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. 2018 Apr 13;6(1):9.
doi: 10.1186/s40352-018-0068-3.

A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study

Jennifer E Becan  1 , John P Bartkowski  2 , Danica K Knight  3 , Tisha R A Wiley  4 , Ralph DiClemente  5 , Lori Ducharme  6 , Wayne N Welsh  7 , Diana Bowser  8 , Kathryn McCollister  9 , Matthew Hiller  7 , Anne C Spaulding  5 , Patrick M Flynn  3 , Andrea Swartzendruber  10 , Megan F Dickson  11 , Jacqueline Horan Fisher  12 , Gregory A Aarons  13
Affiliations

A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study

Jennifer E Becan et al. Health Justice. .

Abstract

Background: This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners.

Methods: The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline.

Discussion: The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations.

Trial registration: NCT02672150 . Retrospectively registered on 22 January 2016.

Keywords: Conceptual frameworks; Data-driven decision making; Exploration, Preparation, Implementation, Sustainment; Facilitation; Juvenile justice; Substance use.

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Conflict of interest statement

Ethics approval and consent to participate

Institutional Review Board approval was granted by all seven research institutions and the coordinating center.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
JJ-TRIALS linear application of EPIS
Fig. 2
Fig. 2
JJ-TRIALS dynamic application of EPIS
Fig. 3
Fig. 3
JJ-TRIALS measurement framework of EPIS stages
Fig. 4
Fig. 4
JJ-TRIALS conceptual framework of EPIS stages and transition points
See this image and copyright information in PMC

References

    1. Aarons, GA. (2004). Mental health provider attributes toward adoption of evidence-based practices: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6(2), 61–74. - PMC - PubMed
    1. Aarons, GA, Fettes, DL, Hurlburt, MS, Palinkas, LA, Gunderson, L, Willging, CE, Chaffin, MJ. (2014). Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. Journal of Clinical Child and Adolescent Psychology, 43(6), 915–928. - PMC - PubMed
    1. Aarons GA, Green AE, Trott E, Willging CE, Torres EM, Ehrhart MG, Roesch SC. The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: A mixed-method study. Administration and Policy in Mental Health and Mental Health Services Research. 2016;43(6):991–1108. doi: 10.1007/s10488-016-0751-4. - DOI - PMC - PubMed
    1. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research. 2011;38(1):4–23. doi: 10.1007/s10488-010-0327-7. - DOI - PMC - PubMed
    1. Becan JE, Knight DK, Flynn PM. Innovation and adoption as facilitated by a change-oriented workplace. Journal of Substance Abuse Treatment. 2012;42(2):179–190. doi: 10.1016/j.jsat.2011.10.014. - DOI - PMC - PubMed

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