Core Intervention Components: Identifying and Operationalizing What Makes Programs Work. Implications

02/01/2013

Given the importance of identifying core components, what are the implications for research agendas, program development, funding of service initiatives, and policy making, as well as for implementation in typical service settings. Research that focuses on operationalizing, measuring, and testing the efficacy of the independent variables (e.g., the core components) would improve our understanding of ‘what works' and what is necessary for evidence-based programs and practices to produce outcomes. At present, research standards, publication constraints, and journal requirements for publication do not significantly support or encourage such detailed attention to core components. Michie et al. (2009) argue that, "If a more explicitly theoretical approach to deciding how to design and report interventions were taken, it may be that more effects may be revealed and more understanding of their functional mechanisms gleaned….promoting the understanding of causal mechanisms that both enrich theory and facilitate the development of more effective interventions". They also argue that the use of the web for publishing allows for the publication of detailed intervention protocols, which would further improve the identification, operationalization, and testing of core components.

Funders of demonstration programs and pilots can further support the development of and attention to core components by including requirements to specify the underlying theoretical bases and the definition of interventions as deliverables at the end of the demonstration or pilot phase. Such attention then might see demonstrations and pilots as the launching pad for replications and scalability and the first in a series of development steps rather than islands of excellence that come and go.

As communities, agencies, and government entities turn to evidence-based programs and practices and evidence-informed innovations to address specific needs, they, too, can promote increased attention to the importance of well-defined core components. By asking program developers about fidelity measures, research related to fidelity measures, the rationales for core components, and the description of intervention core components, they can discern which programs and practices are more likely to be ready for use in their communities. In addition, they serve notice to program developers who intend to be purveyors (Fixsen et al., 2005) that such information may be an important deciding factor when communities and agencies select interventions or prevention programs.

Similarly, policy makers need to be aware that providing funding for evidence-based programs and practices needs to be coupled with attention to the degree to which such programs' core components are defined, operationalized, and validated. Failure to have both identified program models and well-specified core components can lead to significant implementation and sustainability challenges. If the intervention is poorly specified and performance assessment (fidelity) measures do not target functional core components, then achieving outcomes may not be realistic. Similarly, policy makers need to support and require continued attention to fidelity and outcome assessments in order to maintain and improve service outcomes over time and across practitioners and leadership changes. This requires funding for the infrastructure needed to collect and use data. Resources to collect, analyze and interpret data are as important as the skills of the practitioner for achieving, interpreting, and improving outcomes. At present, core components and research done related to them are not targeted by registries, or clearly cited; and in some cases, you can even find research studies related to components, but not in a systematic way or highlighted as such. This representation gap requires systematic and sustained attention.

In summary, defining, operationalizing and measuring the presence and strength of core components are important if we are to improve our knowledge about "what works" and understand how to implement with benefits in everyday service settings.

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