The Replicating Effective Programs (REP) framework was designed by the U.S. Centers for Disease Control and Prevention (CDC) to develop effective approaches for implementing HIV interventions. Since its initial design, the framework has been adapted to other contexts.
The strength of this framework is that it can be adapted for the implementation of evidence-based programs in different contexts, such as healthcare systems and community-based organizations (Kilbourne, 2007).
The REP framework focuses on the following 4 phases of implementation activities: preconditions, pre-implementation, implementation, and maintenance and evolution.
During the preconditions phase, researchers and organization/practice leaders must determine where the gaps in quality or outcomes lie, and take stock of their contexts. This includes articulating the need for, and barriers to, an intervention, and then identifying evidence-based interventions that would be appropriate for addressing that need and those barriers within the organization’s setting.
Before moving forward, the intervention must be ‘packaged’ or translated into easily accessible tools and elements, so that a community-based provider is able to readily pick up and implement the intervention package.
During the pre-implementation phase, you’ll need to create a Community Working Group. The Community Working Group and researchers finish refining the intervention package, its core elements, and the training and technical plans and materials. Pilot the intervention package to seek feedback for further refinement.
Initiate activities to develop a plan for dissemination and then disseminate the intervention package. At this phase, you also should identify other organizations for potential partnerships.
During the implementation phase, a broader range of organization stakeholders are involved. Researchers and staff implement training so they can begin the monitoring and evaluation protocols.
Technical support will also be needed during these early phases, and actively reaching out to end users via regular contacts is encouraged. Together, the Community Working Group and researchers will continue addressing the need to incorporate feedback and evaluation information to improve and refine the intervention and its implementation.
During the maintenance and evolution phase, the focus shifts to preparing the intervention for sustainability. This work is conducted largely by the Community Working Group and researchers. Together, they adapt the intervention to contextual factors, adjust financing and organizational structures to help sustain the intervention, and, in some cases, document the return on investment of implementing the intervention so that the intervention can be used more widely.
The Replicating Effective Program (REP) framework has been most often used in CDC HIV interventions. To enable this work, the CDC developed user-friendly REP packages focused on target populations and service sectors. By providing population- and context-specific materials, they were able to disseminate HIV behavioral and treatment interventions for implementation in community-based service settings, notably AIDS service organizations. (Neumann & Sogolow, 2000). The project indicated the success of the REP method of technology transfer in packaging, implementing, and evaluating different types of interventions.
In a series of publications, Kilbourne et al. (2012, 2015) have contributed to the evidence base of REP and the extension of REP for mental health conditions. Through the Recovery-Oriented Collaborative Care Study, an enhanced version of REP was developed and examined through a randomized controlled trial. The goals of this research project were to understand how REP could be applied to Collaborative Care settings and to assess the effect of an enhanced version of REP on client outcomes.
Enhanced REP included additional coaching, the tailoring of resources to the topic and context, and technical support. The process for developing the enhanced REP was presented in the authors’ 2012 work, and results of the study were presented in their 2015 work. In the 2015 paper, they concluded—with the important caveat that more research was needed—that improved patient outcomes were not associated with the use of the enhanced REP.
The REP framework has been used by CDC researchers and scientists, practitioners, healthcare settings, and community-based organizations. REP can also be used for Collaborative Care models and psychosocial interventions for mood disorders, VA Mental Health Interventions, and Falls & Dementia caregiver support teams.
Kilbourne et al. (2007) suggests that a REP framework can be used for implementing evidence-based interventions in healthcare settings. Neumann & Sogolow (2000) state that CDC’s REP project has been successful in developing systematic and effective strategies to prepare HIV interventions for dissemination.
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