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A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study
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BACKGROUND: This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. METHODS: The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. DISCUSSION: The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. TRIAL REGISTRATION: NCT02672150 . Retrospectively registered on 22 January 2016.
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“Future studies that include an EPIS adoption decision phase is warranted as both theoretical and research-based publications related to the EPIS framework indicate that an adoption decision is the end result of the Exploration Phase (Becan et al., 2018; Nilsen, 2015).”
From Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study (2021) · cites this paper as Becan et al., 2018
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Self-citationMaking sense of implementation theories, models and frameworks
Nilsen, P. (2015) · Implementation Science · doi:10.1186/s13012-015-0242-0 · Cited by 4,447
Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors
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“It was initially designed for implementation science research focused on public sector services including mental health and child welfare, and similarly organized systems such as substance use disorder treatment (Aarons et al., 2011).”
BackgroundMethodInfluentialSelf-citationImplementation strategies: recommendations for specifying and reporting
Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013) · Implementation Science · doi:10.1186/1748-5908-8-139 · Cited by 2,585
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Self-citationBridging Research and Practice
Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.05.024 · Cited by 1,386
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Self-citationA compilation of strategies for implementing clinical innovations in health and mental health
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., Glass, J. E., & York, J. L. (2012) · Medical Care Research and Review · doi:10.1177/1077558711430690 · Cited by 1,069
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Additional file 1 of Ten years of implementation outcomes research: a scoping review
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Metadata
- Authors
- Becan, J. E., Bartkowski, J. P., Knight, D. K., Wiley, T. R. A., DiClemente, R., Ducharme, L., Welsh, W. N., Bowser, D., McCollister, K., Hiller, M., Spaulding, A. C., Flynn, P. M., Swartzendruber, A., Dickson, M. F., Fisher, J. H., & Aarons, G. A.
- Affiliations
- Texas Christian University (US)
- The University of Texas at San Antonio (US)
- National Institute on Drug Abuse (US)
- Emory University (US)
- National Institute on Alcohol Abuse and Alcoholism (US)
- Temple University (US)
- University of Miami (US)
- University of Georgia (US)
- University of Kentucky (US)
- National Center on Addiction and Substance Abuse at Columbia University (US)
- University of California San Diego (US)
- Corresponding author
- Becan, Jennifer E.
- ORCID
- Venue
- Health & Justice
- Published
- 2018-04-13
- Volume
- 6
- Issue
- 1
- Pages
- 9-9
- ISSN
- 2194-7899 (ISSN-L)
- PMC
- PMC5899075
- OpenAlex
- W2799439473
- Cited by
- 119
- References
- 46
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 18 · 2023: 13 · 2022: 17 · 2021: 26 · 2020: 10 · 2019: 5 · 2018: 3
- FWCI
- 16.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Health & Justice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- TUScholarShare (Temple University) (submittedVersion, cc-by)
- Funders
- National Institute on Drug Abuse (U01DA036221, U01DA036226, U01DA036233, U01DA036176, U01DA036225, U01DA036224, U01DA036158, R21DA044378)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Social Sciences › Public Administration › Evaluation and Performance Assessment
- Keywords
- EPIS framework, implementation science, juvenile justice, substance use, implementation strategies, outcome measurement, interorganizational relationships, data-driven decision making, vulnerable populations
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