Degrees and Certifications

Ph.D., Health Behavior and Health Education, University of Michigan School of Public Health

M.P.H., Health Behavior and Health Education, University of Michigan School of Public Health

M.S., Occupational Therapy, University of Indianapolis

B.A., Biological Basis of Behavior, University of Pennsylvania

Responsibilities

Community Health

Health Education, Division of Kinesiology, Health and Sport Studies

Area of Expertise

• Mixed methods
• Community-based intervention research
• Program evaluation
• Economic evaluation in implementation science
• Quantitative methods

TARGET POPULATION EXPERTISE

• Adolescents 

SUBSTANTIVE AREA EXPERTISE

• Implementation science
• Applied economic evaluation of implementation strategies
• Substance use prevention
• Social-emotional learning
• Health disparities
• Health interventions in educational settings

Research Interests

Dr. Eisman’s research interests center around improving adolescent health through the effective implementation of evidence-based interventions in schools. This includes the design of innovative strategies to enhance intervention translation and implementation; cost and cost-effectiveness analysis of implementation strategies; research-community collaborations; and deploying implementation strategies to advance health equity.

Awards

NIH Loan Repayment Program, Health Disparities Research 2016-2020

NIH Loan Repayment Program, Pediatrics, National Institute on Drug Abuse, 2020-2022

Grants

National Institute on Drug Abuse (NIDA), R34: Enhancing the Impact of Evidence-Based Prevention for Youth: the Rapid Adaption to Prevent Drug Use (RAPD) Implementation Strategy, 2022-2025

National Institute on Drug Abuse (NIDA), K01: Preventing Substance Use Among Youth: Behavioral and Economic Impact of Enhanced Implementation Strategies for Communities, 2019-2024

Community Engagement Activities

 Michigan Model for Health Steering Committee

(previous) President, MJR Foundation for Suicide Prevention

Presentations

• Eisman A.B., Koffkey C., Palinkas L.A., Harvey C., Fridline J., Kilbourne A.M., Hutton D.W. A Mixed Methods Stakeholder-Focused Cost Analysis to Deploy Implementation Strategies for School-Based Universal Prevention. The Society for Implementation Research Collaboration (SIRC) Conference 2022.
• Eisman, A.B., Hutton, D.W.; Prosser, L.A., Smith, S.N., Kilbourne A.M. Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies. 42nd Annual Meeting of the Society for Medical Decision Making. October, 2020.
• Eisman A.B., Greene D., Choi S., Boyd C.J., Smith S., Rusch A., Kilbourne A.M. School professional expertise in cognitive behavioral therapy and student risk of polysubstance use: Examining potential halo effects of school-based mental health implementation support. Academy Health 12th Annual Conference on the Science of Dissemination and Implementation Research in Health, Arlington, VA, December 4-6, 2019.
• Eisman A.B., Heinze J., Melde C., Franzen S., Rexin M., McGarrell E. Using Implementation Facilitation to Enhance Delivery of Mental Health First Aid as Part of a Comprehensive School Safety Program. American Public Health Associations’ Annual 2019 Meeting and Expo, Philadelphia, PA, November 2-6, 2019.
• Eisman A.B., Prosser L.A., Smith S.M., Eisenberg D., Kilbourne A.M., Economic Evaluation of Implementation Strategies: Making the Business Case for Implementation Science in the Real World. Society for Implementation Research Collaboration (SIRC). Seattle, WA, September 12-14, 2019.
• Eisman A.B., Heinze J.E., Melde C., Franzen S., Rexin M., McGarrell E. Using Implementation Facilitation to Enhance Delivery of a Comprehensive Intervention for School Safety. Society for Prevention Research Annual Meeting, San Francisco, CA, May 28-31, 2019.

