A review by Mihalic and Irwin (2003) concluded that a consistently important factor in the success or failure of implementation of evidence-based interventions is the quality of ongoing technical assistance. With appropriate training and monitoring, programs can be disseminated with fidelity (Fagan and Mihalic, 2003; Spoth, Guyll, et al., 2007; Spoth, Redmond, et al., 2007). However, systems for delivering proactive technical assistance are limited and generally not up to the task required for large-scale dissemination (Mitchell, Florin, and Stevenson, 2002). For example, the Blueprints project attempted to implement a set of 10 empirically supported programs, but only 4 of these programs had sufficient organizational capacity to implement the intervention in 10 different communities per year (Elliott and Mihalic, 2004). The Blueprints project has a rigorous system for identifying violence prevention programs with a very high level of evidence, facilitates tests of replication of promising programs, disseminates knowledge of these programs to communities, and provides technical support for community implementation, with the direct involvement of the program’s developers. One of its key findings was that both the program developers and the implementation sites often required substantial multiyear technical assistance. For schools, the major training difficulties were lack of time to work with the model and the need for continual training due to staff turnover (Elliott and Mihalic, 2004). With intensive effort, however, sites were able to implement chosen programs with high fidelity, often approaching or exceeding the level of fidelity achieved by the program developers in the original study.
The Blueprints project examined the degree to which chosen programs were adapted locally, even though most of the intervention trainers discouraged adaptation. Very little local adaptation in these particular programs was needed to achieve acceptance, participation, and quality implementation, even in diverse communities, and fidelity and sustainability were emphasized. However, by design, Blueprints does not evaluate impact on behavioral outcomes in the implementation communities, relying instead on each program’s earlier empirical success. It is possible that the programs had different rates of success in the implementation sites compared with those in the original studies.
To address capacity-building and training needs, the Nurse-Family Partnership has established a nonprofit National Service Office to develop community capacity to implement a home visitation program with high fidelity and provide training and technical assistance (Olds, Hill, et al., 2003).
In addition to training and technical assistance provided by program