Five state HEP dissemination care providers, and healthcare systems. It is important to hospitalization. Previous research indicates that under note that participants reported on herein were not recruited certain conditions, HEP also improves participants’ to participate in a study, nor was the program delivered in a perceived health and function. controlled study environment. Rather, because this was an evaluation of the effectiveness of a program whose efficacy had been previously established, findings are indicative of outcomes achievable under real world conditions. Fourth, the use of an internet-based data collection and tracking system (WellWare©) permitted identification of variations in process or outcomes across the different sites that could be addressed as part of ongoing programmatic quality improvement. What are the broader implications of the present evaluation? Several issues must be addressed for the HEP program to continue to expand. First, small caseloads were observed in several sites. This phenomenon was likely due to the fact that HEP staff were responsible for developing their own referral base. Though a strong referral base is absolutely essential to ensure adequate program reach, the development of such referral bases needs to be the responsibility of the program administration rather than HEP staff. Second, a great deal of time and effort was expended in order to enroll people of color and refugee/immigrant populations. Many potential participants were found to be in a pre-contemplative stage of readiness for change in health-related behavior, focused on more immediately pressing issues such as economic survival. While such individuals do appear to benefit from HEP participation, they are unlikely to enroll without a physician’s encouragement. Therefore, referrals from healthcare providers working in the local community where HEP is offered are essential to ensure program sustainability, and proactive efforts to increase provider awareness of HEP need to be undertaken at the program’s organizational level. Finally, several sites had a lengthy start-up period. Analysis of this issue by SSSKC revealed that some sites were not ready to implement HEP. SSSKC has now adopted a business plan for further dissemination of HEP that includes a structured marketing and referral strategy. SSSKC has also partnered with the National Council on Aging to develop a site-readiness assessment instrument that will permit them to determine whether sites with an interest in offering HEP are ready to do so. In conclusion, the HEP continues to operate and expand under real world conditions, reaching elders at risk for functional decline. 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