Featured publications

A Mixed Methods Partner-Focused Cost and Budget Impact Analysis to Deploy Implementation Strategies for School-Based Prevention

Eisman A.B., Whitman J., Palinkas L.A., Fridline J., Harvey C., Kilbourne A.M., Hutton D.A. (Accepted for publication). A Mixed Methods Partner-Focused Cost and Budget Impact Analysis to Deploy Implementation Strategies for School-Based Prevention. Implementation Science Communications.

Keywords

Implementation science
Economic evaluation
Prevention

Background: Obtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives.

Methods: Our study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives. 

Results: Based on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8,263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8,659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget).

Conclusions: Previous research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives. 

Aligning organizational priorities and system policies to support implementation scale-up of a tailored classroom-based physical activity Intervention in low-resource schools

Beemer L.R., Wassmann A., Eisman A.B., Rabut L., Templin T., Zernicke R.F., Malinoff L., Hasson R.E. Aligning organizational priorities and system policies to support implementation scale-up of a tailored classroom-based physical activity Intervention in low-resource schools. Journal of School Health.

Keywords

Implementation
Policy
Physical activity
Schools

Dissemination and Implementation Research in Health: Translating Research to Practice

Lee, R.M., Eisman A.B., Gortmaker S.L. Health Dissemination and Implementation within Schools (in press). In Brownson R.C., Colditz G.A. & Proctor E.K. (Eds.), Dissemination and Implementation Research in Health: Translating Research to Practice. Third Edition. New York, NY: Oxford University Press.

Keywords

Implementation science
Schools

A Novel Policy Alignment and Enhancement Process to Improve Sustainment of School-based Physical Activity Programming

Penelope E Friday, Lexie R Beemer, Diane Martindale, Amy Wassmann, Andria B Eisman, Thomas Templin, Ronald F Zernicke, Lynn Malinoff, Anna Schwartz, Tiwaloluwa A Ajibewa, Michele Marenus, Rebecca E Hasson (accepted). A Novel Policy Alignment and Enhancement Process to Improve Sustainment of School-based Physical Activity Programming. International Journal of Environmental Research and Public Health.

Keywords

Implementation science
Classroom-based physical activity interventions
Exploration
Preparation
Implementation
Sustainment framework

The purpose of the current study was twofold: (1) to evaluate the strength and comprehensiveness of district wellness policies in one central Michigan intermediate school district (ISD; 16 districts), and (2) to pilot a novel policy alignment and enhancement process in one district within the ISD to improve sustainment of district-wide physical activity (PA) programming. Policy evaluation and alignment were determined using WellSAT 3.0. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to guide a seven-step policy alignment and enhancement process. Initial evaluation of the PA policy for the ISD revealed a strength score of 19/100 (i.e., included weak and non-specific language) and 31/100 for comprehensiveness (i.e., mentioned few components of the Comprehensive School Physical Activity Program). For the pilot school district, initial strength scores were 19/100 and 38/100 for comprehensiveness (exploration). An alignment of the tailored PA policy with current practices resulted in a 100% increase in strength (score of 38/100), and 132% increase in comprehensiveness (score of 88/100; preparation). However, district administrators encountered barriers to adopting the tailored policy and subsequently integrated the PA requirements into their curriculum guide and school improvement plan (implementation and sustainment). Future research should examine the effectiveness of our EPIS-informed policy evaluation, alignment, and enhancement process to promote widespread increases in student PA. 

Closing the gap between classroom-based physical activity intervention adoption and use in low-resource schools

Hasson R.E., Beemer L.R., Eisman A.B., Friday P. Closing the gap between classroom-based physical activity intervention adoption and use in low-resource schools. Human Kinetics.

Keywords

Health disparities
Physical activity
Implementation science

A Mixed Methods Investigation of Implementation Determinants for a School-Based Universal Prevention Intervention

Eisman A.B., Palinkas L.A., Brown S., Lundahl L., Kilbourne A.M. A Mixed Methods Investigation of Implementation Determinants for a School-Based Universal Prevention Intervention. Implementation Research and Practice.

