.MethodThrough the directed qualitative content analysis of plans drafted by County Leaders, we examine how counties envisioned providing implementation support and provide definitions, examples, and frequencies of five commonly used implementation support strategies in real-world practice.ResultsTools, trainings, and technical assistance were mentioned in the majority of plans, incentives in approximately half the plans, and feedback loops were referenced in only 27% of the plans. We found that implementation support strategies were innovatively combined to build the capacity of local practitioners in integrated and responsive ways. We also present two new dimensions to conceptualize implementation support and advance theory-building in the field. The first dimension is implementation support strategy orientation, or the degree to which strategies are responsive to local preferences, resulting in a spectrum of top-down to bottom-up approaches. Second, implementation support strategy facilitation, describes the degree to which support strategies range in their level of requisite preparation.ConclusionsUltimately, our findings aim to inform implementation planning, advance and refine current frameworks, and narrow the bidirectional gap between research and practice.

Digital mental health interventions are often touted as the solution to the global mental health crisis. However, moving mental health care from the hands of professionals and into digital apps may further isolate individuals who need human connection the most. In this commentary, we argue that people, our society’s greatest resource, are as ubiquitous as technology. Thus, we argue that research focused on using technology to support all people in delivering mental health prevention and intervention deserves greater attention in the coming decade.