Framework 1: The EPIS Model of Implementation

The EPIS implementation framework—the acronym stands for Exploration, Preparation, Implementation, and Sustainment—offers a practical and logical way to guide implementation of evidence-based programs, interventions, and practices. Implementation scientists at the University of California, San Diego and the Child and Adolescent Services Research Center, with funding from the National Institute of Mental Health, developed the EPIS model to improve implementation in public service sectors such as mental health, substance abuse, juvenile justice, and child welfare.

The EPIS model works along 2 planes: an outer context and an inner context plane. The outer plane addresses external factors, such as federal or local government policies, funding mandates, and the organization’s relationships to outside organizations. The inner plane addresses elements in the organization’s operations, climate, and culture, such as staffing, internal policies, and the like.

Resources

EPIS Infographic

In this infographic, you will see the 4 phases of the EPIS Implementation Model, which are explained below.

 

The EPIS model focuses on the following 4 phases of implementation activities: exploration, preparation, implementation, and sustainment.

In the exploration phase, planners must evaluate their needs and determine whether a specific evidence-based program (EBP) might fit their environment. In doing so, planners must consider internal and external opportunities and challenges, as outlined by the following questions:

  • Will the funding be there?

  • Is the program in conflict with internal or governmental policies?

  • Is the environment open to change?

  • Is this the optimum time to adopt a new program? Or might there be a better time?

In this phase, planners should include someone with the authority to green-light the program.

Exploration Steps:

  1. Form an implementation team

  2. Identify the problem

  3. Narrow the focus

  4. Conduct a needs assessment

  5. Identify potential solutions

  6. Determine program fit

  7. Create a written summary

Exploration Tools:

If the EBP is deemed suitable for the planners’ needs, they may proceed to the preparation phase, during which time they will plan how and when to integrate the program into their existing system.

Planners must take a full inventory of possible challenges that might affect the application of the program to their system and adapt the program where necessary. This phase consists of getting appropriate buy-in from internal and external partners. At this stage, planners should begin to think about how they might embed the program into their organization over the long term.

Preparation Steps:

  1. Ensure leadership buy-in

  2. Develop an implementation support system

  3. Work with stakeholders

  4. Ensure that the chosen EBP fits with consumer concerns

  5. Identify viable funding streams

  6. Develop timetables

Preparation Tools:

In the implementation phase, the planners become implementers themselves or facilitate the work of implementers, who must then put the program in place. Essential to program success is assuring the fidelity with which the EBP is delivered. That is, the program should follow, insofar as possible, the recipe crafted by the original program developers to achieve efficacy or effectiveness. Continued outer system and inner organizational support are also keys to success.

Implementation Steps:

  1. Verify buy-in

  2. Ensure priority

  3. Complete training

  4. Prepare materials

  5. Confirm referral processes

  6. Monitor fidelity to the EBP

  7. Collect and evaluate outcomes

  8. Explore scale-up in the service system (or systems)

Implementation Tools:

In the sustainment phase, the program is embedded in the system and/or organization for the long haul. To do so, implementers must monitor the program, ensure quality control and continued staffing, and secure stable funding. 

Sustainment Steps:

  1. Funding and support

  2. Ongoing training needs

  3. Ongoing fidelity monitoring

  4. Outcomes

  5. Making refinements

  6. Reviewing referral process

Sustainment Tools:

 

Supporting Materials

Aarons, Hurlburt, & Horwitz (2011): This paper advances a conceptual model of factors that, in the authors’ opinion, are some of the most likely to have a strong influence on the implementation of EBPs in publicly funded settings serving children and families. It concentrates on two sectors:

  • Child welfare settings

  • Specialty mental health service

Examples provided in Webinar March 2015—The Exploration, Preparation, Implementation, Sustainment (EPIS) framework: A phased and multilevel approach to implementation (National Cancer Institute).

Examination of Sustainment Using EPIS: This project looks at sustainment in 11 child welfare service systems in California and Oklahoma (services cover 87 counties combined across the 2 states), with emphases on the sustainment phase and on examining the inner and outer context factors.

Continuing EPIS adaptations for specific initiatives:

  • Juvenile Justice and Community SUDT (JJ-Trials)

  • HIV prevention in Mexico and other low- and middle-income countries

Measuring development and tailoring for specific settings:

  • Schools

  • Specific interventions (Cognitive–Behavioral Therapy, Problem-Solving Therapy)

Aarons, Hurlburt, and Horwitz (2011) state that EPIS can be used in various child welfare settings and mental health services. EPIS could also be used in various other initiatives, such as juvenile justice trials and HIV prevention projects, as well as in other settings, such as schools. 

In addition, the EPIS model can be used in management science, organizational development, organizational psychology, business quality improvement, health care quality improvement, public health, population health, education, ethnography, informatics, economics, engineering/systems dynamics. (Webinar)

Webinar: Practical Application of Frameworks and Strategies for Evidence-Based Practice Implementation Research

Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.

National Cancer Institute. (2015). The Exploration, Preparation, Implementation, Sustainment (EPIS) framework: A phased and multilevel approach to implementation (Webinar)

Last Updated: 08/21/2017