Abraham Wandersman

This study examines (1) coalition survival, (2) prevalence of evidence-based prevention interventions (EBPIs) to reduce substance abuse implemented as part of the Tennessee Strategic Prevention Framework (SPF) State Incentive Grant (SIG), (3) EBPI sustainability, and (4) factors that predict EBPI sustainability. Secondary data were collected on 27 SPF SIG-funded coalitions and 88 EBPI and non-EBPI implementations. Primary data were collected by a telephone interview/web survey five and one-half years after the SPF SIG ended. Results from secondary data show that 25 of the 27 coalitions survived beyond the SPF SIG for one to five and one-half years; 19 coalitions (70%) were still active five and one-half years later. Further, 88 EBPIs and non-EBPIs were implemented by 27 county SPF SIG coalitions. Twenty-one (21) of 27 coalitions (78%) implemented one to three EBPIs, totaling 37 EBPI implementations. Based on primary survey data on 29 of the 37 EBPI implementations, 28 EBPIs (97%) were sustained between two and five and one-half years while 22 EBPI implementations (76%) were sustained for five and one-half years. When controlling for variability among coalitions (nesting of EBPIs in coalitions), increases in data resources (availability of five types of prevention data) was a strong predictor of length of EBPI sustainability. Positive change in extramural funding resources and level of expertise during SPF SIG implementation, as well as level of coalition formalization at the end of the SPF SIG predicted EBPI sustainability length. One intervention attribute (trialability) also predicted length of sustainability. Implications are discussed.

Many evaluations of programs tend to show few outcomes. One solution to this has been an increasing prominence of the movement that requires programs to implement evidence-based interventions (EBIs). But in a complex world with complex organizations and complex interventions, many challenges have arisen to the implementation of EBIs with fidelity to achieve outcomes at scale. This includes challenges to achieving outcomes in each setting. In this article, we propose the use of empowerment evaluation and one of its major approaches (Getting To Outcomes [GTO]) as a promising method to address the challenges, and GTO can help organizations achieve outcomes by leading them through a set of “accountability questions” for implementing EBIs in their particular setting. These questions can be asked at multiple levels (e.g., national, state, and local organizations) responsible for achieving outcomes. Although we illustrate the possibilities with examples from health care and public health, the potential strategies can be applied to many areas of health and human services and education.

Despite the availability of many evidence-based prevention interventions (EBIs), gaps exist in bringing these programs into widespread practice. Technical assistance (TA) is a strategy for enhancing the readiness of practitioners to implement EBIs. Although many millions of dollars are spent on TA each year, there is little consensus about what the essential features of TA are and how to provide TA with quality. A broad-based research synthesis methodology was used for analyzing the current evidence base for TA using three frames: (1) applying the Getting To Outcomes (GTO) model for categorizing evidence on TA that specifies tasks for planning, implementing, and evaluating TA; (2) understanding the relevance of a successful relationship between the TA provider and TA recipient; and (3) considering the extent to which TA fits the life cycle needs of the preventive intervention. Results indicated that an explicit model or organizing framework is rarely used to plan, implement, and/or evaluate TA; specific TA tasks performed vary widely across studies; TA is rarely delivered to recipients who are seeking to sustain innovations subsequent to adoption and implementation; however, there is systematic attention to relationships and relationship-building. Overall, this synthesis indicates that the extent to which TA is being delivered systematically is limited. We suggest that funders and other stakeholders develop and implement standards for TA quality in order to ensure that many of these limitations are addressed.

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement.

There are many challenges when an innovation (i.e., a program, process, or policy that is new to an organization) is actively introduced into an organization. One critical component for successful implementation is the organization's readiness for the innovation. In this article, we propose a practical implementation science heuristic, abbreviated as R = MC². We propose that organizational readiness involves (a) the motivation to implement an innovation, (b) the general capacities of an organization, and (c) the innovation‐specific capacities needed for a particular innovation. Each of these components can be assessed independently and be used formatively. The heuristic can be used by organizations to assess readiness to implement and by training and technical assistance providers to help build organizational readiness. We present an illustration of the heuristic by showing how behavioral health organizations differ in readiness to implement a peer specialist initiative. Implications for research and practice of organizational readiness are discussed.

The interest and effort in evaluation capacity building (ECB) continues to grow enormously among organizations, funders, and evaluators. Yet a research synthesis of the ECB literature (Labin, Duffy, Meyers, Wandersman, & Lesesne, 2012) revealed major limitations in the science and practice of ECB. This forum on ECB, which includes two past presidents of the American Evaluation Association, takes a hard look at the progress and challenges of ECB. Laura Leviton challenges funders, organizations, and evaluators to answer key What, When, and How questions about ECB. Tina Taylor-Ritzler and Yolanda Suarez-Balcazar describe the importance of linking the science and practice of ECB. Abe Wandersman describes research and practice on the Getting To Outcomes (GTO) results based approach to accountability; it is an example of connecting the Why, What, How, and Outcomes of ECB. In exploring the What of ECB, Susan Labin advances our thinking about measurement of ECB. In relation to the How of ECB, Hallie Preskill describes the need to move forward with the practice of ECB. Janet Clinton ends the forum on a positive empirical note, by providing evidence that stakeholder engagement in evaluation influences the outcomes of a program. The forum participants propose that improving the theory, implementation, methods, measures, and practice of ECB will have a significant impact on the field of evaluation and on society.

The Labin et al. logic model describes the why, how, what, and potential outcomes of evaluation capacity building (ECB). Getting To Outcomes offers a frame and empirical results for operationalizing the ECB logic model of Labin et al. and for deepening the science and practice of ECB.

Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith