Andria B. Eisman

Introduction: Despite an increased interest in implementation costs, there is little to no practical guidance on how to conduct implementation cost evaluations. Recommendations, tools, and examples are needed to incorporate reliable and feasible costing approaches into implementation studies and guidance on when an economist is necessary. To this end, we identified key issues and developed this paper and a guide on pragmatic approaches for assessing and reporting implementation costs. Method: We assembled a team of implementation scientists and health economists working in various settings to identify central issues related to implementation costing. Our objective was to support the broad application of costing in implementation studies that is consistent, feasible, and can be practically applied. We engaged in a limited, iterative process of developing initial guidelines and soliciting feedback, consistent with principles of USE-EBPI (Usability Evaluation for Evidence-Based Psychosocial Interventions) methodology, to make refinements and enhance broad applicability. Results: We developed initial recommendations for a limited number of critical issues to advance the application of costing in implementation science and illustrated them using a study example. These issues were: (a) identifying relevant resource costs, (b) capturing resources using activity-based costing (ABC), (c) valuing resource units, summarizing and reporting, and (d) estimating replication and sustainment costs. We also emphasize the need to tailor approaches to meet different contexts and project-specific needs, and provide guidance when additional help may be needed. Conclusions: Key to ensuring any program's successful adoption, implementation, and sustainment is understanding the costs and resources required. Costing implementation in the “real world” is both an art and a science; teams must make decisions about give-and-take related to precision and burden on participants and the research team while still producing generalizable estimates. Transdisciplinary costing guidance can address these issues and provide details and resources to help pragmatically cost and report implementation efforts.

Schools engaged in prevention efforts struggle to respond quickly and effectively to changing drug use trends due to insufficient investment in infrastructure at local, state, and national levels. This results in preventable morbidity and mortality among adolescents. This study estimated the costs associated with implementing Rapid Adaptation to Prevent Drug use (RAPD), infrastructure-building implementation strategies, using mixed methods to optimize data collection feasibility, quality and support a comprehensive understanding of outcomes. We conducted semi-structured interviews in Step 1 (pre-pilot trial) to inform the initial cost data collection approach. During Step 2, we used activity-based costing, conducted sensitivity analysis, and estimated budget impacts of replication. Step 3 included interviews with pilot participants to contextualize the results and verify time reporting. Thirty-four school personnel participated in Step 1 interviews and four health coordinators and six teachers participated in the pilot study. We identified cost drivers and pragmatic constraints related to effective time-cost data collection and developed an activity-based costing data collection plan. The estimated costs for deploying RAPD (Step 2) were $6,215/school. We estimated the budget impact of replication to be $5,551/school with 52% of the cost during the pre-implementation phase. In Step 3 interviews participants identified financial and staffing resources as central challenges to infrastructure development. This study uses a mixed methods approach, including an exploratory sequential design, to proactively guide microcosting. By identifying potential barriers in advance, we enhanced the rigor and feasibility of our data collection process. The study offers preliminary cost estimates to deploy RAPD infrastructure-building strategies to address emerging drug trends and sustain prevention efforts. Building prevention infrastructure is essential in preventing the onset and escalation of substance use among youth. Implementation strategies are key in building robust implementation infrastructure for prevention. Estimating costs associated with infrastructure building strategies is vital in realizing the public health impact of prevention interventions.

Background : Promoting physical activity (PA) among children is critical for their overall health and development. Despite the availability of various interventions, adherence to structured PA programs remains a challenge, particularly in home settings. The Interrupting Prolonged Sitting with Activity (InPACT) at Home program was designed to address this issue by offering a flexible and accessible means for children to engage in regular PA. However, understanding the factors that influence adherence to such interventions is essential for optimizing their effectiveness. Purpose : To examine adherence to the InPACT at Home intervention and potential barriers and facilitators. Methods : A sequential mixed methods design was used. Children ages 7–12 years engaged in a 20-day intervention where they were asked to complete three, 8-min InPACT at Home PA videos, 5 days per week. Informed by the Consolidated Framework for Implementation Science Research 2.0 framework, individual characteristics, intervention characteristics, and inner setting characteristics were assessed via interviews. Results : On average, participants engaged in 2.2 out of three exercise videos per day. Twenty-one out of 88 participants (23.9%) completed all videos. Individual characteristics, including parent support and intervention design/compatibility were identified as facilitators. Intervention characteristics, including adaptability, and inner setting structural characteristics and compatibility with the home environment were identified as barriers. Conclusions : This study suggests that, on average, children accumulated 12–16 additional minutes of daily PA through the InPACT at Home program. However, implementation strategies may be needed to enhance adherence.

Background: Many school‐based physical activity (PA) interventions are implemented without adequately assessing their contextual fit, which can hinder their effectiveness and sustainment, ultimately reducing their impact on student health and well‐being. This study aimed to assess the pre‐implementation fit of the Interrupting Prolonged Sitting with ACTivity (InPACT) classroom PA intervention in one resource‐limited intermediate school district (ISD; encompassing 16 local districts and 32 elementary schools) in central Michigan.Methods: Assessments were conducted by the regional school health coordinator and ISD support staff during 2020–2021, using the Hexagon Discussion and Analysis Tool. Ratings on a 5‐point Likert scale were totaled for need, fit, support, evidence, usability, and capacity.Results: The first assessment score was 19/30; the second assessment score was 28/30, indicating a 47% increase in fit over a year. Field notes revealed a growing need for school‐based PA due to limited opportunities during COVID‐19. Improvements in support, fit, evidence, usability, and capacity were linked to enhanced knowledge and capacity of the regional school health coordinator.Implications for School Health Policy, Practice, and Equity: The initial misalignment between intervention and context highlights the importance of addressing contextual barriers in resource‐limited schools to effectively promote PA equity.Conclusions: By conducting multiple assessments, schools can identify and address barriers to intervention fit, increasing readiness and the likelihood of successful implementation.

