Development and Preliminary Evaluation of an Implementation Facilitation Training Program

Abstract

Background: Implementation scientists are identifying evidence-based implementation strategies that support the uptake of evidence-based practices and other clinical innovations. However, there is limited information regarding the development of training methods to educate implementation practitioners on the use of implementation strategies and help them sustain these competencies. Methods: To address this need, we developed, implemented, and evaluated a training program for one strategy, implementation facilitation (IF), that was designed to maximize applicability in diverse clinical settings. Trainees included implementation practitioners, clinical managers, and researchers. From May 2017 to July 2019, we sent trainees an electronic survey via email and asked them to complete the survey at three-time points: approximately 2 weeks before and 2 weeks and 6 months after each training. Participants ranked their knowledge of and confidence in applying IF skills using a 4-point Likert scale. We compared scores at baseline to post-training and at 6 months, as well as post-training to 6 months post-training (nonparametric Wilcoxon signed-rank tests). Results: Of the 102 participants (76 in-person, 26 virtual), there was an increase in perceived knowledge and confidence in applying IF skills across all learning objectives from pre- to post-training (95% response rate) and pre- to 6-month (35% response rate) follow-up. There was no significant difference in results between virtual and in-person trainees. When comparing post-training to 6 months (30% response rate), perceptions of knowledge increase remained unchanged, although participants reported reduced perceived confidence in applying IF skills for half of the learning objectives at 6 months. Conclusions: Findings indicated that we have developed a promising IF training program. Lack of differences in results between virtual and in-person participants indicated the training can be provided to a remote site without loss of knowledge/skills transfer but ongoing support may be needed to help sustain perceived confidence in applying these skills. Plain Language Summary While implementation scientists are documenting an increasing number of implementation strategies that support the uptake of evidence-based practices and other clinical innovations, little is known about how to transfer this knowledge to those who conduct implementation efforts in the frontline clinical practice settings. We developed, implemented, and conducted a preliminary evaluation of a training program for one strategy, implementation facilitation (IF). The training program targets facilitation practitioners, clinical managers, and researchers. This paper describes the development of the training program, the program components, and the results from an evaluation of IF knowledge and skills reported by a subset of people who participated in the training. Findings from the evaluation indicate that this training program significantly increased trainees' perceived knowledge of and confidence in applying IF skills. Further research is needed to examine whether ongoing mentoring helps trainees retain confidence in applying some IF skills over the longer term.

Evaluation of implementation facilitation integrated into a national mentoring programme to improve access to evidence-based psychotherapy for post-traumatic stress disorder within the veterans health administration: a quality improvement report

“…IF was preceded by the training of PTSD mentors in facilitation during a 2.5-day workshop through the VHA Implementation Facilitation Learning Hub. 20 The mentors who were to serve as facilitators identified a PCT within their VISN to receive IF based on the following criteria: (1) low EBP reach (< 25%) as identified through PERSIST EBP reach reports; (2) a potential champion for the project at the PCT; and (3) facility leadership and network chief mental health officer support for the project. The PTSD mentoring programme used the IF model adopted by VHA 10 and customised for low-reach PCTs, 13 with reach reports to monitor progress.…”

Getting to implementation: Adaptation of an implementation playbook

“…To ensure fidelity to GTI, facilitators were trained in both the facilitation method as well as the GTI process. Initially, the evaluation team, including two team members who would serve as facilitators ("evaluation-facilitators") were trained to perform facilitation by the Behavioral Health QUERI via two halfday, virtual sessions (36,37). Evaluation-facilitators were two masters level social workers.…”

Building a sharable literature collection to advance the science and practice of implementation facilitation

“…For example, one gap is determining the “active ingredients” or mechanisms of multifaceted IF strategies and documenting mediators and moderators of IF effectiveness ( 22 ). Another gap is ascertaining the variety of skills and techniques to emphasize in the content and educational methods utilized in IF training/mentoring programs ( 23 ). Further, researchers are still unclear on the requisite composition and intensity of IF strategies for a given implementation effort based on varying contextual factors across settings, recipient characteristics, and/or complexity of the clinical innovation itself ( 24 ).…”

“…To address these gaps, the field could benefit from innovative, non-traditional tools made readily available to enable more rapid and streamlined investigation into these and other important questions pertaining to IF strategies. For example, active learning groups such as the Department of Veterans Affairs (VA) Behavioral Health Quality Enhancement Research Initiative's (QUERI) Implementation Facilitation Learning Collaborative ( 23 ) and the North American Primary Care Research Group's practice facilitation community ( 25 ) could benefit from such tools in their work to identify and address gaps in the science and practice of IF. Below we describe the development of a comprehensive collection of literature on the conceptualization and application of IF strategies.…”