1. Installing Alternative Response in Ohio
Using Implementation Drivers for Systems Change
Allison Metz, PhD
Karen Blase, PhD Melissa Van Dyke, LCSW
Frank Porter Graham Child Development Institute
University of North Carolina at Chapel Hill
Ohio Alternative Response Summit
Workshop on Implementation Drivers
May 14, 2010
(c) Dean Fixsen and Karen Blase, 2004

2. Common Goal
The Ohio Department of Job and Family Services [in collaboration with several entities] will develop a statewide child protection system with two pathways: an investigation pathway and an alternative response pathway – that assesses and responds to unique safety concerns, risks, and protective capacities of each family who is subject of an accepted report of child maltreatment.

3. Linking the “What” AND “How”
To successfully implement and sustain a new intervention, you need to understand:
The WHAT - What is the intervention (e.g. Evidence-based practice, “best practice” initiative, broad system change initiative)
AND
The HOW - Effective implementation and sustainability frameworks (e.g. strategies to change and maintain behavior of adults)

4. Defining your Intervention
From what current state to what future state?
The “intervention” must be operationalized whether it is:
An evidence-based practice or program
A best practice Initiative
A broad systems change initiative
Operationalize
Part of Speech:  verb Definition:  to define a concept or variable so that it can be measured or expressed quantitatively Webster's New Millennium™ Dictionary of English, Preview Edition (v 0.9.7) Copyright © Lexico Publishing Group, LLC

5. OH Alternative Response Model
Principles
All child protective services (CPS) interventions
Alternative response specific
Core Elements
E.g., Two or more discrete pathways; screening decisions; assessments are child-centered and family focused
(c) Dean Fixsen and Karen Blase, 2004

6. OH Alternative Response Model
Foundational Tenets of the Practice Model
Alternative response, families, services
Workers’ Skill Sets
Characteristics, competencies, values
Selected Indicators of Quality Practices with Families
Behaviors indicative of fidelity to the Alternative Response model
(c) Dean Fixsen and Karen Blase, 2004

7. Reflection Work – Operationalizing. . .
Take a moment to consider
When the Alternative Response Model has been developed and implemented as intended –
What will child welfare staff be saying and doing more often? Less often?
What will child welfare supervisors, managers, and leaders be saying and doing more often? Less often?
What will partner agency personnel be saying and doing more often? Less often?
Which child welfare activities and processes will be affected?
(c) Dean Fixsen and Karen Blase, 2004

8. Putting “It” Into Action
Who will do what differently?
Who will help change occur? AND How will change happen? At all levels….
Practice
Program
Organization
System
(c) Dean Fixsen and Karen Blase, 2004

9. Work of Implementation
“Systems don’t change - people do.”
Jim Wotring, Georgetown University
Changing the thinking and behavior of:
Adult human service professionals (frontline practitioners) so that positive outcomes are more frequently created for children and families.
Administrators in organizations (Supervisor, Managers, Directors) so that structures, cultures, and climates change to support new ways of work
System directors, policy makers, and funders (State Agency, Family Courts) so that implementation is supported and outcomes can be achieved
(c) Dean Fixsen and Karen Blase, 2008

10. The Work of Implementation
Changing the behavior of adult human service professionals is hard work
It requires a systematic approach to support behavior change of practitioners, volunteers, administrators, and policy makers
It requires the application of Implementation Drivers [
© Karen A. Blase & Dean L. Fixsen, 2004
(c) Dean Fixsen and Karen Blase, 2008

11. What are the Implementation Drivers?
Competency Drivers are mechanisms that help to develop, improve, and sustain one’s ability to implement an intervention with fidelity and benefits to consumers. Competency Drivers include: Selection, Training, Coaching, and Performance Assessment
Organization Drivers are mechanisms to create and sustain hospitable organizational and systems environments for effective services. Organization Drivers include: Decision Support Data System, Facilitative Administration, and Systems Intervention
Leadership Drivers are methods to manage Technical problems where there is high levels of agreement about problems and high levels of certainty about solutions and to constructively deal with Adaptive challenges where problems are not clear and solutions are elusive

12. Improved outcomes for children and families
Implementation Drivers
Performance Assessment
Coaching
Systems
Intervention
Facilitative
Administration
Training
Adaptive
Competency Drivers
Organization Drivers
Integrated & Compensatory
Decision Support
Data System
Selection
Technical
Leadership
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008 12

13. Why These Drivers Focus First on Practitioner’s Behavior?
In child welfare, the Practitioner IS THE INTERVENTION
Build supports in relationship to what the Practitioner needs to be competent
Create the conditions under which practitioners can do the right thing for the right reason at the right time to maximize positive results
Wide ranging inputs (individuals with all their past history and current realities)
(c) Dean Fixsen and Karen Blase, 2004

