For successful implementation (and sustainment) of new interventions, it is critical that barriers are identified and addressed prior to change. It is challenging, however, for agencies to independently assess their own strengths and weaknesses in order to develop plans for organizational improvement. Furthermore, the sheer number of strategies that promote implementation also make it difficult for agency leadership to identify the most appropriate evidence-based intervention for their own contexts and needs. This project develops and pilot tests Mapping Approaches to Prepare for Implementation Transfer (MAP-IT). MAP-IT is an organizational intervention that includes three key elements: (1) instruction on mechanisms known to impact implementation, (2) tools and instruction for conducting an agency-driven diagnosis of potential implementation barriers, and (3) tools for developing an implementation blueprint to address identified barriers (including instruction on strategies for addressing potential barriers prior to implementation). The premise of this application is significant in that it provides a low-cost and sustainable alternative to promoting effective organizational adoption of new practices. Firstly, the MAP-IT intervention is low cost in that it provides for deliberate, agency-driven opportunities to prepare for implementation change without ongoing external coaching. Secondly, the intervention provides a sustainable alternative for promoting organizational program change via targeted skill development for multiple people within the organization or agency.
The specific aims of the proposed research are as follows:
AIM 1 – Synergistically integrate and adapt three established implementation intervention tools to promote deliberate agency implementation preparation – organizational assessment and feedback; taxonomy of implementation strategies; and visual-spatial decision making techniques – as combined into a comprehensive training and manualized bundle, MAP-IT.
AIM 2 – Conduct a 2-arm cluster randomized efficacy trial of the MAP-IT intervention with twelve substance abuse treatment community-based residential and juvenile justice secure agencies serving adolescents (including those with opioid use disorders) randomized to either MAP-IT (evidenced-based practice and MAP-IT trainings) or the non-intervention control condition (evidence-based practice training only).
Successful completion of the following aims is expected to:
(1) establish preliminary evidence for the efficacy of a low-cost, sustainable alternative for improving implementation preparation that agencies can use to support and expedite implementation transfer
(2) shift the current paradigm by encouraging researchers (designing uptake studies) and health care agencies (independently striving to implement new practices) to place greater emphasis on pre-implementation preparations for change
(3) provide an empirical examination of how exploration and preparation can support implementation, using established measurement platforms and theoretical frameworks
(4) provide documentation of agency selection of implementation strategies for promoting change in real-world settings
Findings from this R21 study will inform intervention effectiveness testing and implementation strategy selection in a future R01 study aimed at improving uptake of best practices within behavioral healthcare delivery services using a full-scale randomized control trial.
Selected Publications for MAP-IT
Becan, J.E., Crawley, R.D., Knight, D.K. (in press). Using a Train-the-Trainer Model to Promote Practice Change among Agencies Serving Justice Involved Youth. Federal Probation Journal.
Becan, J.E., Pankow, J., Lehman, W., Wiese, A., Joe, G., Goldberg, G. (2019). Mapping Approaches to Prepare for Implementation Transfer (MAP-IT). Fort Worth: Texas Christian University, Institute of Behavioral Research.
Becan, J., Wiese, A., Lehman, W. E. K., Goldberg, G., Knight, D. K. (October, 2019). Using the Consolidated Framework for Implementation Research (CFIR) to Predict Agency Use of a Motivational Enhancement Curriculum. Presentation at the Addiction Health Services Research Conference, Park City, UT.