Moving Science to Practice: Exploring Implementation Practice Capacity in Community Settings

Due to the significant prevalence of mental and substance use disorders in the United States, the push for the development and implementation of evidence-based practices (EBPs) has grown exponentially in the last 30 years. Community-based organizations (CBOs) (i.e., self-governing and/or not-for profit) have been identified as significant providers of behavioral health services. However, there are gaps in the literature surrounding CBO implementation capacity, meaning their ability to adopt, implement, and sustain EBPs. There is a need for more research examining capacity training initiatives that specifically target CBOs and implementation practice. The purpose of this dissertation research was to investigate how individuals working within Florida CBOs conceptualize implementation practice capacity, what is needed to reach adequate capacity for implementing an EBP, what would be required of an implementation training initiative to increase capacity, and whether these perspectives differ by organizational level. This dissertation began with a thorough review of the implementation science research and practice literature. This served to inform the first manuscript, which provides a comprehensive overview of the history of EBP practice and implementation science, challenges associated with implementation, discussion of implementation practice, and proposes targeted research efforts to build organizational capacity to implement EBPs most effectively. In addition, the literature review assisted in providing the theoretical foundation for the dissertation study and guiding the second and third manuscripts. An explanatory sequential design was used to examine participant perceptions of implementation practice areas and building implementation practice capacity both quantitatively and qualitatively. The quantitative portion of the study, which informed the second manuscript, was used to assess how implementation capacity is conceptualized by CBOs at the administrative and practitioner levels and what areas of implementation are deemed essential for success (Phase 1) using the Implementation Practice Survey (IPS) (N=97). The IPS examines perceived importance, presence, and organizational capacity in nine implementation practice areas (IPAs) (fit and adaptation, collaboration and communication, organizational readiness, culture and climate, leadership, external policy, data-based decision-making and evaluation, education, training, and coaching, and sustainability). Differences between subgroups on ratings of importance, presence, and organizational capacity were examined, as well as associations between organizational capacity and the nine implementation practice areas. Results revealed statistically significant differences between subgroups on their ratings of presence and organizational capacity. Results also revealed the nine IPAs significantly predicted organizational capacity. Of the nine IPAs examined, fit and adaptation, culture and climate, leadership, and collaboration and communication added significantly to the prediction of organizational capacity. Culture and climate, leadership, and collaboration and communication added significantly to the prediction of adoption, and leadership added significantly to the prediction of implementation. The quantitative phase served to inform participant recruitment and protocol development for the qualitative portion of the study. The qualitative portion, which informed the third manuscript, consisted of semi-structure interviews with eight administrators and nine practitioners currently employed by CBOs who deliver evidence-based behavioral health services for a total sample size of 17. The interviews allowed for an in-depth exploration of participants’ perceptions of their CBOs’ ability to implement EBPs, what IPAs are deemed essential, if the importance and presence of those areas are related, training needs, and why the participant subgroups may differ when statistically tested (Phase 2). Results showed that IPAs such as leadership, culture and climate, training, data-based decision-making and evaluation, funding, and collaboration/communication (i.e., both internal and external) were all important areas of EBP utilization. The level of importance of the IPAs seemed to differ based on organizational level and the stage of implementation. In addition, themes such as buy-in, importance of EBP use, funding, and the notion of ‘why’ certain things are important for EBP utilization emerged. As a whole, this dissertation provides a discussion and implications for research and practice regarding implementation practice capacity in community settings, including capacity trainings needs. Incorporating stakeholders’ feedback in the creation of a training initiative aimed at building capacity may result in an adequately tailored framework and training techniques, greater buy-in within the organizations, and increased efficacy in the operationalization of capacity building strategies and interpretation of data evaluating a training initiative