Table 3.

Implementation Roadmap components.

Implementation phase	Implementation Roadmap component	Example actions identified by interviewees
Pre-implementation	Identify high priority needs	• Disconnect between the needs of community and the needs of research project can impact implementation success. Align needs from the start. [PI] • Performing a formal needs assessment on-site can ensure that stakeholder-communicated needs were consistent with observed “on the ground” needs and that the EBI aligned with the specific, high-priority needs of the community. [Project Staff]
	Engage stakeholders	• Bring together diverse representatives from all constituents and stakeholders from the beginning. Regular meetings with frontline “day-to-day” practitioner and implementers from the start ensures ongoing investment. [PI/Project Staff] • Identify a project champion who can advocate for EBI use when the implementation project team was not physically present. [PI]
	Select essential metrics	• Take time to develop organization/reporting systems from the start. Plan for their usage throughout the implementation and sustainability phases of a project. [Project Staff/Community Partners] • Sample metrics to consider collecting data on and monitoring include the number of providers trained, number of consumers receiving EBI, counties served, etc. [PI/Project Staff]
	Assess contextual factors	• On-site staff do not necessarily know what leadership is agreeing to, so webinars/calls/meetings with these staff members can help minimize miscommunication and confusion from the start. [Project Staff] • Time-intensive tasks often fall outside of the immediate research teams' control, and the research teams, community partners, and MDHHS all operate under different time constraints; assessing and budgeting for these differences in timelines can lead to better EBI implementation. [Project Staff/Community Partners] • Collaborate with partners to identify/plan for all contextual factors that could impact EBI implementation and establish norms for revisiting these plans if/when other factors arise. [PI]
	Clarify core features of the EBI	• Talk about practical components, i.e., explicitly what the project will look like, space needs, staffing needs, technology availability, and roll out plan, initially. [Project Staff/Community Partners] • Walk through a process mapping exercise with partners for EBI implementation before implementation begins. [Project Staff/Community Partners]
	Refine the EBI	• Do a needs assessment. Spend time at sites to see the needs in the context of the community setting, if viable. [Project Staff/Community Partners] • Remain open to refinements throughout the pre-implementation process and encourage community partner participation and feedback in this step. [Project Staff]
	Adapt select features to local context	• Send team members physically to sites to understand the local context. Workflows vary by clinics so allow for workflows to be tailored to local circumstances. [Project Staff]
Implementation	Solicit feedback and further tailor EBI	• Solicit feedback frequently and adapt as needed via emails, polls, phone calls or visits. Gather feedback from different levels of the organization. [Project Staff]
	Communicate regularly	• Maintain face-to-face meetings when possible, following up on relationship building from pre-implementation. Maintain site engagement through electronic tools and online spaces to share experiences and feedback both between community sites and research teams as well as among community sites. Share expertise and findings when possible and appropriate. [PI/Project Staff]
	Maintain engagement	• Timing between recruitment for and initiation of an EBI can be long and lead to engagement struggles. Once started, regional support groups are good opportunities for growing teams to report to each other and continue conversations as teams spread across the state. [Project Staff]
	Develop and utilize resources	• Invest in high quality, useful material. Monitor the needs of community partners and use the implementation process to develop needed resources that can be used long-term by community sites. Consider developing technological-based tools and resources that can be tailored to sites. [Project Staff]
	Support transitions	• Leadership transitions are unpredictable and hard to prepare for, so work with partners early when a leadership change is announced. Community sites can experience higher staff turnover, so develop a plan to maintain implementation should staff changes occur. [PI/Project Staff]
	Collect and monitor key metrics	• Be upfront that documentation and reporting takes time. Reporting requirements can get burdensome, so be upfront about the process for data collection and monitoring as it begins. Plan for opportunities to share collected data and findings with community partners throughout the implementation process. [Project Staff/Community Partners]
Sustainability	Analyze and use collected data	• Showing evidence of efficiency and effectiveness and fidelity allows projects to expand. Analyze collected metrics and inform stakeholders of project impacts. [PI/Project Staff]
	Determine costs and establish a return on investment	• Compensate providers/implementers for their time whenever possible. Consider their time as part of your costs. Consider outcomes impacted by EBI implementation beyond primary health outcomes; include outcomes as part of projects' return on investment. [PI]
	Establish a business model	• Ability to fund staff working on a project beyond the year(s) of funding is problematic for some sites. Consider solutions before funding is removed. Utilize partnerships with MDHHS to carry out conversations with policymakers/funders on long-term funding mechanisms. [PI]
	Plan to transition ownership to stakeholders	• Think about the policy implications of the work being done/carried out and how that can be used to influence sustainability from a policy perspective. This can often be incentivizing for sites. [PI]