The Implementation & Sustainment Facilitation (ISF) Strategy: Guiding theory, framework, principles, and empirical support

BRYAN R. GARNER, PhD
RTI International

Facilitation (i.e., the process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship) has been identified as one of 73 discrete implementation strategies (Powell et al., 2015). The Implementation and Sustainment Facilitation (ISF) Strategy is a facilitation-based strategy that has experimental evidence that supports its effectiveness (Garner et al., 2020). This presentation/poster will focus on describing the ISF Strategy’s guiding theory, framework, principles, and empirical support.

The ISF Strategy was originally developed to help improve the integration of a motivational interviewing-based brief intervention for substance use within HIV service settings. However, the ISF Strategy is currently being used to help improve the implementation of contingency management with opioid treatment settings.

The ISF Strategy is guided by the theory of implementation effectiveness (Klein & Sorra, 1996), the EPIS (exploration-preparation-implementation-sustainment) framework (Aarons, Hurlburt, and Horwitz, 2011), and the principles of motivational interviewing in groups (Wagner & Ingersoll, 2012). See www.ISFstrategy.org for more information. As part of the Substance Abuse Treatment to HIV Care (SAT2HIV) Project, a dual-randomized type 2 hybrid trial was used to test the effectiveness of the ISF Strategy as an adjunct to the staff-focused Addiction Technology Transfer Center (ATTC) Strategy for implementation of motivational interviewing (i.e., training, feedback, and on-going consultation).

Thirty-nine HIV organizations were randomized to either the ATTC Strategy (n = 19) or the ATTC+ISF Strategy (n = 20). Each HIV organization identified two staff members to be prepared to implement the MIBI (N = 78). Subsequently, during the implementation phase, HIV organizations in each condition randomized client participants (N = 824) to one of the two intervention conditions: usual care (UC; n = 415) or UC + MIBI (n = 409). The ISF Strategy improved implementation effectiveness (i.e., the consistency and the quality of implementation; ? = .65, p = .01), as well as intervention effectiveness (i.e., the effectiveness of the MIBI), at least in terms of significantly decreasing the odds (odds ratio = 0.11, p = .02) of clients using their primary substance daily during follow-up.

ISF Strategy is a well-grounded facilitation-based strategy with experimental evidence supporting its effectiveness. Use of the ISF Strategy as part of future implementation research and/or implementation practice is warranted.