Keywords

Prevention
Substance use
Adolescence
School health
Implementation science
Mixed methods

Abstract:

Background: Effective implementation of evidence-based prevention interventions in schools is vital to reducing the burden of drug use and its consequences. Universal prevention interventions often fail to achieve desired public health outcomes due to poor implementation. One central reason for suboptimal implementation is the limited fit between the intervention and the setting. Research is needed to increase our understanding of how intervention characteristics and context influence intervention implementation in schools to design implementation strategies that will address barriers and improve public health impact.  

Methods: Using a convergent mixed methods design we examined qualitative and quantitative data on implementation determinants for an evidence-based health curriculum, the Michigan Model for Health^TM (MMH) from the perspective of health teachers delivering the curriculum in high schools across the state. We examined data strands independently and integrated them by investigating data alignment, expansion, and divergence.  

Results: We identified three mixed methods domains: 1) Acceptability, 2) Intervention-context fit, and 3) Adaptability. We found alignment across data strands as teachers reporting low acceptability also reported low fidelity. The fit between student needs and the curriculum predicted fidelity (expansion). Teachers mentioned instances of poor intervention-context fit (discordance), including when meeting the needs of trauma-exposed youth and keeping updated on youth drug use trends. Teachers reported high adaptability (concordance) but also instances when adaptation was challenging (discordance). 

Conclusions: This investigation advances implementation research by deepening our understanding of implementation determinants for an evidence-based universal prevention intervention in schools. This will support designing effective implementation strategies to address barriers and advance the public health impact of interventions that address important risk and protective factors for all youth. 

Advancing Rapid Adaptation for Urgent Public Health Crises: Using Implementation Science to Facilitate Effective and Efficient Responses

Eisman A.B., Kim B., Salloum R.G., Shuman C.J., Glasgow R.E. (accepted). Advancing Rapid Adaptation for Urgent Public Health Crises: Using Implementation Science to Facilitate Effective and Efficient Responses. Frontiers in Public Health.

Keywords

Rapid
Adaptation
Iterative
Public Health Crisis
Costs
Implementation 

Responding rapidly to emerging public health crises is vital to reducing their escalation, spread, and impact on population health. These responses, however, are challenging and disparate processes for researchers and practitioners. Researchers often develop new interventions that take significant time and resources, with little exportability. In contrast, community-serving systems are often poorly equipped to properly adopt new interventions or adapt existing ones in a data-driven way during crises’ onset and escalation. This results in significant delays in deploying evidence-based interventions (EBIs) with notable public health consequences.  

This prolonged timeline for EBI development and implementation results in significant morbidity and mortality that is costly and preventable. As public health emergencies have demonstrated (e.g., COVID-19 pandemic), the negative consequences often exacerbate existing health disparities. Implementation science has the potential to bridge the extant gap between research and practice, and enhance equity in rapid public health responses, but is underutilized. For the field to have a greater “real-world” impact, it needs to be more rapid, iterative, participatory, and work within the timeframes of community-serving systems.  

This paper focuses on rapid adaptation as a developing implementation science area to facilitate system responses during public health crises. We highlight frameworks to guide rapid adaptation for optimizing existing EBIs when responding to urgent public health issues. We also explore the economic implications of rapid adaptation. Resource limitations are frequently a central reason for implementation failure; thus, we consider the economic impacts of rapid adaptation. Finally, we provide examples and propose directions for future research and application. 

Michigan Model for Health Learning to Enhance and Adapt for Prevention: protocol for a pilot randomized trial comparing Enhanced Replicating Effective Programs versus standard implementation to deliver an evidence-based drug use prevention curriculum

Eisman A.B., Palinkas L.A., Koffkey C., Herrenkohl T.I., Abbasi U., Fridline J., Lundahl L., Kilbourne A.M. (Accepted) Michigan Model for Health Learning to Enhance and Adapt for Prevention (Mi-LEAP): protocol for a pilot randomized trial comparing Enhanced Replicating Effective Programs versus standard implementation to deliver an evidence-based drug use prevention curriculum. Pilot and Feasibility Studies.