14. Improved outcomes for children and families
Implementation Drivers
Performance Assessment
Coaching
Training
Competency Drivers
Implementation Lens
Selection
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008 14

15. Recruitment and Selection
Purposes:
Select for the “unteachables”
Screen for pre-requisites
Make expectations explicit
Allow for mutual selection through interview process
Improve likelihood of retention after “investment”
Improve likelihood that training, coaching and supervision will result in implementation
(c) Dean Fixsen and Karen Blase, 2004

16. Recruitment and Selection
Implementation Best Practices:
Job or role description clarity about accountability and expectations
Sampling of skills and experience is related to “new practices” and expectations
Interactive Interview Process
Skilled interviewers
Using Data for Integration and Compensatory Features
Feed interview information forward to trainers, coaches, administrators
(c) Dean Fixsen and Karen Blase, 2004

17. Recruitment and Selection Driver in Early Stages of Implementation
Identify selection criteria for different levels of staff and roles
Select and recruit participants for Implementation Work Groups
Assess capacity to recruit and select appropriate staff to implement planned systems reforms
Assess staff readiness and commitment
Identify possible data sources and processes that will tell you how well the Selection Driver is currently functioning in your State or County agency.
(c) Dean Fixsen and Karen Blase, 2004

18. Pre-Service and In-Service Training
Purposes:
Knowledge acquisition
Basic Skill Development
“Buy-in”
Implementation Best Practices:
Theory grounded (adult learning)
Skill-based
Behavior Rehearsals vs. Role Plays
Knowledgeable Feedback Providers
Practice to Criteria
Feedback to Selection and Feed Forward to Supervision
Data-based (pre and post testing)
(c) Dean Fixsen and Karen Blase, 2004

19. Training Driver in the Early Stages of Implementation
Identify your populations of concern
Whose capacity are you building?...to do what?
Whose knowledge skills and abilities are you attempting to impact?
Identify and assess training requirements and needed resources
Assess capacity to train staff effectively at multiple levels of the system to implement and sustain change initiative
(c) Dean Fixsen and Karen Blase, 2004

20. Training Driver in the Early Stages of Implementation
Identify training requirements and available training resources
Assess how current child welfare training practices in your state or county currently reflect implementation best practices?
Identify possible data sources and processes that will tell you how well the Training Driver is currently functioning in your State or County agency.
(c) Dean Fixsen and Karen Blase, 2004

21. Supervision and Coaching
Purposes:
Ensure implementation
Develop good judgment
Ensure fidelity
Provide feedback to selection and training processes
(c) Dean Fixsen and Karen Blase, 2004

22. Coaching Driver OUTCOMES 10% 5% 0% 30% 20% 60% 95% Knowledge
% of Participants who Demonstrate Knowledge, Demonstrate New Skills in a Training Setting,
and Use new Skills in the Classroom
TRAINING
COMPONENTS
Knowledge
Skill
Demonstration
Use in the
Classroom
Theory and Discussion
10% 5% 0%
..+Demonstration in Training
30%
20%
…+ Practice & Feedback in Training
60%
…+ Coaching in Classroom
95%
(c) Dean Fixsen and Karen Blase, 2004

23. Coaching Implementation Best Practices:
Design a Coaching Service Delivery Plan
Develop accountability structures for Coaching – Coach the Coach!
Regular satisfaction feedback from employees and volunteers
Regular review of adherence to Coaching Service Delivery Plan
Look at data – Fidelity, Staff Satisfaction with Support, Skill Acquisition
(c) Dean Fixsen and Karen Blase, 2004

24. Coaching Driver in Early Stages of Implementation
Ensure that Alternative Response has been fully operationalized and practice profiles completed
Assess levels of buy-in for executing coaching plan in agency
Assess coaching requirements and identify available resources
Assess capacity to coach staff effectively at multiple levels of the system to implement change initiative
Identify possible data sources and processes that will tell you how well the Coaching Driver is currently functioning in your State or County agency.
(c) Dean Fixsen and Karen Blase, 2004

25. Improved outcomes for children and families
Implementation Drivers
Performance Assessment
Coaching
Training
Competency Drivers
Implementation Lens
Selection
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008 25

26. Performance Assessment
Purposes:
Ensure implementation
Reinforce staff and build on strengths
Develop skills and abilities
Measure fidelity
Interpret Outcome Data
Feedback to Agency, County, State Implementation Teams on functioning of
Recruitment and Selection Practices
Training Programs (pre and in-service)
Supervision and Coaching Systems
(c) Dean Fixsen and Karen Blase, 2004