Drug use trends change rapidly among youth, leaving educators and researchers struggling to respond promptly. Widely adopted universal evidence-based interventions (EBIs), such as the Michigan Model for Health™ (MMH), and their delivery systems offer an opportunity to reach large youth populations and reduce the onset and escalation of emerging drug use trends. Tier 1 EBIs do not always reflect the most current needs of the context and population. Implementation strategies are needed to optimize EBIs and system responsiveness to emerging drugs. This study employs after action review (AAR) to examine past responses to emerging drugs and design implementation strategies for rapid responses. AAR centers on four key questions: (1) What was expected to happen? (2) What happened? (3) What went well? and (4) What can be improved? We collected qualitative data from 35 participants, including state education partners, school administrators, counselors, teachers, prevention specialists, and the state’s health coordinator network. We used rapid qualitative and iterative inductive-deductive thematic analytic approaches. Data analysis revealed three central tenets for rapid responses: collaboration, readiness, and planning. We then identified implementation strategy core functions aligned with the central tenets and strategy form options (e.g., build/leverage a coalition) for each function to accommodate school-level heterogeneity. We created a systematic process to develop and deploy an implementation blueprint for building prevention infrastructure to enhance rapid responses for emerging drugs leveraging an existing intervention (MMH) and delivery system. AAR is a promising approach to identifying gaps and best practices in school-based responses to urgent drug crises. Our results indicate that while the core implementation strategy functions are constant, health coordinators benefit from strategy options tailored to their context. Trial registration: NCT05806840, https://classic.clinicaltrials.gov/ct2/show/NCT05806840 .

Background: School-based universal prevention programs, like the Michigan Model for Health™ (MMH), hold promise for enhancing youth behavioral health but often face implementation challenges due to insufficiently addressing priority student issues. Previous research identified trauma-sensitive content as a student need in the MMH. Enhanced Replicating Effective Programs (REP), a multicomponent implementation strategy, is well suited to support program providers in addressing priority health issues among youth. Method: This pilot cluster-randomized controlled trial compared Enhanced REP (tailored curriculum, training, and implementation facilitation with trauma-sensitive content) to standard REP (standard curriculum, initial training, as-needed technical assistance) across eight high schools serving low-income students. Through semistructured interviews at three time points, we assessed teacher perceptions of feasibility, acceptability, and appropriateness related to REP core and enhanced components. Results: Teachers generally found Enhanced REP to deliver MMH satisfactory and suitable. However, the school environment, notably administrative support, influenced feasibility compared to standard REP. Enhanced REP teachers reported benefits in meeting student needs that were not seen in the standard REP group. The standard REP data helped to understand the comparative value of the enhanced strategy during a time of notable upheaval and mental health challenges due to the COVID-19 pandemic. Conclusions: While some schools may succeed with less intensive strategies (REP), many may require more intensive approaches for effective implementation. Enhanced REP shows promise in tailoring curriculum delivery and providing additional support to meet student needs, but its success may hinge on organizational support, especially from leadership. Future research should investigate the addition of organizational-level strategies, such as leadership training, to optimize implementation and explore the comparative effectiveness of Enhanced versus standard REP.

Background: Drug use trends change rapidly among youth, leaving intervention experts struggling to respond promptly. Delays in responses can lead to preventable morbidity and mortality. The COVID-19 pandemic underscored the need for implementation science to facilitate rapid, equitable responses using existing treatment and prevention efforts. Existing, widely adopted evidence-based interventions (EBIs; e.g., the Michigan Model for Health™: MMH) are well suited to address emerging drug trends. We have a critical need to advance implementation strategies to optimize system responsiveness to these emerging drug issues. This research aims to design and test implementation strategies to (1) improve the responsiveness of school-based EBIs in addressing urgent issues and (2) find ways to support teachers in implementing updated EBIs, attending to unique considerations of schools serving economically disadvantaged students. Methods: The research aims are as follows: aim 1: identify implementation gaps and best practices using After Action Review (a reflective process used by health organizations in responding to emergent public health events) using qualitative methods. Aim 2: design and pilot test RAPD (Rapid Adaptation to Prevent Drug use) based on aim 1 findings. RAPD refers to a novel set of implementation strategies designed to enhance the capacity of an existing, widely adopted evidence-based universal prevention curriculum (MMH) to respond to emerging drug issues among youth. We will pilot test RAPD in ten middle schools serving diverse student populations using a two-group, mixed method, cluster randomized controlled trial design. Aim 3: assess the costs and benefits of RAPD from multiple partner perspectives using a mixed methods approach. Discussion: This study focuses on designing and deploying implementation strategies to reduce the detrimental impact of emerging drugs and provide an infrastructure to make future adaptations that can be applied in other contexts. After Action Review (AAR) provides a valuable opportunity to review the statewide response to past drug use events, specifically the vaping crisis, using the MMH curriculum, which can systematically guide implementation strategy selection and deployment to meet identified gaps. The rationale for the proposed research is that designing and testing RAPD will advance implementation science in responding to urgent public health events and ensure equitable responses across youth populations. Trial registration: ClinicalTrials.gov NCT05806840.