Implementation research: a synthesis of the literature.
In the past few years several major reports highlighted the gap between our knowledge of effective treatments and services currently being received by consumers. These reports agree that we know much about interventions that are effective but make little use of them to help achieve important behavioral health outcomes for children, families, and adults nationally. This theme is repeated in reports by the Surgeon General (United States Department of Health and Human Services, 1999; 2001), the National Institute of Mental Health [NIMH] National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment (2001), Bernfeld, Farrington, & Leschied (2001), Institute of Medicine (2001), and the President's New Freedom Commission on Mental Health (2003). The authors call for applied research to better understand service delivery processes and contextual factors to improve the efficiency and effectiveness of program implementation at local, state, and national levels. Our understanding of how to develop and evaluate evidence-based intervention programs has been furthered by on-going efforts to research and refine programs and practices, to define "evidence bases", and to designate and catalogue "evidence-based programs or practices". However, the factors involved in successful implementation of these programs are not as well understood. Current views of implementation are based on the scholarly foundations prepared by Pressman & Wildavsky's (1973) study of policy implementation, Havelock & Havelock's (1973) classic curriculum for training change agents, and Rogers' (1983; 1995) series of analyses of factors influencing decisions to choose a given innovation. These foundations were tested and further informed by the experience base generated by pioneering attempts to implement Fairweather Lodges and National Follow-Through education models, among others. Petersilia (1990) concluded that, "The ideas embodied in innovative social programs are not self-executing." Instead, what is needed is an "implementation perspective on innovation--an approach that views postadoption events as crucial and focuses on the actions of those who convert it into practice as the key to success or failure". (excerpt)