Intermediary/purveyor organizations for evidence-based interventions in the US child mental health: characteristics and implementation strategies

BACKGROUND: Many psychosocial interventions are disseminated and supported by organizations, termed "Intermediary/Purveyor Organizations" (IPOs). Because IPOs remain largely unstudied, we lack understanding of their scale and the strategies they utilize. The role and function of organizations that link resource systems with user systems, such as IPOs, have been identified as an important but understudied issue in implementation science. The objectives of this paper are to describe features of IPOs that disseminate evidence-based interventions (EBIs) for child behavioral health and identify the strategies they use to support their implementation. METHODS: The Substance Abuse and Mental Health Services (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) listed 119 unique IPOs for the 127 child behavioral health EBIs listed on its website. Data characterizing each organization were drawn from NREPP and GuideStar profiles. From 119 unique IPOs identified, we found contact information for 108. We sent an electronic survey to capture additional organizational information and implementation strategies the IPOs employed in spreading the EBIs; response rate was 50%. Data are presented descriptively and analyzed using ordinary least squares (OLS) regression and Latent Class Analysis (LCA). RESULTS: Virtually all identified EBIs had an IPO. IPOs train individuals, organizations, and communities and provide supervision for the use of EBIs. About 20% of IPOs trained at large scale, some training 500-1000+ providers annually. IPOs reported using an average of 32 distinct strategies to implement their EBIs, with most using educational, planning, and quality improvement strategies. However, there was little convergence around strategy helpfulness. The only significant predictor of number of strategies used by an IPO was the NREPP-posted implementation readiness score of the intervention. LCA revealed that IPOs either used several implementation strategies or used very few. CONCLUSIONS: Findings add significantly to knowledge about IPO structure, scale, and function. They use numerous and varying implementation strategies but report little consensus in what works. The study advances methods for measuring and characterizing real-world implementation by demonstrating the feasibility of using a common nomenclature, per a published compilation and of LCA for data reduction in characterizing profiles of implementation approaches.