This prompt introduces the article titled “A methodology for generating a tailored implementation blueprint: an exemplar from a youth residential setting” by Cara C. Lewis, Kelli Scott, and Brigid R. Marriott, published in Implementation Science in 2018.
The article addresses a critical challenge in healthcare: while tailored implementation approaches are widely acknowledged as more effective for integrating evidence-based practices (EBPs), concrete methodologies for achieving such tailoring are scarce. Traditional methods, such as training combined with consultation, are often insufficient for achieving widespread penetration and long-term sustainment of EBPs in complex environments like residential treatment settings. The authors highlight that effectively tailoring strategies to the unique contextual factors that influence implementation is crucial for success, yet this process is often considered a “black box” in implementation science, needing to be revealed for successful efforts to be replicable.
The primary objective of this paper is to introduce a novel, empirically-driven, and collaborative methodology for developing a formal, tailored implementation blueprint. This methodology is illustrated through a case example focusing on the implementation of Cognitive Behavioral Therapy (CBT) within a youth residential center. The proposed methodology consists of five distinct steps aimed at two overarching goals: (1) identifying the determinants of practice, primarily focusing on barriers, and (2) selecting and matching implementation strategies to address these identified determinants.
The methodology employs a model-driven, mixed-methods approach for a comprehensive needs assessment. Participants in the case example included mental health therapists and operations staff from two programs at Wolverine Human Services. Data collection involved both surveys (clinicians N=10; operations staff N=58; other N=7) and focus groups (clinicians N=15; operations staff N=38), guided by the domains of the Framework for Dissemination. A modified conjoint analysis method was then piloted to collaboratively generate the implementation blueprint.
Key results from applying this methodology include the identification of 76 unique barriers to implementation following the needs assessment and mixed-methods analysis. Through a modified conjoint analysis, 23 of these barriers were prioritized based on high feasibility and importance ratings. Subsequently, 36 implementation strategies were selected for their high impact or feasibility (or both) to address these prioritized barriers. The process culminated in the creation of a 3-phase implementation blueprint (pre-implementation, implementation, and sustainment) which organized these strategies over a 5-year timeline, with 45 unique strategies across all nine categories of implementation strategies. The blueprint included specific action steps, responsible parties (Implementation Team or external experts), and ratings for importance, feasibility, and impact.
Ultimately, this novel methodology offers a relatively low-burden, collaborative approach that leverages advancements in implementation science, including measurement, models, strategy compilations, and methods from other fields. It provides a clear plan, enhances transparency, and fosters stakeholder ownership in the process of implementing evidence-based practices effectively.
APA Reference:
Lewis, C. C., Scott, K., & Marriott, B. R. (2018). A methodology for generating a tailored implementation blueprint: an exemplar from a youth residential setting. Implementation Science, 13(1), 76. https://doi.org/10.1186/s13012-018-0761-6