The EPIS Framework
The CEBC has adopted the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework as the basis for its implementation work. The EPIS framework was developed by CEBC-affiliated implementation scientists at the Child and Adolescent Services Research Center (CASRC) through funding from the National Institute of Mental Health (NIMH)(Aarons, Hurlburt, & Horwitz, 2011; see below for link to article). It is based on existing research on implementation and was developed specifically for use in child welfare and similar service sectors.
EPIS Overview - 1 Page Summary
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.
Article summary: Implementation science is a quickly growing discipline. Lessons learned from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g., public mental health, social service, alcohol/drug sectors). This paper describes the multilevel, four phase EPIS (Exploration, Preparation, Implementation, Sustainment) model of the implementation process, derived from existing literature, and applies it to public sector services. The paper highlights features of the model likely to be particularly important in each phase, while considering the outer and inner contexts of public sector service systems. The full article is available for download here.
Moullin, J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A. (2019). Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Sci, 14(1), 1.
BACKGROUND: Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
METHODS: A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1-5 scale).
RESULTS: In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5).
CONCLUSION: This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.
Recorded Webinars on the EPIS Framework:
National Cancer Institute (March 2015)
The Exploration, Preparation, implementation, Sustainment (EPIS) framework: A phased and multilevel approach to implementation
This webinar describes the EPIS framework, how it has been used in different sectors, measurement of EPIS constructs, adaptations of the EPIS framework for the implementation of various initiatives or projects, and tools and supports for the application of the EPIS framework.
Presenter: Greg Aarons, PhD, Professor, Department of Psychiatry, University of California, San Diego
National Child Traumatic Stress Network (May 2017)
- Cambria Walsh, Project Co-Director, Center for Child Welfare Trauma-Informed Policies, Programs, and Practices
- Jared Martin, Implementation & Training Specialist, California Evidence-Based Clearinghouse
The Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework
This webinar details the EPIS framework, with an emphasis on the Exploration Phase, and applies the framework to implementing an evidence-based treatment and system-wide changes.
Link: https://learn.nctsn.org/enrol/index.php?id=466 (Note: Viewing this webinar requires registration with the free NCTSN Learning Center - the link brings you to the registration/login page)