Keywords

Implementation science
Prevention
Substance use
Adolescents

Background: School-based drug use prevention programs have demonstrated notable potential to reduce the onset and escalation of drug use, including among youth at risk of poor outcomes such as those exposed to trauma. Researchers have found a robust relationship between intervention fidelity and participant (i.e., student) outcomes. Effective implementation of evidence-based interventions, such as the Michigan Model for HealthTM (MMH), is critical to achieving desired public health objectives. Yet, a persistent gap remains in what we know works and how to effectively translate these findings into routine practice. The objective of this study is to design and test a multi-component implementation strategy to tailor MMH to meet population needs (i.e., students exposed to trauma), improve the population-context fit to enhance fidelity and effectiveness. 

Methods: Using a 2-group, mixed-method randomized controlled trial design, this study will compare standard implementation versus Enhanced Replicating Effective Programs (REP) to deliver MMH. REP is a theoretically-based implementation strategy that promotes evidence-based intervention (EBI) fidelity through a combination of EBI curriculum packaging, training, and as-needed technical assistance and is consistent with standard MMH implementation. Enhanced REP will tailor the intervention and training to integrate trauma-informed approaches and deploy customized implementation support (i.e., Facilitation). The research will address the following specific aims: 1) Design and test an implementation strategy (Enhanced REP) to deliver the MMH versus standard implementation and evaluate feasibility, acceptability, and appropriateness using mixed methods, 2) Estimate the costs and cost-effectiveness of Enhanced REP to deliver MMH versus standard implementation.

Discussion: This research will design and test a multi-component implementation strategy focused on enhancing the fit between the intervention and population needs while maintaining fidelity to MMH core functions. We focus on the feasibility of deploying the implementation strategy bundle and costing methods and preliminary information on cost input distributions. The substantive focus on youth at heightened risk of drug use and its consequences due to trauma exposure is significant because of the public health impact of prevention. Pilot studies of implementation strategies are underutilized and can provide vital information on designing and testing effective strategies by addressing potential design and methods uncertainties and the effects of the implementation strategy on implementation and student outcomes.

Rapid cycle adaptation of a classroom-based program to promote equity in access to youth physical activity

Hasson R.E., Eisman A.B., Wassman A., Martin S., Pugh P., Robinson L., Zernicke R., Rabaut L. (accepted) Rapid cycle adaptation of a classroom-based program to promote equity in access to youth physical activity. Translational Behavioral Medicine.

Non-Partner Polysubstance Use and Trait Mindfulness

Galano M.M., Stein S.F., Hart N., Ramirez J.I., Cunningham R.M., Walton M. A., Eisman A.B., Ngo Q.M. (accepted) Non-Partner Polysubstance Use and Trait Mindfulness, Psychology of Violence.

Keywords

Violence perpetration
Polysubstance use
Emerging adults
Mindfulness

Objective: Violence is a leading cause of death among individuals ages 18-25, with alcohol misuse consistently linked with violence perpetration. However, the association between polysubstance use and violence perpetration is less clear, despite the frequency of use of alcohol with other drugs. Additionally, protective factors such as mindfulness that may reduce violence perpetration among emerging adults have been understudied. This cross-sectional study examined the association between substance use, trait mindfulness, and violence perpetration outside of romantic relationships, utilizing a compensatory model of resilience. Methods: Data were drawn from a sample of 665 emerging adults ages 18-25, recruited from an urban Emergency Department (68% male). Participants self-administered a computer survey that assessed non-partner violence perpetration (NPV), alcohol use, marijuana use, prescription drug misuse, and trait mindfulness. Fifteen percent reported non-partner violence perpetration over the past six months. Results: Multivariate logistic regression tested associations between violence perpetration, substance use, trait mindfulness, and demographic characteristics. Results showed that alcohol use alone (OR= 3.04), prescription opioid use alone (OR = 3.58), alcohol and marijuana use (OR = 3.75), and use of all three substances (OR= 7.78) were positively associated with violence perpetration. Post-hoc contrasts demonstrated that polysubstance use significantly increased risk over single substance use. Trait mindfulness (OR= 0.97) was negatively associated with violence perpetration after controlling for substance use. Conclusions: Findings suggest that polysubstance use may increase risk for violence. Interventions that address polysubstance use, potentially including mindfulness, could reduce non-partner violence perpetration among emerging adults and requires further study.

