Implementing Change: Analysis of an Epis-Based Peer Co-Production Capacity Building Intervention

Background and Significance. Peer co-production refers to the process of hiring and engaging people with lived experience (PWLE) to collaborate with other service providers and users on service delivery with the goal of creating more responsive and effective services. A pilot program that engages PWLE in program planning and intervention implementation can serve as a gateway for organizations to experience the implications of peer co-production, prior to fundamentally changing organizational structure. There is a need to create interventions that provide organizations with the capacity (knowledge, skills, and self-efficacy) to engage in peer co-production. A Capacity Building Assistance Center (CBAC) created a peer co-production capacity building intervention using an implementation science framework— the Exploration, Planning, Implementation, Sustainment (EPIS) framework. The CBAC works with over 60 HIV service organizations in the US South through social justice oriented collaborative grantmaking and capacity building. The CBAC supports organizations in implementing multi-level trauma informed care interventions, focusing on meaningful involvement of PWLE. This study aims to 1) explore how the CBAC used the EPIS framework to facilitate peer co-production among its partner organizations and 2) identify preliminary outcomes of the CBAC’s peer co-production capacity building intervention.

Methods. We used qualitative evaluation data from the CBAC for this study. Multi-level data include a) field notes from staff and protocols for the intervention (CBAC-level) and b) pre/post assessments of 11 HIV organizations and in-depth interviews with 20 HIV organizational leaders (HIV organization-level). Field notes, interviews and organizational assessments were analyzed using thematic analysis based on the EPIS framework.

Results. Aim 1: CBAC’s intervention components included work plan development, monthly calls, and various capacity building sessions. In the exploratory phase, the CBAC supported organizations in engaging PWLE in problem definition and project goal setting. In the planning phase, the CBAC oversaw development of implementation work group structures and transparent decision-making procedures with PWLE. Throughout intervention implementation, the CBAC provided ongoing support through monthly calls to discuss tensions related to power shifting and provide third party accountability to the peer co-production efforts. Finally, the CBAC explored with organizations how co-production could be sustained beyond intervention implementation through organizational structural change.

Aim 2: We found that organizations exhibited a commitment to continued peer co-producing projects; created new structures for peer co-production (ex: policies prioritizing PWLE for employment and service delivery); and improved mechanism for broader community engagement.

Implications and Conclusions. Our findings reveal that the development and implementation of a project with support from the CBAC peer co-production capacity building intervention served as an important gateway to pilot peer co-production mechanisms. This study shows how the CBAC used the EPIS framework to prioritize peer co-production and facilitated HIV organizations’ sustained integration of peer co-production in daily practice. Our findings suggest that using an implementation science framework in combination with social justice rooted, co-production models can lead to structural organization changes. Grantmakers and capacity building centers are uniquely placed to prioritized peer co-production and support organizations on creating structures that facilitate peer co-production.