Michelle A. Duda, Ph.D., BCBA, Dean L. Fixsen, Ph.D. & Karen A. Blase Ph.D., Melissa Van Dyke, LCSW Frank Porter Graham Child Development Institute University of North Carolina – Chapel Hill Working Smarter: The implementation journey to improve student outcomes

A Framework for Implementation (Stages of Implementation) Part 3

Who does the work? Implementation Teams Develop effective, flexible, adaptable capacity to initiate and manage continual change o Requires new roles, functions, and skill sets that do not exist currently

Implementation Team Policy members o change policy, barrier busters, facilitators Practice members o do the innovation, test policies, feedback Families and stakeholders Management members o establish and define roles and functions Others?

Implementation Team A group that knows your states ESD initiative very well (formal and practice knowledge) A group that knows how to implement that innovation with fidelity and good effect A group that accumulates data & experiential knowledge -- more effective and efficient over time (information economics, K. Arrow)

Implementation Team School Management (leadership, policy) Administration (HR, structure) Supervision (nature, content) Teacher State and Community Context District/Division Implementation Team Simultaneous, Multi-Level Interventions

Implementation Team Functions Implementation Team Prepare Communities Prepare schools faculty, staff Work with Researchers Assure Implementation Prepare Districts Assure Student Benefits

Implementation Team Terms of Reference Scope, Objectives, and Expected Outcomes Term (Time or Outcome-Based) Membership (inclusive of family members, youth, system partners, providers, with attention to cultural diversity) Leadership, Roles, and Functions Boundaries and Limitations (what is not authorized) Authority, Accountability and Reporting Requirements Decision-making Processes (e.g. Majority, Consensus) Values and way of work that are to be evident during the term of work (e.g. no meetings without family members and youth present)

Implementation Team Change the behavior of adult education professionals o “Systems don’t change, people do” o Change organizational structures, cultures, and climates o Change the thinking of system directors and policy makers

Implementation Team Overarching Roles and Responsibilities: Moving the project through the stages of implementation Ensuring that the implementation drivers needed for fidelity and sustainability are integrated and successfully embedded in the overall effort Identify barriers and find solutions Identify facilitators and institutionalize them

Stages of Implementation Implementation is not an event A mission-oriented process involving multiple decisions, actions, and corrections

Stages of Implementation Exploration Installation Initial Implementation Full Implementation Innovation Sustainability Implementation occurs in stages: Fixsen, Naoom, Blase, Friedman, & Wallace, – 4 Years

Implementation Components What do we need to know about successful implementation methods? Stages of Implementation Drivers (Implementation Components) Multilevel Influences (Systems, organizations)

The Exploration “Stage”: Consensus Building

“Many implementation efforts fail because someone underestimated the scope or importance preparation. Indeed, the organizational hills are full of managers who believe that an innovation’s technical superiority and strategic importance will guarantee acceptance.”  Leonard-Barton & Kraus,  Harvard Business Review, 1985

Consensus Building Forming an Implementation Team (Oversight Team) Assessing community needs and current performance and outcomes related to that need Studying and assessing “fit” Exploration Stage Goals

Exploration : Making the Adoption Decision (or not) Overall Goals: Examine degree to which the EBP, best practice, or policy meets the needs of the District, school, & community Determine whether adoption and implementation is desirable and feasible Create readiness for change Time of Interaction and Assessment: With Schools, Teachers, and Teachers With Broad Range of Stakeholder With Providers and Funders With Content Experts or TA Resources With Other Implementing States, Districts, Schools

Exploration : Making the Adoption Decision (or not) What happens during Exploration to develop readiness for change? Assess capacity, resources, “fit” and “buy-in” Awareness, garnering support (parents, teachers, stakeholders, leaders, champions) Describe risk and help partners manage risk Identify schools or classrooms comfortable with their ability to manage risk Assess the accessibility of knowledge experts – who knows the innovation

Key Stakeholders Include; Consumers Family Members Broad Members from the community Providers Funders Other Implementation sites Others???

