Each implementation setting is unique, and when trying to bring evidence-based programming to scale in an array of settings (e.g., schools, clinics), it is necessary to work with each setting as a separate entity to ensure that the programming gets embedded appropriately. This variability is beneficial in promoting system wide learning about how to implement with quality in a variety of environmental conditions. For example, SSI-trained health educators participate in monthly community of practice meetings, during which time they share experiences, including how problems are effectively addressed and what challenges still need to be resolved. Thus, although the settings in which Safer Sex Intervention (SSI) is implemented are unique, lessons can still be applied across the board, with appropriate customizations (e.g., how has SSI been successfully implemented in a particular clinic? Has it been successfully embedded in a different clinic? What are some effective implementation strategies?).
Over the course of the grant, It's Your Future (IYF) leaders have learned of the need for training and coaching to effectively support second-order change,1 over and above the tactical, intervention-specific support that is typically provided to health educators. IYF health educators generally have higher level training needs related to how systems work (e.g., working in school systems) and how to build and sustain relationships (e.g., working with parents). For the next round of funding, IYF plans to develop a strategy for identifying sources of support to address these higher level needs. Such supports may be realized locally or may require IYF leaders to look outside of the county.
1 Second-order change refers to changing the way systems work (in contrast, first-order change focuses on surface-level issues but leaves the underlying systems-level challenges intact) (Watzlawick, Weakland, & Fisch, 1974).