Researchers and evaluators are in Bethesda, Maryland, this week, to work at “methods and measurements” for a new science of dissemination and implementation.

Few will dispute that there are big obstacles to the uptake of evidence-based interventions in children’s services, and that even when they are commissioned they are not necessarily implemented very well.

Successful introduction is no guarantee of sustainability: interventions may be delivered for a short period — typically as part of a pilot supported by ring-fenced funding — but then they fizzle out.

This year’s third annual US National Institutes of Health conference on the subject is covering five key issues related to these thorny problems.
 
The first is how to measure the fidelity and quality of implementation. Few of the available products synthesize information about promising implementation practices in a language that will reach non-scientific audiences. Conference presenters will be exploring the value of tools that offer more practical guidelines for increasing the quality of implementation.
 
If consumers, clinicians, funders, and policy makers are to be able to determine how far they get the interventions they need and ask for, more efficient and effective fidelity measurement methods are wanted.

A key challenge is to make such judgments routine, but few fidelity measures are used in practice and fewer meet the different needs of clinicians and manager. Such measures as there are tend to be unwieldy and expensive. So a key question, particularly pressing in schools, for example, concerns the necessary trade-off between effective (valid and reliable) and efficient calculations of fidelity.

A second issue on the conference agenda is how to develop capacity among providers for the suitable selection and implementation of evidence-based interventions. Prevention “operating systems” such as Communities that Care, which assist communities and service delivery agencies in the selection and implementation of programs, have demonstrated the value of improving local capacity.
 
But does providing community stakeholders with technical assistance actually improve their insight into the selection, implementation and evaluation of interventions? And can the growth of expertise be assessed qualitatively as time goes by? A study of the Iowa-made PROSPER operating system examines these questions.
 
A third fundamental concerns scaling up effective interventions. Is there reliable routine practice that can be followed when implementing widely across communities a program that been tested and proven in a relatively small number of trial sites?

Case studies to be presented, this week, include a five-year prospective study of the process and outcomes of scaling up a family planning innovation in Mali, India, Madagascar, Guatemala and Rwanda.

In those enormously varied surroundings, the researchers applied quantitative measures to establish whether the model was integrated into training programs. They also conducted focus group discussions and interviews with staff to identify the relational, socio-political, environmental and economic factors relating to scale-up.
 
Another presentation considers the value of “train-the-trainer” models of a kind frequently used in public and mental health to disseminate programs to community settings.

“Master trainers” teach “instructor-trainees” the content of an intervention, as well as the process of training others. The newly-trained instructors go on to lead training sessions for target groups. Do trainers disseminate the program to the target audience — and how good is the training by the second generation instructor-trainees?
 
A fourth issue is how to measure and promote organizational readiness for change.
 
Measures such as the Organisational Readiness to Change Assessment (ORCA) developed to support cardiac care are reliable but what is the relationship between baseline readiness scores and implementation? One presentation examines this in relation to hepatitis prevention services.
 
None of these issues will be relevant if no-one knows much about evidence-based interventions in the first place. Many researchers and professionals continue to be frustrated by the low rate and slow pace at which proven solutions are applied in practice. One presentation explores whether the systems and infrastructure commonly used in marketing and distribution have anything to offer.
 
Coca-Cola products should always be “within an arm’s reach of desire” said the drink manufacturer's CEO, Robert Woodruff, in the 1960s. What do programs like PATHS, Incredible Years and Functional Family Therapy have to learn from the company’s market segmentation, sales and customer service activities?