In this episode, IFIC Chief Executive Dr Niamh Lennox-Chhugani is joined by Deborah Cohen, Professor of Family Medicine at Oregon Health & Science University and a member of the US National Academy of Medicine.
Deb reflects on evaluating the scale and spread of an integrated, team-based care model in Oregon, originally piloted to support pregnant women living with substance use disorder. While early pilots showed promising outcomes, the expansion into rural settings revealed significant implementation challenges — offering a powerful real-world example of why evaluation needs to go beyond whether something “works” and focus on how and why interventions succeed or struggle in different contexts.
The conversation explores what evaluation can reveal about implementation, scale-up, and system readiness, and how evaluators can support learning in complex health and care systems — particularly when programmes move from successful pilots to wider adoption.
On what was known — and what wasn’t — about the pilot
“We know that this program is effective. We know that it costs more to deliver this care. What we don’t really know is how to implement it.”
On why scale-up struggled in new contexts
“None of those behavioral health organizations really have been able to navigate a relationship with the medical care part of the team such that they can truly integrate medical care and behavioral health care together.”
On what earlier evaluations missed
“That was work that had not been acknowledged in the other evaluation.”
On the role of evaluation in learning
“Evaluation, in my opinion, is meant to be designed to accelerate that learning process as rapidly as possible, because it’s all about making mistakes and learning from them in a transparent way.”
On how hard it is for implementers to hear difficult findings
“It’s very hard as an implementer to take in lessons when things aren’t working.”
On investing properly in evaluation
“If you shortchange your evaluation, you tend to sometimes shortchange what you can learn.”
On the value of mixed methods
“Evaluation gets stronger when those elements are being done together… and done together iteratively.”
On psychological safety and commissioning
“The tone and culture gets sort of set from the top and having a commissioner that’s open to really understanding the complexity of what’s going on on the ground can make a huge difference.”
On bringing evaluators in early
“That latter case is way better because you really get to build relationships early on.”
