Solving implementation challenges

Evidence-based practices often fail to be implemented or sustained due to barriers at multiple levels of an organization. A variety of implementation strategies can help mitigate challenges at these multiple levels. However, it is impractical to provide all of these strategies to all levels, at all times.

We need an approach that sequences and adapts the provision of implementation strategies to the changing context and needs of practitioners within the multiple levels of an organization.

Multilevel Adaptive Implementation Strategies

A Multilevel Adaptive Implementation Strategy (MAISY) offers a replicable, approach to precision implementation that guides implementers in how best to adapt and re-adapt implementation strategies based on changing context and changing needs at multiple levels.

Multilevel Implementation SMARTs for optimizing MAISYs

Multilevel Implementation SMARTs (MI-SMART) are a type of experimental study design used to construct an optimized Multilevel Adaptive Implementation Strategy (MAISY). In a MI-SMART, there are multiple levels—for example, schools and school practitioners, or clinic and providers within clinic—and multiple time points of randomization. These randomizations help us answer scientific questions about how best to sequence and adapt different strategies across multiple levels of implementation.

EXAMPLE. Consider optimizing a two-stage MAISY for implementing cognitive behavioral therapy (CBT) at high schools across Michigan, which often have multiple school psychologists (SPs) on staff. A MI-SMART may randomize: (i) schools to understand the effect of a school-wide CBT skills coaching strategy in the first stage, and (ii) SPs within schools to understand the effect of a self-efficacy promotion strategy in the second stage.

System Level

Health System / School District

Unit Level

Clinic / School

Practitioner Level

Clinician / School Practitioner

Related Publications

Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy.

Implementation Science

Adaptive School-based Implementation of CBT (ASIC): clustered-SMART for building an optimized adaptive implementation intervention…

Implementation Science

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