Classroom-based strategies to reduce disparities in physical activity among children with asthma

Beemer L., Lewis T.C., Ajibewa T.A., Dopp R.; Eisman A.B., Hasson R.E. Classroom-based strategies to reduce disparities in physical activity among children with asthma. Prevention Science.

Children with asthma often experience physical activity (PA) induced symptoms 5-15 minutes following the start of exercise. Classroom PA breaks provide short intermittent bouts of PA and may represent a novel strategy to safely promote PA participation in this clinical population. The purpose of this study was to determine the feasibility of a classroom-based PA intervention, Interrupting Prolonged Sitting with Activity (InPACT), where teachers implement 5x4-minute moderate-to-vigorous physical activity (MVPA) breaks throughout the school day. METHODS: Nine classrooms at one elementary-middle school in Detroit, MI (student demographics: 79% Hispanic; 80% on free/reduced lunch; 31% prevalence of asthma and asthma-like symptoms) participated in this 20-week intervention. Asthma status was self-reported via the International Study of Asthma and Allergies in Childhood (ISAAC) Video Questionnaire in conjunction with nurse documentation. PA participation, exercise intensity, and asthmatic symptom occurrence were assessed via direct observation. RESULTS: Students accumulated approximately 17 minutes of activity per day during PA breaks. Compared to students without asthma, a higher percentage of students with asthma participated in MVPA (asthma: 52.9% ± 1.2%; non-asthma: 46.2% ± 0.8%; p=0.01), a lower percentage participated in light PA (asthma: 25.9% ± 1.0%; nonasthma: 30.1% ± 0.7%; p=0.01), and sedentary time during activity breaks (asthma: 21.2% ± 0.9%; non-asthma: 23.8% ± 0.7%; p=0.02). Out of 294 observations, six instances of asthmatic symptoms (coughing) were observed in students with asthma 5- 15 minutes following the PA break. Symptoms self-resolved within 15-minutes of the PA break and did not result in sustained exercise-induced bronchoconstriction. CONCLUSIONS: Classroom-based interventions that incorporate short intermittent bouts of PA represent safe exercises for children with asthma and may help to reduce PA disparities in this clinical population.

Understanding Key Implementation Determinants for a School-Based Universal Prevention Intervention: A qualitative study

Eisman A.B., Kiperman S., Rupp L., Kilbourne A.M., Palinkas L.A. (accepted) Understanding Key Implementation Determinants for a School-Based Universal Prevention Intervention: A qualitative study. Translational Behavioral Medicine.

Keyword

Implementation science
School health promotion
Adolescent health
Education
Community health

Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department

Patrick M. Carter, Rebecca M. Cunningham, Andria B. Eisman, Ken Resnicow, Jessica S. Roche, Jennifer Tang Cole, Jason Goldstick, Amy M. Kilbourne, Maureen A. Walton (in press) Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department, The Journal of Emergency Medicine.

Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department

Carter PM, Cunningham RM, Eisman AB, Resnicow K, Roche JS, Cole JT, Goldstick J, Kilbourne AM, Walton MA. Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department. Journal of Emergency Medicine. 

Keywords

Implementation science
Prevention
Adolescents

Implementation Science Issues in Understanding, Collecting and Using Cost Estimates: A multi-stakeholder perspective

Eisman A.B., Quanbeck A., Bounthavong M., Panattoni L., Glasgow R.E. Implementation Science Issues in Understanding, Collecting and Using Cost Estimates: A multi-stakeholder perspective. Implementation Science.

