Evaluating the implementation of evidence-based programs that promote adolescent sexual health: Lessons learned from New York state

Background: Consistent with the New York State Department of Health's promotion of evidence-based practice and the large body of research on adolescent sexual health, 58 community-based providers were funded to implement evidence-based programs (EBPs) that promote positive sexual health outcomes and reduce risky sexual behaviors, as part of a five year pregnancy prevention initiative, begun in 2011. We report evaluation findings and describe our support for quality implementation with fidelity. Methods: For each EBP cycle, grantees complete an Evaluation Packet comprised of an attendance record and fidelity checklist, documenting participant characteristics (demographics, etc.), cycle characteristics (setting, # of sessions, etc.), attendance, and implementation adaptations, successes and challenges. Cycle-level quantitative indicators are calculated (which can be aggregated at multiple levels) and qualitative descriptions of adaptations are coded. Results: Following the pilot phase, data from cycles completed during a 6-month period (January-June 2012), indicate that grantees implemented 726 cycles of 13 different EBPs, reaching 12,877 youth from diverse populations across NYS. Most cycles were conducted in school settings. On average, participants attend 80% of sessions, with 71% of participants attending at least ¾ of the cycle. Most adaptations result from setting constraints, largely time and site policy. Conclusion: Initial findings clearly demonstrate challenges of full-scale EBP implementation in community settings (including constraints associated with instructional settings, time allotments, and special populations), and the importance of feeding evaluation data to program providers. Evaluation of challenges and EBP fidelity can improve implementation and significantly contribute to the fields of implementation science and translational research.