Organizational and systems capacity to implement evidence-based prevention programs is a key factor in achieving public health impacts. Yet the “how” of developing this capacity is an ongoing question in the field of implementation science. Since November 2016, the Impact Center at the Frank Porter Graham Child Development Institute has provided external implementation support to build the capacity of intermediary organizations (IOs) and local implementation agencies (LIAs) to install and scale the Triple P- Positive Parenting System of Interventions across North and South Carolina. This project provides an opportunity to examine the processes behind implementation support and trajectory of the partnership between implementation specialists and implementing agencies.
The Impact Center employs a quality assurance and improvement system to collect data on the type and amount of support provided by a team of implementation specialists. Using Qualtrics, specialists report on process variables (including support format and duration) and type of stage-based support provided (readiness and exploration, capacity development, supported performance, or local regulation). We calculated dose of support per stage from pooled IOs or LIAs data using a two-month average to understand the evolution stage-based support over time. We also examined the relative proportion of capacity development and supported performance activities to observe how external implementation support activities may shift.
By 2019, over 26 months of implementation support data for two intermediary organizations and four local implementing agencies will be available. Overall, the dose of support provided by implementation specialists declines over time, from an average of 13 hours per month in the first three months of the partnership to under 6 hours per month after a year of support. Data from both IOs and LIAs show similar profile mix of stage-based support. Notably, capacity development and supported performance among LIAs does not begin until 5 months into the partnership whereas these activities begin immediately upon partnership with IOs. Both types of organizations receive predominately (>75%) capacity development for 4-6 months, tapering to about 50% of activities after 10-12 months as supported performance activities emerge as a greater focus of support.
External implementation support is a growing field. Formative and process data from the Impact Center’s teams of implementation specialists provides insight for other professionals planning to support the implementation of evidence-based programs by IOs or LIAs.