Global search begins for missing link

Just about every human services organization in the world recognizes the terminology of evidence-based programs and policies.
 
And in the relatively short period since the concept emerged in the UK a broad consensus has been reached on standards, based on the powerful formulation of randomized controlled trials and systematic reviews of findings pioneered by the Cochrane Collaboration and consolidated by the university research community.
 
So, when it comes to assessing the value of policies and programs, we know how to do the research and review the evidence, and we have a basis for declaring some approaches to be more reliably evidence-based than others. 
 
Government investment in proven models of prevention and early intervention has increased as a result of improving confidence in the science.
 
So far so good. But when policy makers and practitioners attempt to make full and effective uses of evidence-based interventions in ordinary service settings they are all too prone to run into trouble. Here, too, we need to be able to offer high-quality evidence – about reliable implementation methods. There is too little of it and insufficient consensus about its usefulness.
 
It is invariably very difficult to do on a large scale what highly motivated prevention scientists have managed to achieve in a relatively small trial, and the consequences can be severe. In the hands of a poorly prepared practitioner, an intervention that has been the subject of numerous randomized controlled trials is no more useful than one that has never been evaluated at all. Sometimes the evidence will simply cease to stack up. 
  
We are coming to see that implementation research can forge the missing link in the chain that connects science to services, and we have already made some good progress, witness, for example, the excellent work by Trisha Greenhalgh. 
 
The US National Implementation Research Network [1] is serving as a guide for more focused research and practice on the subject by organizing current knowledge. We are beginning to understand how to create staff competence, provide useful organization supports for practitioners, and exercise the leadership required to implement effective interventions well.
 
But the fact remains: despite the frustration of not consistently achieving desired outcomes in real world settings and a surge of interest in implementation, current evidence is relatively weak and spotty. There is still no agreed standard of evidence equivalent to that established by the Cochrane, Campbell and other collaborations.
 
To make that necessary quantum leap, implementation aficionados are organizing a Global Implementation Conference [2] in Washington DC in September 2011. A prime objective will be to form implementation practice groups, some of which will focus on organizations designed to assure effective implementation of evidenced based programs, such as Multisystemic Therapy [3], Positive Behavioral Interventions and Supports [4], and ExpandNet [5].
 

We hope that these international groups will hone better practices and create a laboratory where they can be more systematically studied. Other practice groups will focus on policy and leadership.
 
Over the next couple of decades we aim to make as much progress as the Cochrane Collaboration since it was initiated by Iain Chalmers. (We will let future leaders argue over the name!)
 
For more about the work of Trisha Greenhalgh, see: Greenhalgh T, Robert G, MacFarlane F, Bate P, and Kyriakidou O (2004). “Diffusion of innovations in service organizations: Systematic review and recommendations” The Milbank Quarterly, 82(4), 581-629.