(When) Is More Better? Comparative Effectiveness of External Vs External+Internal Facilitation on Site‐Level Uptake of a Collaborative Care Model in Community‐Based Practices That Are Slow to Adopt

Research ObjectiveImplementation scientists generally acknowledge that low‐level implementation support will not suffice supporting adoption of evidence‐based practices (EBPs), but little work has examined the best way to step up support for sites that are slow to implement. Facilitation, that is, interactive strategic thinking support for providers to encourage uptake of EBPs, is often identified as a key component of successful implementation. Several models of facilitation, of varying intensity, have been operationalized, notably models involving external facilitation (EF) versus those combining external with internal facilitation (EF/IF). Relative to EF, IF is thought to better embed the EBP into the practice setting and encourage transformational rather than transactional change. However, few studies have examined whether EF/IF improves uptake of evidence‐based practices relative to EF alone, and/or whether certain sites benefit most from IF. This study examines the comparative effectiveness of EF vs. EF/IF on uptake of an evidence‐based collaborative care model (CCM) at sites not responsive to low‐level implementation support.Study DesignProviders at participating sites received training and technical support to implement a CCM using the Replicating Effective Programs (REP) implementation strategy. After 6 months, nonresponding sites (