27. Performance Assessment
Implementation Best Practices:
Transparent Processes – Orientation
What, When, How, Why
Use of Multiple Data Sources
Content
Competency
Context
Tied to positive recognition – not used ‘punitively’
(c) Dean Fixsen and Karen Blase, 2004

28. Definition of Fidelity
The degree to which the program or practice is implemented ‘as intended’ as defined by the program developers/researchers or experts
Adherence
Integrity
Delivered in a “comparable” manner
SO THAT it is more likely that comparable outcomes will be more consistently achieved

29. Competency Implementation Drivers Analysis and Discussion Template
Does Driver exist?
(yes/no)
Responsibility for Driver? (who, what dept/entity)
How does the Driver currently support implementation?
How well integrated is the Driver with the other Drivers?
Is there a measure of Driver effectiveness? How might you know the Driver is effective?
How can the Driver be used more purposefully to support fidelity, outcomes, and/or sustainability?
Staff Selection
Staff Training
Staff Coaching
Staff Performance
Evaluation
(Fidelity)
(c) Dean Fixsen and Karen Blase, 2004

30. Sobering Observations
"All organizations [and systems] are designed, intentionally or unwittingly, to achieve precisely the results they get." R. Spencer Darling
Business Expert
“The tyranny of the status quo.”
Fritz Oser
Educator
© Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008
Horner, George Sugai, 2008
(c) Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008 30 30

31. Improved outcomes for children and families
Implementation Drivers
Performance Assessment
Coaching
Systems
Intervention
Facilitative
Administration
Training
Competency Drivers
Organization Drivers
Decision Support
Data System
Selection
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008 31

32. Decision Support Data Systems
Purposes:
Provide information to assess effectiveness of Alternative Response Model
To guide further program and practice development
Celebrate success
Engage in continuous quality improvement
Be accountable for quality infrastructure (are Drivers ‘working’) and for outcomes
(c) Dean Fixsen and Karen Blase, 2004

33. Decision Support Data Systems
Implementation Best Practices:
Includes intermediate and longer term outcome measures
Includes process measures (fidelity)
Measures are “socially important”
Useful data are:
Reliable (standardized protocols, trained data gatherers)
Reported frequently (e.g. weekly, quarterly)
Reported at relevant and “actionable” levels (e.g. child, family, agency)
Widely shared
Practical to collect
Useful for and used for making decisions (PDSA)
(c) Dean Fixsen and Karen Blase, 2004

34. Decision Support Data Systems in Early Stages of Implementation
Assess data collection requirements including technology and training needs
Assess technology capacity and integration issues
Identify resources for assessing fidelity
Identify possible data sources and processes that will tell you how well the Decision Support Data Systems Driver is currently functioning in your State or County agency.
Make plans for incorporating data into program improvement cycles
(c) Dean Fixsen and Karen Blase, 2004

35. Facilitative Administrative
No such thing as a purely administrative decision!!....They are all decisions about Quality Practice with Children and Families!!
Purposes:
Facilitates moving through implementation stages
Ensures effective use of Competency Drivers
Takes the lead on Systems Interventions
Utilizes data for improvement
Looks for ways to make work of practitioners easier and more effective!!
(c) Dean Fixsen and Karen Blase, 2004

36. Facilitative Administrative
Implementation Best Practices:
Forms and supports multi-level, functional implementation teams (e.g. service area, cross-agency, senior management)
Uses feedback to make changes in Implementation Drivers
Revises policies and procedures to support the new way of work
Solicits and uses feedback from child welfare staff
Reduces administrative barriers
(c) Dean Fixsen and Karen Blase, 2004

37. Facilitative Administration in Early Stages of Implementation
Assess policies and procedures needed to support new way of work
Provide leadership and support
Identify champions
Create communication plans
Support teaming approach; share decision-making
Create buy-in for business NOT as usual - Take risks!
Identify possible data sources and processes that will tell you how well the Facilitative Administration Driver is currently functioning in your State or County agency.
(c) Dean Fixsen and Karen Blase, 2004

38. Systems Intervention Purposes:
Identify barriers and facilitators for the new way of work
Create a “hospitable” environment for the new way of work
Contribute to cumulative learning in multi-site projects.
(c) Dean Fixsen and Karen Blase, 2004

39. Systems Intervention Implementation Best Practices
Match leadership level needed to intervene
Engage and grow “champions” and “opinion leaders”
Objectively document barriers
Establishes formal PEP – PIP cycles
Uses Transformation Zones to
Identify Systems Issues
Create time-limited, barrier busting processes
Make constructive recommendations and assist in implementing and evaluating them (PDSA)
(c) Dean Fixsen and Karen Blase, 2004

