While research shows that external implementation support (EIS) can help successfully implement and scale up interventions, there has been less investigation about the experience of those receiving EIS. To address this lack of information, a team at The Impact Center at UNC Frank Porter Graham Child Development Institute (FPG) explored the feasibility of implementation support and published, “A feasibility study of external implementation support provided across two states in the U.S.” in Implementation Research and Practice in May 2024.

FPG Senior Implementation Specialist Rebecca Roppolo, MPH, is the lead investigator on the report whose authors also include FPG Senior Implementation Specialists William Aldridge, PhD, and Sherra Lawrence, MA, Ariel Everett, MPH, an implementation associate, and Capri Banks, MA, an FPG implementation specialist, as well as Christina DiSalvo, formerly an FPG implementation specialist and now a program officer at the Duke Endowment.

Implementation support practitioners use EIS strategies such as technical assistance, facilitation, and knowledge brokering to support and facilitate capacity development. The feasibility paper, the third in a trajectory of studies on which the group has been working, is part of the Impact Center’s efforts since 2016 to develop a practice model for implementation support. The previous papers proposed practice principles, core practice components, and a conceptual model for how these components are expected to influence practice outcomes and a descriptive study demonstrating what the model looks like over time.

The current paper examined the feasibility of participating in implementation support under this model within the context of supporting the scale-up of evidence-based parenting and family supports in the Carolinas. For the past eight years, The Impact Center at FPG has employed its model to provide implementation support to regional leaders and implementation team members in North Carolina and South Carolina who are implementing the Triple P – Positive Parenting Program. This is an evidence-based, multilevel, public health approach to parenting and family support.

Regional support teams from the Implementation Capacity for Triple P (ICTP) projects have supported localities in an iterative process of strengthening program implementation and scale-up. The project team used extensive data collected monthly and quarterly across 13 regions in North Carolina and South Carolina from November 2016 to April 2022 through the ICTP projects. Using that data, the report explored the feasibility of engaging in the support relationship with ICTP regional support teams, looking at the extent to which support participants find EIS:

• accessible;
• delivered with high quality;
• appropriate for their needs and goals;
• acceptable in their current context; and
• provides feasible strategies.

The report also explored whether support participants were likely to or actually used resources provided through support in their day-to-day implementation activities. In addition, the degree of collaboration and frequency of contact between support participants and ICTP regional support team members were also explored.

“As implementation support providers, it is important that we also practice what we preach,” said Roppolo. “We need to scrutinize the outcomes of our own model implementation, just as we help others examine their program implementation.”

“As implementation support providers, it is important that we also practice what we preach,” said Roppolo. “We need to scrutinize the outcomes of our own model implementation, just as we help others examine their program implementation.”

That examination received positive results. Participants found implementation support to be accessible, acceptable, appropriate, feasible, and delivered with high quality. Regional support team members reported strong collaboration with support participants and provided support one to two times per month. The report noted that this “pattern of findings suggests that the ICTP practice model is being experienced favorably by those receiving support across different states, over time including during COVID-19, through- out the support relationship, and across tiers of support.” Findings informed some changes in the Impact Center’s internal practice including greatly reducing the frequency and volume of some data collection activities.

Roppolo hopes that other practice models demonstrate their feasibility beyond program outcomes by also looking at the comfort level of those receiving support. “We know that implementation support is helpful, but it would be good to have more data to show that it's also enjoyable,” she said. With a plethora of implementation science models and frameworks in the field, Roppolo believes it is important to glean from practice models to inform the field and adapt what is not working well to make sure that the time and effort of implementation support practitioners is well spent.

Aldridge emphasized the work that he and his colleagues have put into developing this practice model, with the goal of creating and disseminating practice models and tools, case studies, and empirical evidence to strengthen the field. The team is in the process of developing an online practice compendium that will provide a comprehensive guide on using the practice model to support Triple P implementation and scale-up in the Carolinas. Aldridge added, “One of the best things about how we’ve developed this practice model is that it started as a generalized practice model and the lessons and learning from its use in the ICTP projects can inform how support is provided to communities implementing other programs and practices.” 

“When folks working to improve the lives of families and children have data and experience to show that these programs and innovations aren't getting the outcomes that we need, we should be doing something about it,” said Roppolo. “That's what implementation is here to do. The Impact Center at FPG bridges that gap and ensures that the outcomes promised by these rigorous, thoughtful, and robust programs are experienced by the people who are supposed to be enjoying their benefits.”

“When folks working to improve the lives of families and children have data and experience to show that these programs and innovations aren't getting the outcomes that we need, we should be doing something about it,” said Roppolo. “That's what implementation is here to do. The Impact Center at FPG bridges that gap and ensures that the outcomes promised by these rigorous, thoughtful, and robust programs are experienced by the people who are supposed to be enjoying their benefits.”