CONCLUSION

In accordance with the premise of this book, the key theme of this chapter is that behavioral intervention researchers should develop and evaluate interventions keeping the end or big picture in mind, whether that be to change policy, construct new care systems, or change current practices to address a pressing public health priority. Having a vision of where an intervention might be located in a specific setting and payment structure, or in a future health and human service world, can inform intervention development work. In addition, understanding a particular setting, where an intervention might be situated in a work flow as well as how

TABLE 20.3 Exemplar Value Propositions From the Individual, Interventionist, Agency, and Societal Perspectives

Intervention

Individual

Interventionist

Organization

Society

Skills2CareR

Improves indicators of objective and subjective burden and behavioral symptoms

Embraces a person- centered treatment approach

? Brings in revenue; training dollars immediately recouped

? May reduce health care costs but not proven

Get Busy Get Better

Improves symptomatology and activity engagement

Embraces a person- centered treatment approach

  • ? Links care to senior center activities
  • ? Addresses an unmet need of community

? Shown to be cost- effective

Hospital at Home

Improves health, reduces risks

Embraces a person- centered treatment approach

  • ? Reduces risk to patients and costs
  • ? Fulfills mission of improved health care and cost efficiencies

? Reduces length of stay; reduces cost

individuals/end users might access an intervention, can inform evaluation plans. In other words, having some type of vision of where an intervention may be located in the future may ultimately lead to more purposeful intervention development and evaluation when the ultimate goal is for the intervention to be made widely available, if shown to be effective (e.g., clinically, statistically, and from a cost perspective). We also note that contexts themselves are fluid and dynamic, thus adding complexity to deriving the just right fit between an intervention and a setting.

Implementing a proven intervention into a practice setting and promoting its wide-scale adoption involve considerable effort and a different kind of “know-how” than developing and evaluating the intervention for its efficacy and effectiveness. Much can be learned from implementation science and its theories as well as from the experiences of moving proven programs forward. Finally, to advance an understanding of implementation potential, development of measures that capture the nuances of contextual fit is very much needed.

It should also be noted that the eight elements we applied to our three cases reflect “fit” from the perspective of an organization. It may be that practice contexts also need to be evaluated as to their ability to be modified to adopt an intervention. As such, other aspects such as an organization’s readiness and willingness to modify various practices or “de-implement” its ineffective practices, and its malleability to adapt to the characteristics of an intervention may be equally important and necessitate conceptual and measurement development.

Finally, in applying these eight elements, we observe that some of the strengths of an intervention (tailoring to a targeted population’s need) also present as weaknesses for its contextual fit (imprecision in delivery). For example, a clear strength of our three exemplars is that they address unmet needs unique to participant populations and use the principle of tailoring to optimize treatment benefits; yet, that approach precludes prescripting every interaction and treatment session. Rather, on-the-ground decision making by interventionists who are well trained in the principles and parameters of the intervention is required. This has important implications for choice of interventionists and their training. It also suggests that contextual fit may vary by setting and availability of interventionists as well as by the delivery characteristics of the intervention itself.

 
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