What happens during Exploration? Buy-in and consensus building DO NOT end You will never “finish” getting buy-in from stakeholders Assessing how much help is available for implementation Assessing capacity, resources, and “buy-in” Re-Assessing Feasibility Deciding to move ahead/or not

The Installation “Stage”: Setting the Stage for Infrastructure

“Managers may view technology as more of a problem than a solution” Robert Haavind, Editor, New Technology, 1985 “The paradox of non-evidence implementation of evidence-based programs”. Robert Drake, Paul Gorman, Will Torrery, 2002

Setting the Stage for infrastructure To create structural and instrumental changes necessary to initiate the innovation Active participation Installation Stage Goals

Installation Structural and instrumental changes necessary to initiate the innovation Creating space for the new program - Establishing referral flow Staff Recruitment & Hiring Training o Administration/Staff o Teachers

Installation (continued) Infrastructure Development Initiating EBP infrastructure by planning for: o Ongoing Training o Coaching and Supervision o Staff & Fidelity Evaluation o Outcome evaluation o Identifying Administrative Issues o Identifying Broader Systems Issues o Troubleshooting (PDSA cycles)

Performance Assessment (Fidelity) Coaching Training Selection Systems Intervention Facilitative Administration Decision Support Data System CompetencyOrganization Student Benefits Leadership Adaptive Technical Integrated & Compensatory

Installation Stage Challenges Resources consumed but no new services provided for children Start up may add 10-20% to first year costs Status Quo gets challenged Creating new realities o “Oh, I didn’t understand that this would mean……”

Overcoming “Challenges” Anticipatory guidance for champions High level “protection” and support Rapid-cycle problem solving Reduced expectations (initially) and ability to tolerate higher costs during start up Focus on evolving organizational supports Conversations to help establish new community and organizational climates and cultures

The Initial Implementation “Stage”

Initial Implementation Stage Goals Survive the awkward!!!!! Learn from mistakes Continue “buy-in” efforts Manage expectations

Change practices Provide services Put components in place Change organizational and community structures & culture Manage change process Overcome fear & inertia Initial Implementation Activities

The Full Implementation “Stage”

Full Implementation Stage Goals Maintenance and Improvement o Services o Linkages o Support o Infrastructure o Data Collection Systems

Components integrated, fully functioning Skillful Service Purposeful Service Ready to be evaluated o Outcomes o Implementation o process What is Full Implementation?

Well-developed Fidelity Measures Can discriminate between the EBP and other practices Are correlated with better outcomes Help in interpreting research findings Help in interpreting program outcomes and guiding implementation

ACTIVITY TWO Reflection Questions: See handout 20 min Step 1: Meet your “new” team Step 2: Check to make sure you have chart paper and markers Step 3: Elect a recorder for the chart paper Step 4: Decide who will share back Step 5: Begin activity on handout

The Innovation “Stage”

Innovation Stage Goals First do it Right (high fidelity).. … Then do it better! Check in with multiple people at multiple levels Create feedback loops

Consult with Purveyor Model the Master o Institutionalize Innovations by Using the Drivers Evaluate Impact o Discriminate drift from innovation When do we have an innovation?

The Sustainability “Stage”

Sustainability Stage Goals Motivation and Momentum Ensure funding streams for service and infrastructure Ensure high fidelity and positive outcomes through infrastructure improvement and maintenance Continued analysis and incorporation of implementation drivers

Starts during exploration, never stops Part of every stage Information and trust Achieve good outcomes, Expand support base during all stages Ability to retain function while changing form given turnover, changing needs and context Sustainability

Multilevel Influences Successful and sustainable implementation of innovations always requires organizational change at multiple levels. o Changing the behavior of adult human service professionals o Changing organizational structures, cultures, and climates o Changing the thinking of system directors and policy makers

For More Information Dean L. Fixsen, Ph.D Michelle A. Duda, Ph.D At the Frank Porter Graham Child Development Institute University of North Carolina Chapel Hill, NC

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: Monograph/ Monograph/ To order the monograph go to: