Editor’s Note: Tess Grover, a Research Coordinator for the Division of Population Health in the University of Washington’s Department of Psychiatry and Behavioral Sciences, co-authored this blog post.

Since 2013, the University of Washington AIMS Center and The John A. Hartford Foundation have partnered to increase access to effective, evidence-based depression treatment for older people living in rural, medically underserved areas through the Social Innovation Fund initiative. Together we are helping Federally Qualified Health Centers in the western United States implement the highly effective Collaborative Care model.

As important as that goal is, the Social Innovation Fund implementation of the Collaborative Care model provides another important opportunity—namely, to characterize “what it takes” to successfully implement an evidence-based model of care.

Understanding key processes and milestones are critical for effective implementation and support strategies, and without tools to measure these aspects, implementations can be hindered.

To provide this critical information for Collaborative Care implementations, the Foundation and the AIMS Center collaborated with Lisa Saldana and her team at the Oregon Social Learning Center (OSLC). Saldana and her team have developed a Stages of Implementation Completion (SIC) tool, and they have now adapted the tool for Collaborative Care (CC-SIC).

Mindy Vredevoogd with UW AIMS Center colleague, Diane Powers

UW AIMS Center staff, Diane Powers and Mindy Vredevoogd

Collaborative Care is an evidence-based practice that has been tested in more than 80 randomized controlled trials in the U.S. and abroad. If implemented well, it more than doubles the likelihood that patients will experience significant improvement in mental health conditions, such as depression and anxiety, when compared with usual care.

However, as with other evidence-based programs, the likelihood of successful patient outcomes is reduced when the model is implemented poorly.

Although many evidence-based interventions, like Collaborative Care, have been developed, large knowledge gaps remain regarding how to routinely move these practices into usual care. What are the key aspects of the process that lead to a successful implementation? What steps are most challenging, costly, or likely to trigger an organization’s decision to stop or to continue implementation?

While working on implementation of an evidence-based program for youth in foster care, Saldana and her team realized there was a distinct lack of adequate measures for evaluating the implementation process. So they developed the original SIC tool, which has since been adapted for a broad range of implementations.

However, as with other evidence-based programs, the likelihood of successful patient outcomes is reduced when the model is implemented poorly.

The SIC framework helps characterize the key factors needed to achieve a successful implementation. For example, what agency-based factors need to be in place before successful implementation can occur? What is the timing and duration of each implementation milestone?

Consisting of eight stages, the SIC tool tracks the implementation process and milestones, with the stages spanning three phases: pre-implementation, implementation, and sustainability. The eight stages contain phase-specific implementation activities, ranging from “Engagement” to “Achieving Competency.”

Items in the tool denote the date that a specific site has completed each activity associated with implementation. It provides an assessment of how long it took the site to complete each stage, the proportion of activities that the site completed, and how far the site has moved along the path toward successful implementation.

To adapt the SIC to Collaborative Care, the original SIC measure was modified to include activities specific to that model.  These are activities that, when implemented well, achieve accountable care. Using these core principles, along with the AIMS Center’s Collaborative Care experience and OSLC’s SIC expertise, the CC-SIC was developed. The tool was born out of an iterative process, resulting in a final list of 89 items and activities across the eight stages of implementation.

The innovative work of developing and validating the CC-SIC were shared at the November 2015 American Evaluation Association meeting in Chicago. Saldana and I had the privilege of presenting the SIC tool and the important information it brings to effectively implement evidence-based practices. The process to develop the CC-SIC and preliminary use of data from our Social Innovation Fund initiative were also highlighted, illustrating the adaptability and utility of the SIC tool to different implementations.

As the Social Innovation Fund implementation continues over the next year, the AIMS Center and the OSLC will continue to gather data to see what the CC-SIC reveals about our implementation success. With the knowledge that can be gained about which activities and milestones are vital to success, the CC-SIC, in its final iteration, can be used as a roadmap to help optimize the potential for successful adoption of Collaborative Care at new sites and in new projects.

The beauty and power of the SIC tool is its adaptability. The adaptability and use of the tool has endless potential for additional implementations, including other Social Innovation Fund initiative projects, creating an innovative way to evaluate implementation, increasing success and impact.