A Model for Rigorously Applying the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework in the Design and Measurement of a Large Scale Collaborative Multi-Site Study

Background This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. Methods The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. Discussion The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. Trial registration NCT02672150. Retrospectively registered on 22 January 2016

A Web-Based Geolocated Directory of Crisis Pregnancy Centers (CPCs) in the United States: Description of CPC Map Methods and Design Features and Analysis of Baseline Data

Background Crisis pregnancy centers (CPCs) are nonprofit organizations that aim to dissuade people considering abortion. The centers frequently advertise in misleading ways and provide inaccurate health information. CPCs in the United States are becoming more medicalized and gaining government funding and support. We created a CPC Map, a Web-based geolocated database of all CPCs currently operating in the United States, to help individuals seeking health services know which centers are CPCs and to facilitate academic research. Objective This study aimed to describe the methods used to develop and maintain the CPC Map and baseline findings regarding the number and distribution of CPCs in the United States. We also examined associations between direct state funding and the number of CPCs and relationships between the number of CPCs and state legislation proposed in 2018-2019 to ban all or most abortions. Methods In 2018, we used standard protocols to identify and verify the locations of and services offered by CPCs operating in the United States. The CPC Map was designed to be a publicly accessible, user-friendly searchable database that can be easily updated. We examined the number of CPCs and, using existing data, the ratios of women of reproductive age to CPCs and CPCs to abortion facilities nationally and by region, subregion, and state. We used unadjusted and adjusted negative binomial regression models to examine associations between direct state funding and the number of CPCs. We used unadjusted and adjusted logistic regression models to examine associations between the number of CPCs by state and legislation introduced in 2018-2019 to ban all or most abortions. Adjusted models controlled for the numbers of women of reproductive age and abortion facilities per state. Results We identified 2527 operating CPCs. Of these, 66.17% (1672/2527) offered limited medical services. Nationally, the ratio of women of reproductive age to CPCs was 29,304:1. The number of CPCs per abortion facility was 3.2. The South and Midwest had the greatest numbers of CPCs. The number of CPCs per state ranged from three (Rhode Island) to 203 (Texas). Direct funding was associated with a greater number of CPCs in unadjusted (coefficient: 0.87, 95% CI 0.51-1.22) and adjusted (coefficient: 0.45, 95% CI 0.33-0.57) analyses. The number of CPCs was associated with the state legislation introduced in 2018-2019 to ban all or most abortions in unadjusted (odds ratio [OR] 1.04, 95% CI 1.01-1.06) and adjusted analyses (OR 1.11, 95% CI 1.04-1.19). Conclusions CPCs are located in every state and particularly prevalent in the South and Midwest. Distribution of CPCs in the United States is associated with state funding and extreme proposals to restrict abortion. Researchers should track CPCs over time and examine factors that influence their operations and impact on public health and policy. </jats:sec

A Web-Based Geolocated Directory of Crisis Pregnancy Centers (CPCs) in the United States: Description of CPC Map Methods and Design Features and Analysis of Baseline Data (Preprint)

BACKGROUND Crisis pregnancy centers (CPCs) are nonprofit organizations that aim to dissuade people considering abortion. The centers frequently advertise in misleading ways and provide inaccurate health information. CPCs in the United States are becoming more medicalized and gaining government funding and support. We created a CPC Map, a Web-based geolocated database of all CPCs currently operating in the United States, to help individuals seeking health services know which centers are CPCs and to facilitate academic research. OBJECTIVE This study aimed to describe the methods used to develop and maintain the CPC Map and baseline findings regarding the number and distribution of CPCs in the United States. We also examined associations between direct state funding and the number of CPCs and relationships between the number of CPCs and state legislation proposed in 2018-2019 to ban all or most abortions. METHODS In 2018, we used standard protocols to identify and verify the locations of and services offered by CPCs operating in the United States. The CPC Map was designed to be a publicly accessible, user-friendly searchable database that can be easily updated. We examined the number of CPCs and, using existing data, the ratios of women of reproductive age to CPCs and CPCs to abortion facilities nationally and by region, subregion, and state. We used unadjusted and adjusted negative binomial regression models to examine associations between direct state funding and the number of CPCs. We used unadjusted and adjusted logistic regression models to examine associations between the number of CPCs by state and legislation introduced in 2018-2019 to ban all or most abortions. Adjusted models controlled for the numbers of women of reproductive age and abortion facilities per state. RESULTS We identified 2527 operating CPCs. Of these, 66.17% (1672/2527) offered limited medical services. Nationally, the ratio of women of reproductive age to CPCs was 29,304:1. The number of CPCs per abortion facility was 3.2. The South and Midwest had the greatest numbers of CPCs. The number of CPCs per state ranged from three (Rhode Island) to 203 (Texas). Direct funding was associated with a greater number of CPCs in unadjusted (coefficient: 0.87, 95% CI 0.51-1.22) and adjusted (coefficient: 0.45, 95% CI 0.33-0.57) analyses. The number of CPCs was associated with the state legislation introduced in 2018-2019 to ban all or most abortions in unadjusted (odds ratio [OR] 1.04, 95% CI 1.01-1.06) and adjusted analyses (OR 1.11, 95% CI 1.04-1.19). CONCLUSIONS CPCs are located in every state and particularly prevalent in the South and Midwest. Distribution of CPCs in the United States is associated with state funding and extreme proposals to restrict abortion. Researchers should track CPCs over time and examine factors that influence their operations and impact on public health and policy. </sec