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Am J Community Psychol. 2018 Sep;62(1-2):189-202. doi: 10.1002/ajcp.12258. Epub 2018 Jul 3.

Letting Go: Conceptualizing Intervention De-implementation in Public Health and Social Service Settings.

Author information

1
Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
2
Institute of Clinical and Translational Science, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
3
Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
4
Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
5
Center for Mental Health Services Research, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
6
Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA.
7
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
8
Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

The discontinuation of interventions that should be stopped, or de-implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de-implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de-implemented. We identify three criteria for identifying interventions appropriate for de-implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well-documented examples illustrate each of the criteria. We describe de-implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de-implementation research as a supplement. Finally, we conclude with a discussion of de-implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de-implementation research, especially identifying interventions appropriate for de-implementation in a systematic manner; and highlight special ethical considerations to advance the field of de-implementation research.

KEYWORDS:

De-implementation; Implementation science; Public health; Social service; Theory

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