Ripple effects are positive or negative outcomes that are caused by efforts to implement Evidence Based Interventions (EBI) and are unplanned, unanticipated, and/or more relevant to stakeholders other than researchers and implementers.
Any EBI implementation effort includes one or more implementation strategies that are generally intended to increase the use, availability, or quality of services. Implementation scientists call these “adoption”, “reach”, and “fidelity”. For instance, providing training to providers on an EBI will increase the likelihood the provider will use the EBI, and the quality of the EBI.
But implementation strategies may have positive or negative unintended consequences, which we call ripple effects. For instance, one strategy for increasing EBI availability is state mandates for public providers. While this may increase the availability of EBIs, it may also result in increased health equity (as it results in increased access to EBIs for low-income individuals), or in “counterfeit” services as therapists adopt low-quality versions of the EBI to meet state mandates.
Implementation Strategy
Mandating the use of EBIs by provider agencies
Intended Outcome
Increased availability of EBIs
Possible Ripple Effects
Increased equity
Therapist using
“off label” treatment