A conversation with Abe Wandersman

by Jon Scaccia August 19, 2024

Abe Wandersman, PhD is a distinguished professor emeritus at the University of South Carolina and founder of the Wanderman Center. Over a decades-long career, he has done highly influential work pushing the science of implementation and quality support forward. He has co-edited, with Dr. Larry Scheier, a special issue in Evaluation & the Health Professions on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. This issue will be available for open access until around the end of September 2024.

We talked with Abe about his hopes for this special issue and how it comments on the support that is needed to reach public health outcomes.

The article mentions a significant gap between the volume of TTA services provided and the evaluation of these services. Can you elaborate on why this gap exists and what challenges prevent TTACs from using evidence-based approaches?

A straightforward reason for the gap is what the article says about the “chicken and egg” puzzle. What is supposed to come first—knowledge and evidence about what types of support (e.g., training, TA) is more effective vs less effective Or funders requiring support that Is provided to be evidence-informed or evidence-based. Given the huge amount of money spent on training and technical assistance (e.g., coaching), there has been little interest by funders in promoting or requiring or funding evidence-based support; therefore, there has been a relatively small evidence base on what is evidence-based support. The status quo is a version of “nobody rocking the boat”—we haven’t sunk yet—so “if it aint broke, don’t fix it”. While there are exceptions to the above, this appears to be the norm.

The article discusses various capacity and motivational barriers that practitioners face. How can TTACs effectively address these barriers to improve the implementation of evidence-based interventions?

There is a substantial research literature on motivation and capacity. In the article, we use the R=MC 2 approach (Scaccia et al., 2015). It proposes that readiness is a multiplicative function of the general capacity of an organization/community (how it functions day-to-day) x motivation to do an innovation (specific program, policy, process) x innovation-specific capacity (capacities needed to do the innovation). If motivation and capacities are important to implement with quality, then a major job for a TTAC is to help delivery system organizations (e.g., schools, health care organizations, community coalitions) build their readiness to implement.

The Interactive Systems Framework (ISF) is highlighted as a valuable framework for linking research and practice. Can you explain how TTACs can practically implement the ISF to improve their support systems?

A TTAC has the opportunity to provide four major types of support (tools, training, technical assistance, quality assurance/quality improvement) to a delivery system. Aligning these support approaches to motivation and capacities will help the delivery system be ready to implement with quality.

The article points to a “chicken and egg” problem with funders not pushing for evidence-based approaches. How can funders be encouraged to prioritize and support systematic, evidence-based TTA approaches?

The problem with the “chicken and egg” is what comes first. Funders may want to know that there is evidence that the extra cost in time, effort, and money in higher quality training and technical assistance is worth the extra money that high-quality work and the systems to support the cost. One of my responses to your very important question is: Are we getting the outcomes we want? Often, we aren’t. If that’s the case, then funders should be thinking about the theory of change. More detailed versions of the ISF propose that support from a TTAC should have a logic model and theory of change about How and Why the support provided should increase the motivation and capacities needed to implement an innovation. Testing this can lead to return on investment evaluations of what is being achieved with hundreds of millions (really billions) of dollars spent on training and TA. This is an example of how and why funders should prioritize promoting the science and practice of implementation support.

Based on the findings from this special issue, what are the most critical next steps for advancing the science and practice of TTA?

Great question. Part of the answer will be revealed in volume 2 of the special issue that will appear in December 2024—so stay tuned. For now, I will say that a public health perspective of awareness, concern, and action needs to be strategized.

Awareness: We must make each of the key stakeholder groups (funders, Training and TA providers, TTA recipients, researchers/evaluators) aware of the importance of having an evidence base on what is more effective, less effective, and not effective in implementation support

Concern: If we aren’t getting the outcomes we want and think that supporting delivery systems is a key booster in achieving readiness to implement with quality, then we need to consider making changes in what we consider quality support a priority for funding support and for the practice of support.

Action: We don’t necessarily need a lot more money to fund implementation support. We need to reallocate implementation support funding in ways that allow for planning, implementing, and evaluating the support that is delivered to meet a higher standard of evidence. Then, we synthesize and translate the growing evidence base and promote a higher standard of practice. I want to be clear that the science of implementation support will be highly improved by the use of evidence-based practice and practice-based evidence (provided by skilled practitioners who are willing to evaluate and improve their work).

The lead article can be found here, along with others within the special issue.

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