Keywords

Implementation
Costs
Stakeholders

Understanding the resources needed to achieve desired implementation and effectiveness outcomes is essential to implementing and sustaining evidence-based practices (EBPs). Despite this frequent observation, cost and economic measurement and reporting are rare, but becoming more frequent in implementation science; and when present is seldom reported from the perspective of multiple stakeholders (e.g., the organization, supervisory team), including those who will ultimately implement and sustain EBPs.

Incorporating a multi-level framework is useful for understanding and integrating the perspectives and priorities of the diverse set of stakeholders involved in implementation. Stakeholders across levels, from patients to delivery staff to health systems, experience different economic impacts (costs, benefit, and value) related to EBP implementation and have different perspectives on these issues. Economic theory can aid in understanding multi-level perspectives and approaches to addressing potential conflict across perspectives.

This paper provides examples of key cost components especially important to different types of stakeholders. 

The Longitudinal Association between Exposure to Violence and Patterns of Health Risk Behaviors among African American Youth

Hsieh, H-F., Mistry R., Lee, D. B, Scott, B., Eisman, A. B., Heinze, J. E. & Zimmerman, M.A. (accepted). The Longitudinal Association between Exposure to Violence and Patterns of Health Risk Behaviors among African American Youth. American Journal of Health Promotion.

Adapting the InPACT Intervention to Enhance Implementation Fidelity and Flexibility

Hasson, R. E., Beemer, L. R., Ajibewa, T. A., & Eisman, A. B. (2021). Adapting the InPACT Intervention to Enhance Implementation Fidelity and Flexibility. Prevention science : the official journal of the Society for Prevention Research, 10.1007/s11121-020-01199-z. Advance online publication.

Keywords

Implementation science
Physical activity interventions
Prevention

Adapting classroom-based physical activity interventions are critical for program feasibility and fidelity in low-resource elementary schools. The purpose of this pilot study was to use Replicating Effective Programs (REP) framework to tailor the Interrupting Prolonged sitting with ACTivity (InPACT) intervention and evaluate its effectiveness on program fidelity in classrooms within a low-resource school. REP was applied to adapt program packaging, teacher training, and technical assistance to disseminate Tailored InPACT, a 20-week intervention where teachers implemented 5 × 4-min activity breaks per day. Tailored InPACT was implemented in nine, 3rd-6th grade classrooms in one low-resource school in Detroit Michigan (80% qualified for free/reduced lunch). Intervention fidelity was measured via daily, weekly, and end-of-study self-report questionnaires and direct observation. Throughout the 20-week intervention period, 3rd-5th grade teachers achieved intervention dose (5 activity breaks per day at an average duration of 4 min 8 s). Sixth grade teachers did not achieve intervention dose as they were only able to implement 2 activity breaks per day at an average duration of 4 min 12 s.

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies

Eisman A.B., Hutton D.W., Prosser L.A., Smith S.N., Kilbourne A.M. (in press) Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies. Implementation Science. 

Keywords

Implementation science
Economic evaluation
Mental health service

Adapting the InPACT Intervention to Enhance Implementation Fidelity and Flexibility

Hasson R.E., Beemer L., Ajibewa T.A., Eisman A.B. (in press) Adapting the InPACT Intervention to Enhance Implementation Fidelity and Flexibility. Prevention Science.

Keywords

Implementation science
Physical activity interventions
School-based programs

 

Economic evaluation in implementation science: Making the business case for implementation strategies

Eisman, A. B., Kilbourne, A. M., Dopp, A. R., Saldana, L., & Eisenberg, D. (2020). Economic evaluation in implementation science: Making the business case for implementation strategies. Psychiatry research, 283, 112433. 