40. Systems Interventions Driver in Early Stages of Implementation
Identify systems barriers and facilitators
Create and strengthen necessary external partnerships
Set up policy to practice to policy to practice (4P) feedback loops
Identify transformation zones
Engage and grow systems champions
Identify possible data sources and processes that will tell you how well the Systems Intervention Driver is currently functioning in your State or County agency.
(c) Dean Fixsen and Karen Blase, 2004

41. Organizational Implementation Drivers Analysis and Discussion Template
Does Driver exist?
(yes/no)
Responsibility for Driver? (who, what dept/entity)
How does the Driver currently support implementation?
How well integrated is the Driver with the other Drivers?
Is there a measure of Driver effectiveness? How might you know the Driver is effective?
How can the Driver be used more purposefully to support fidelity, outcomes, and/or sustainability?
Systems Interventions
Facilitative Administration
Decision Support Data Systems
(c) Dean Fixsen and Karen Blase, 2004

42. Prevention and Intervention Benefits for Individuals and Community
Implementation Drivers
Performance Assessment
Coaching
Systems
Intervention
Facilitative
Administration
Training
Adaptive
Competency Drivers
Organization Drivers
Decision Support
Data System
Selection
Technical
Leadership
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008 42

43. Types of Leadership Needed
Different strategies for different challenges
Technical Leadership
Adaptive Leadership
According to Ron Heifitz and his colleagues, one of the biggest mistakes “leaders” make is to incorrectly identify the type of challenge they are facing
Using technical approaches for adaptive issues
(c) Dean Fixsen and Karen Blase, 2004

44. Technical Work Perspectives are aligned (views, values)
Definition of the problem is clear
Solution and implementation of the solution is clear
Primary locus of responsibility for organizing the work is the leader
(c) Dean Fixsen and Karen Blase, 2004

45. Adaptive Work Legitimate, yet competing, perspectives emerge
Definition of the problem is unclear
Solution and implementation is unclear and requires learning
Primary locus of responsibility is not the leader
(c) Dean Fixsen and Karen Blase, 2004

46. The Adaptive Work of the Leader
Get on the balcony
Identify the adaptive challenge
Regulate distress
Maintain disciplined attention
Give the work back to the people
Protect all voices
R. Heifetz and D. Laurie: The Work of Leadership. Harvard Business Review, 1998.

47. Improved outcomes for children and families
Implementation Drivers
Performance Assessment
Coaching
Systems
Intervention
Facilitative
Administration
Training
Adaptive
Competency Drivers
Organization Drivers
Integrated & Compensatory
Decision Support
Data System
Selection
Technical
Leadership
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008 47

48. Integrated and Compensatory
Consistency in philosophy, goals, knowledge and skills across these processes
Compensatory
Assessment of weaknesses and strengths in Driver functioning
Installation of Drivers at multiple levels of the system (practitioner, agency, county, state)
(c) Dean Fixsen and Karen Blase, 2008

49. Are you ready to get a bit more complicated
Are you ready to get a bit more complicated? Applying the Drivers to a Driver
Example: Creating a “system” for competent trainers for Alternative Reponse Model in OH
How to Select them?
How to train them?
How to coach them?
How and what to measure to see if fidelity to the training model, content and processes over time?
What training outcomes should we measure?
What internal and external systems changes will be needed for trainers to be supported and effective?
(c) Dean Fixsen and Karen Blase, 2004

50. Innovation Fluency X Drivers
How much do the experts know about what it takes to implement Alternative Response in typical settings?
What will they contribute related to Drivers and their “innovation”?
Knowledge?
Theory?
Data?
Recommendations based on implementation in typical settings
Tools, training, monitoring systems?
(c) Dean Fixsen and Karen Blase, 2004

51. Applications Implementation Drivers
INTRODUCING DRIVERS TO SUPPORT YOUR CHANGE INITIATIVE: Discuss how you will introduce Drivers to your county workgroups or implementation teams. What would you need to do to prepare for such a conversation?
DRIVERS AND DATA: Consider Alternative Response model. List the data sources for assessing each driver and discuss a yearly process for evaluating the quality and integration of the Drivers.
BEST PRACTICES FOR DRIVERS: Consider an innovation that your state is currently implementing. Using the Drivers Checklist, assess the current implementation practice against the best practices listed on the handout for one “key position” (e.g. family group conferencing facilitator).
Given your assessment, what are your next steps.
If you don’t have information, what are your sources of information?
(c) Dean Fixsen and Karen Blase, 2004

52. For More Information Allison Metz, Ph.D. 919-218- 7540
At the Frank Porter Graham Child Development Institute
University of North Carolina
Chapel Hill, NC
(c) Dean Fixsen and Karen Blase, 2004

53. For More Information
Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).
Download all or part of the monograph at:
To order the monograph go to:
(c) Dean Fixsen and Karen Blase, 2004