I feel like it is difficult to scale up the interventions, even though the research designs and evaluation strategies are rigorously designed.

Happy to share.

Thank you for sharing; I agree.

I agree with you. I think there are several reasons. First, a program may have been provided to higher-risk children and adults during research trials. When scaled up (implemented in real-world settings), program participants may not represent the high-risk trial group, reducing intervention effectiveness. Second, research study participants tend to be homogeneous in research trials. When the program is scaled up, program clients who receive services will likely differ from those who participated in the research trial. Third, when programs are implemented on a larger scale, inadequate funding to keep the program operating, insufficient staff trained to implement the intervention, or other problems often occur. Fourth, when programs are no longer implemented within a closely controlled environment, fidelity can be a problem.