Implementation researchers have made notable progress in developing and testing implementation strategies (i.e., highly-specified methods used to help providers improve uptake of mental health evidence-based practices: EBPs). Yet, implementation strategies are not widely applied in healthcare organizations to improve delivery of EBPs. Economic considerations are a key factor influencing the use of implementation strategies to deliver and sustain mental health evidence-based practices, in part because many health care leaders are reluctant to invest in ongoing implementation strategy support without knowing the return-on-investment. Comparative economic evaluation of implementation strategies provides critical information for payers, policymakers, and providers to make informed decisions if specific strategies are an efficient use of scarce organizational resources. Currently, few implementation studies include implementation cost data and even fewer conduct comparative economic analyses of implementation strategies. This summary will introduce clinicians, researchers and other health professionals to the economic evaluation in implementation science. We provide an overview of different economic evaluation methods, discuss differences between economic evaluation in health services and implementation science. We also highlight approaches and frameworks to guide economic evaluation of implementation, provide an example for a cognitive-behavioral therapy program and discuss recommendations.

Comprehensive approaches to addressing mental health needs and enhancing school security: a hybrid type II cluster randomized trial

Eisman, A. B., Heinze, J., Kilbourne, A. M., Franzen, S., Melde, C., & McGarrell, E. (2020). Comprehensive approaches to addressing mental health needs and enhancing school security: a hybrid type II cluster randomized trial. Health & justice, 8(1), 2. 

Background: School safety is fundamental to fostering positive outcomes for children. Violence remains a critical public health issue with 8.1% of elementary and 21.8% of middle school students reporting daily or weekly bullying in 2015-16. Similarly, over half of lifetime mental health concerns become evident before age 14. Thus, elementary school is a key time for comprehensive school safety interventions. Yet, interventions are rarely delivered with fidelity in community settings. Evidence-based interventions must be complemented by implementation strategies to achieve desired public health outcomes.

Methods: We develop and test an intervention focused on promoting a positive school climate guided by a school-based 3-person leadership team (3-PLT) using a hybrid Type II design. The 3-PLT includes a School Resource Officer, (SRO), administrator and mental health services professional as a newly appointed climate specialist (CS). The interventions to be delivered include 1) Restorative justice, 2) Mental Health First Aid and 3) Crime Prevention Through Environmental Design. The CS will lead the team and coordinate implementation through a process of interactive problem solving and supports, consistent with the implementation facilitation strategy. We will conduct a cluster randomized controlled trial with staged entry over two school years in Genesee County, Michigan (n = 20 elementary schools, with 10 participating per school year). We will use a combination of data sources including data collected by schools (e.g., discipline data), a student survey, and a teacher survey. We will also conduct a process evaluation and assess implementation and sustainability through focus groups with key stakeholders, teachers, and students. Finally, we will conduct a cost-benefit analysis.

Discussion: Results from both the behavioral outcome and implementation strategy evaluations are expected to have significant implications for school safety and student well-being. This study adopts a unique approach by integrating three evidence-based programs and incorporating implementation facilitation led by the CS as part of the 3-PLT to support intervention delivery and enhance public health impact among schools in disadvantaged communities with students at risk of poor health outcomes. This study aims to create a comprehensive, well-integrated model intervention that is sustainable and can be translated to similar high-risk settings.

The User-Program Interaction: How Teacher Experience Shapes the Relationship Between Intervention Packaging and Fidelity to a State-Adopted Health Curriculum

Eisman, A. B., Kilbourne, A. M., Greene, D., Jr, Walton, M., & Cunningham, R. (2020). The User-Program Interaction: How Teacher Experience Shapes the Relationship Between Intervention Packaging and Fidelity to a State-Adopted Health Curriculum. Prevention science : the official journal of the Society for Prevention Research, 21(6), 820–829. 

