Are Your Programs and Services Evidence-Based? Implementation Science can Help!

February 14, 2022
Switchboard

Many resettlement agencies want to design and deliver more evidence-based services, but providers often struggle with putting available evidence into action. Guidance from the field of implementation science can help address this challenge.

What is Implementation Science?

Implementation science researches methods to promote the adoption and integration of evidence-based practices into routine service delivery. Implementation science is rooted in the health care sector and has not been widely applied in refugee resettlement, but it has the potential to bridge the gap between evidence, action, and improving client outcomes. Implementation science is concerned with questions like these:

How acceptable is a particular evidence-based practice (EBP) to our clients and staff?
How appropriate and feasible is the EBP for our program?
What are the best strategies for increasing uptake of the EBP in our program?
To what extent have staff adopted the EBP, and are they delivering it as intended (practice fidelity)?
How sustainable is the newly adopted EBP?

Tips from Implementation Science: Promoting Uptake of an Evidence-Based Practice

A review of implementation science literature identifies six organizational features that impact the success of implementing an evidence-based practice:

Organizational culture: Organizational openness to trying new innovations and an organizational learning culture are highly associated with implementation success.
Networks and communication: Organizational networks and communication foster implementation success. These include intra- and inter-agency collaborations and teamwork.
Leadership: Leaders optimize implementation success by expressing enthusiasm for the change; being present, supportive, and attentive to the implementation process; and demonstrating willingness to ask for feedback from staff regarding the change.
Resources: Successful implementation requires adequate financial resources, staffing and workload, time, and education and training.
Evaluation, monitoring, and feedback: Appropriate feedback mechanisms benefit EBP implementation by preserving engagement among staff who implemented the change.
Champions: Having a champion to advocate for the innovation leads to more successful EBP uptake.

Limited time? Check out the JBI Manual for Evidence Implementation!

Section 2 of the manual provides an overview of the seven steps required when conducting a small (single unit or single site) or large-scale (multi-unit or multi-site) evidence implementation project.

Case Study

In 2020, The Kentucky Office of Refugees (KOR) received a four-year ORR Wilson-Fish grant for a TANF Coordination Program. The grant required, in part, that an EBP case management strategy be employed. In developing the grant application, KOR leadership team members Maria Koerner and Rylan Truman identified motivational interviewing, a well-established EBP, as an appropriate EBP for their refugee client population based on a review of the literature and their practice knowledge. They determined that implementing this EBP would be feasible given the grant resources.

Upon receiving the grant funding, KOR initiated several strategies to promote the adoption of motivational interviewing in resettlement agencies statewide, including:

Trainings on motivational interviewing for all resettlement agency staff statewide. As part of evaluation, monitoring and feedback, staff completed a pretest and posttest to gauge foundational motivational interviewing skills. After the training, they also completed a survey addressing their satisfaction with (one element of acceptability), and adoption of, motivational interviewing to date. They were also asked to identify successes and challenges in using the intervention.
Training for interpreters, recognizing their crucial role. Following their training, interpreters provided their feedback on motivational interviewing with clients using an open-ended questionnaire.
Establishing an inter–agency network, called the Motivational Interviewing Community of Practice, whose members will serve as motivational interviewing champions within their agencies.

The feedback from these early-stage strategies has already yielded valuable lessons for planning the next stages of the implementation process, including exploring organizational culture, expanding adoption, and assessing fidelity. Ultimately, KOR expects that as adoption and fidelity increase, client outcomes will improve.

Looking for evidence relevant to your programs and services?

Switchboard hosts an evidence database that includes over 100 articles related to refugee service provision and eleven evidence summaries. These summaries synthesize the research on the most effective intervention or approach for a specific challenge. Recent summaries include:

Conclusion

Implementation science can be a valuable source of knowledge and guidance for resettlement program design, implementation, monitoring, and evaluation. In the design stage, program planners must select evidence-based interventions acceptable to staff and clients. In the implementation stage, stakeholders must employ strategies to increase the chosen intervention’s adoption. Monitoring and evaluation staff must develop routines for collecting data on adoption, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Finally, for program evaluators, implementation science provides a roadmap for the uptake of their recommendations.