Magnus Bergmark

What influences a sustainable implementation of evidence-based interventions in community mental health services? Development and pilot testing of a tool for mapping core components

Abstract Background: An important aspect of research regarding the implementation of evidence-based practice is the sustainability and long-term stability of a programme. There is a need to measure these critical components for establishing successful programmes. Aim: The aim was to develop and pilot test the sustainable implementation scale (SIS) for measuring the critical components in the sustainable implementation of community mental health services. Method: The scale was based on implementation research and consisted of three subscales regarding (1) the organisational level, (2) the team level and (3) continuous support. Data from interviews and documents were collected from 14 programmes implementing the Individual Placement and Support model of supported employment. Results: Internal consistency was acceptable for all subscales and for the scale as a whole. Regarding the scale, an analysis of the differences between fully established programmes and the programmes that were not established or were or only partially established after three years showed statistically significant differences, indicating that a greater number of implementation components were present in the fully established programmes. Conclusions: SIS showed both good reliability and acceptable internal consistency as well as the ability to predict programme survival.

Implementation of evidence-based interventions : analyzing critical components for sustainability in community mental health services

ABSTRACT This study analyses the implementation and sustainability of evidence-based community mental health services in the form of publicly financed Individual Placement and Support programs. Critical implementation components and program fidelity were assessed after one year. After two years, program fidelity was assessed once again. After three years, the programs’ sustainability was assessed and semi-structured interviews performed, in order to deepen the understanding of implementation. Interviews and documents provided the quantitative and qualitative data, which were analyzed by the use of the Supported Employment Fidelity Scale, the Sustainable Implementation Scale (which was developed in a connecting study), and qualitative content analysis. Despite promising fidelity results after one year, eight out of 14 programs were terminated within three years. Implementation of integrated evidence-based programs in community-based settings is a delicate undertaking. Implementing agencies can benefit from rigorous preparation before program start, especially concerning the circumstances at the organizational level, such as making plans for collaboration, financing and assessments of program fidelity.