Intervention effects observed in efficacy trials are rarely seen when programs are broadly disseminated, underscoring the need to better understand factors influencing fidelity. The Michigan Model for Health™ (MMH) is an evidence-based health curriculum disseminated in schools throughout Michigan that is widely adopted but delivered with limited fidelity. Understanding implementation determinants and how they influence fidelity is essential to achieving desired implementation and behavioral outcomes. The study surveyed health teachers throughout Michigan (n = 171) on MMH implementation, guided by the Consolidated Framework for Implementation Research. We investigated relationships between context, intervention and provider factors and dose delivered (i.e., the proportion of curriculum delivered by teachers), a fidelity dimension. We also examined whether intervention factors were moderated by provider factors to influence fidelity. Our results indicated that program packaging ratings were associated with dose delivered (fidelity). We also found that this relationship was moderated by teacher experience. The strength of this relationship diminished with increasing levels of experience, with no relationship among the most experienced teachers. Intervention adaptability was also associated with dose delivered. We found no association between health education policies (context), provider beliefs, and dose delivered. Intervention factors are important determinants of fidelity. Our results suggest that providers with more experience may need materials tailored to their knowledge and skill level to support materials' continued usefulness and fidelity long-term. Our results also suggest that promoting adaptability may help enhance fidelity. Implementation strategies that focus on systematically adapting evidence-based health programs may be well suited to enhancing the fidelity of the MMH curriculum across levels of teacher experience.

Publications

 RECENT PUBLICATIONS

• Eisman A.B., Hutton D.W., Prosser L.A., Smith S.N., Kilbourne A.M. Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies. Implementation Science. December 2020: 15:109, 1-13.
• Eisman A.B., Kilbourne A.M., Walton M.A., Cunningham R.M. (2020) The User-Program Interaction: How teacher experience shapes the relationship between intervention packaging and fidelity to a state-adopted health curriculum. Prevention Science. April 20; doi:10.1007/s 11121-020-01120-8.
• Eisman A.B., Kilbourne A.M., Ngo Q.M., Fridline J., Zimmerman M.A., Greene, D., Cunningham R.M. Implementing a State-Adopted High School Health Curriculum: A Case Study. (2020) Journal of School Health. June; 90(6): 447-456.
• Eisman A.B., Heinze J., Kilbourne A.M., Franzen S., Melde C., McGarrell E. (2020) Comprehensive Approaches to Addressing Mental Health Needs and Enhancing School Security: A Hybrid Type II Cluster Randomized Trial. Health and Justice, 14;8(1).
• Eisman A.B., Kilbourne A.M., Dopp A., Saldana L., Eisenberg D. (2020) Economic Evaluation in Implementation Science: Making the Business Case for Implementation Strategies. Psychiatry Research, Jan; 283
• Veliz P., Eisman A.B., McCabe S.E., Evans-Polce R., McCabe V., Boyd C. (2020) E-cigarette Use, Poly-tobacco Use, and Longitudinal Changes in Tobacco and Substance Use Disorder Symptoms among U.S. Adolescents. Journal of Adolescent Health, 66(1):18-26.
• Eisman A.B., Hicks M., Kernsmith P., Rupp L., Smith-Darden J., Zimmerman M.A. (2019) Adapting an Evidence-Based Positive Youth Development Intervention to Prevent Sexual and Teen Dating Violence. Translational Behavioral Medicine. November 20; doi: 10.1093 /tbm/ibz156.

Complete bibliography available here: https://www.ncbi.nlm.nih.gov/myncbi/andria.eisman.1/bibliography/public/

Courses taught by Andria B. Eisman

Fall Term 2024 (future)

• HE6560 - Integrating Evidence-Based Practices in Community Health: Translating Research-To-Practice

Winter Term 2024

• HE6330 - Health Behavior Change

Fall Term 2023

• HE6501 - Measurement and Evaluation in Community Health Education

Winter Term 2023

• KHS9601 - Professional Seminar
• HE6560 - Integrating Evidence-Based Practices in Community Health: Translating Research-To-Practice

Fall Term 2022

• HE6501 - Measurement and Evaluation in Community Health Education

Winter Term 2022

• HE6330 - Health Behavior Change

Recent university news spotlights

• Wayne State University College of Education receives grant to help schools implement curriculum to prevent drug abuse
• Eisman designs and tests curriculum to reduce substance abuse among youth who experience trauma
• Five individuals join faculty ranks in the college

← Return to listing