Association for Public Policy Analysis & Management

Replicating, adapting, and scaling up evidence-based programs with fidelity requires careful attention to implementation (Supplee and Metz 2015; Fixsen et al. 2013). A growing body of research suggests that creating an infrastructure to support practitioners as they prepare for and deliver evidence-based programs is critical for promoting fidelity to program models (Metz et al. 2015; Supplee and Metz 2015; Metz and Albers 2014). The infrastructure should contain a process for assessing fit between the program and the community, implementing agency, target population, intended outcomes, and the resources to support implementation; a system for collecting data to inform decision making; communication and feedback loops among administrators, practitioners, and other stakeholders; and ongoing use of data for continuous quality improvement (Supplee and Metz 2015; Metz and Albers 2014).

To help reduce pregnancies, sexually transmitted infections (STIs), and associated risk behaviors among teens, Congress authorized PREP as part of the 2010 Patient Protection and Affordable Care Act (ACA). PREP is administered by the Administration on Children, Youth, and Families (ACYF) within the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (HHS). Under the ACA, Congress appropriated $75 million in annual funding to PREP, with most funding for formula grants to states to implement evidence-based teen pregnancy prevention programs that provide information on abstinence and contraception. Given the research suggesting that an implementation infrastructure may be a critical component for effective adoption of evidence-based programs, this presentation will describe the infrastructures that four state (PREP) grantees developed to support high-fidelity delivery of evidence-based teen pregnancy prevention programs.  

Beyond the primary requirement to implement evidence-based programs, states had a fair amount of discretion in how they would do so. Yet, in this space of discretion, several common approaches emerged. Most states opted to provide all or most of their programming through schools.  And most states planned to offer programming through sub-awards to local youth serving organizations.  Furthermore, states providing PREP programs in very different contexts independently developed very similar support infrastructure. They (1) worked with providers before or in the early stages of implementation to fit their implementation plans to the local context (2) formed a pool of qualified trainers on the evidence-based programs to train program facilitators and provide ongoing technical assistance, (3) went beyond federal performance measure requirements, collecting additional data for monitoring service delivery and informing continuous quality improvement, and (4) established communication and feedback loops to facilitate data gathering, data sharing, and identification of lessons learned for continuous quality improvement.

This presentation will describe this impressive infrastructure developed under an unprecedented effort to replicate evidence-based teen pregnancy prevention programs nationally. It will provide greater detail on what states are doing and how they are doing it, and share their “lessons learned” and considerations for supporting large scale replication of evidence-based programs with fidelity.