The Importance of Contextual Fit when Implementing Evidence-Based Interventions. What Are the Policy Implications of Contextual Fit?

09/01/2014

Increasingly, federal, state, and local agencies are focused on improving the implementation of evidence-based interventions (Spencer et al., 2012). However, existing implementation science models do not fully consider the realities and constraints imposed by federal grants award and management processes. For example, organizations that seek federal grants must respond to Funding Opportunity Announcements (FOAs) within short timeframes and adapt proposals to respond to problems or issues that have already been identified by the federal government. In contrast, many implementation science models assume a community-driven planning and conceptualization process in which local groups of concerned persons or organizations identify a problem, build commitment to address the problem, identify the best evidence-based interventions for solving the problem, and then find the resources to refine and implement the interventions selected. The implementation timeframes of discretionary grant projects are further constrained by the limited duration of grants, which typically last from 3 to 5 years and sometimes as little as 17 months. These factors all affect the speed and trajectory of the entire implementation process for a discretionary grant program from initial startup to long-term intervention adaptation and sustainability.

To address these limitations, we offer three policy considerations. First, policymakers could consider including criteria for contextual fit into FOAs to facilitate preparing and selecting grantees. The elements of contextual fit should be clearly defined and grantees should be evaluated on their plans for assessing each of the elements. And, because assessment of contextual fit is multifaceted, longer planning periods may be necessary to ensure the successful selection, adoption, implementation, and sustainability of grantee interventions.

Second, because longer planning periods within a 5- or 3-year grant may not be feasible, policymakers might also consider developing a series of FOAs, beginning with planning grants that assess contextual fit and tie it to implementation readiness, so that grantees can build their infrastructure and capacity for implementing evidence-based interventions over time to ensure optimal success. An example of this is a series of cooperative agreements and grants offered by the http://www.samhsa.gov/grants/2009/sp_09_001.aspx . The funding opportunities began with developing and implementing comprehensive needs assessments to estimate the prevalence of substance abuse among youth in target communities. Based upon the data, the target communities were able to develop plans to build collaboration and capacity for substance abuse prevention efforts across service systems. CSAP then funded an effort focused on building core measures for intermediate and distal substance abuse outcomes across a limited number of states. The next opportunity was the State Incentive Grants (SIGs) that funded the implementation of evidence-based interventions statewide. The next generation of SIG grants were the Strategic Prevention Framework grants (SPF-SIGs), culminating in the current SPF-Partnerships for Success (PFS) grants. It is through these various funding opportunities provided over a 14-year period that CSAP has supported states and communities in the development of infrastructure and capacity to implement evidence-based interventions.

Third, policymakers should investigate the kinds of changes needed in the organization of federal, state, and regional TA efforts to help grantees determine contextual fit. Assessment of any single element of contextual fit can be intensive and time consuming, as evidenced in the assessment of need by the KIPP (see p. 6) and IYG (see p. 7). Assistance for implementing new interventions should be tied to establishing a contextual foundation in which implementation will be both efficient and effective. The U.S. Department of Education’s current emphasis on TA of “multi-tiered systems of support” is a good example. Not only are interventions defined with multiple tiers of intensity, but the TA available to schools and communities is organized around multiple tiers of TA intensity. Some schools/communities will need more training, more coaching, and more organizational support to adopt new interventions. Intervention intensity should match the needs of the individual and TA intensity should match the needs of the host organization. A major step toward advancing these multi-tiered efforts will be the incorporation of contextual fit measures at both the intervention and TA levels.

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