1. Implementation Science Introduction
10/30/12
Implementation Science Introduction
DPI
Heidi Walter
Melissa Passehl
NIRN
Kathleen Ryan Jackson
Dean Fixsen
CESA2
Gail Anderson
Ed O’Connor

2. Implementation Defined
Implement = Use
Implementation Science = The study of factors that influence the full and effective use of innovations in practice
The goal is not to answer factual questions about what is, but to determine what is required (mission driven)
From asking “What can we do with what we have?” to asking “What will it take to do what needs to be done?” (William Foege, 2011)
Foege, W. H. (2011). House on fire: the fight to eradicate smallpox. Berkeley (CA): University of California Press.
© Dean Fixsen and Karen Blase, 2015

3. Implementation practice and science are dedicated to:
Philosophy and Values
Implementation practice and science are dedicated to:
Delivering on the promise of science in service
Produce promised outcomes in practice
Equity and fairness in the use of science in service
Equal access to effective innovations independent of personal or socio-economic factors not related to the effectiveness of the innovation
Using data to assess efforts to impact services and produce population benefits
Objective measures for decision making
National Implementation Research Network 2016
© Dean Fixsen and Karen Blase, 2015

4. Implementation Science
Implementation Research:
A Synthesis of the Literature
Formula comes from a synthesis of the literature
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).
© 2014 Karen A. Blase and Dean L. Fixsen 4

5. Research to Practice Gap
Between the saying and the doing there is a sea...
Research
Practice TO
IMPLEMENTATION
Teachers cannot use practices effectively without on-going support and many students do not benefit from quality instruction they do not receive

6. Vernez, Karam, Mariano, & DeMartini (2006)
Implementation Gap
Evidence Base
Comprehensive School Reforms
Every Teacher Trained
Every Teacher Continually Supported
Actual Supports
Years 1-3
Fewer than 50% of the teachers received some training
Fewer than 25% of those teachers received support
Fewer than 10% of the schools used the CSR as intended
Vast majority of students did not benefit
Outcomes
Years 4-5
8,000 schools, $2 billion
Aladjem, D. K., & Borman, K. M. (Eds.). (2006). Examining comprehensive school reform. Washington, DC: Urban Institute Press.
Vernez, G., Karam, R., Mariano, L. T., & DeMartini, C. (2006). Evaluating comprehensive school reform models at scale: Focus on implementation. Santa Monica, CA: RAND Corporation.
Four CSR models designed for grades K–8 are included in this study: Accelerated Schools (AS), Core Knowledge (CK), Direct Instruction (DI), and Success for All (SFA).
To date, the nation has more than 20 years of experience with CSR. More than 8,000 elementary and secondary schools (mostly low performing) have adopted a CSR model, and more than $2 billion of federal funds have been used to implement CSR strategies. Nonetheless, the potential of this school reform to improve student achievement and meet the No Child Left Behind goal of 100 percent proficiency in reading and mathematics by the year 2014 is unknown.
Vernez, Karam, Mariano, & DeMartini (2006)
© Dean Fixsen and Karen Blase, 2015

7. Formula for Success Effective Innovations Effective Implementation
Enabling Contexts
Educationally Significant Outcomes
National Implementation Research Network 2008

8. Formula for Success: District Example
Effective Innovations
Evidence based practices
Clearly defined instructional and behavioral practices
Fidelity of practice
Effective Implementation
Linked teaming structure; clearly defined purpose, procedures
Support systems to use instructional-behavioral practices
Data collections rules, decisions, action planning
Enabling Contexts
Board policy approved district-wide adoption
Practice Policy Loops: board, district, principal and teacher
Sustainable enabling context since 1997
Educationally Significant Outcomes
Seventy-five percent (341 of 456) of students who met the DIBELS benchmark at the end of first grade (2002) did, in fact, exceed the state reading benchmark at the end of third grade (2004).
National Implementation Research Network 2008
Sadler and Sugai, 2009

9. Formula for Success Effective Innovations Effective Implementation
Enabling Contexts
Educationally Significant Outcomes
National Implementation Research Network 2008

10. Change is great… You go first

11. Active Implementation
Letting it happen
Recipients are accountable
Helping it happen
Making it happen
Purposeful and proactive use of implementation practice and science
Implementation Teams are accountable
Based on Hall & Hord (1987); Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou (2004); Fixsen, Blase, Duda, Naoom, & Van Dyke (2010)
Fixsen, D. L., Blase, K., Duda, M., Naoom, S., & Van Dyke, M. (2010). Implementation of evidence-based treatments for children and adolescents: Research findings and their implications for the future. In J. Weisz & A. Kazdin (Eds.), Implementation and dissemination: Extending treatments to new populations and new settings (2nd ed., pp ). New York: Guilford Press.
Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4),
Hall, G., & Hord, S. M. (1987). Change in schools: Facilitating the process. Albany, NY: SUNY Press.
© Dean Fixsen and Karen Blase, 2015

12. Active Implementation Frameworks
© Dean Fixsen and Karen Blase, 2015

13. Benefits of Frameworks
Frameworks provide guidance for purposeful and effective action in complex human service environments
Guidance for Planning
Guidance for Problem Solving
The National Implementation Research Network
Fixsen, Blase, & Metz, 2015
© Dean Fixsen and Karen Blase, 2015

14. Benefits of Frameworks
Promote the ability to generalize beyond the immediate project or initiative (e.g. smallpox)
Enhance communication among partners (e.g. common language, common metrics, alignment of efforts)
More easily share and apply “lessons learned” among groups
Fixsen, Blase, & Metz, 2015
© Dean Fixsen and Karen Blase, 2015

15. Anything worth doing poorly… is worth doing well. Karen Blase
“Readiness” is defined as a developmental point at which a person, organization, or system has the capacity and willingness to engage in a particular activity.
Readiness Brief: SISEP Brief: Readiness for Change

16. Implementation Capacity Development
It takes TEAMS
It takes SUPPORTS
Julia
There are four key ingredients or strategies that support active implementation that you can use in your work to support programs, and that programs can use to support implementation of teaching practices, and we want to share what we’ve learned in each of these areas.
It takes time: Implementation of effective education practices takes time. District and building leaders and staff need to be engaged and persist over several years to bring about meaningful changes for students. It is important to note that the stages are not as linear as they appear. It may be better to view the Stages as additive since no Stage is ever “done” in a final sense. A review of the literature and best practices indicate that it often requires 2 to 4 years for an intervention to reach the Full Implementation Stage. Few interventions ever make it that far without systematic support from an Implementation Team.
What we’ve learned: Work flow needs to monitored and adaptive as we progress through stages of implementation.  We appreciate the flexibility of the directors and superintendents in making space for the work in adaptive ways.
It takes teams: Research has shown that, without the use of implementation teams that keep a focus on implementation infrastructures, it takes an average of 17 years to achieve full implementation in only 14% of sites. However, with the support of implementation teams, we can reach full implementation in 80% of sites, in only 3 years. And that difference of 14 years is the full career of a generation of students. Implementation teams ensure support (readiness, buy-in, planning, monitor, and adjust) of evidence-based practices and engage in improvement cycles, engage the community (stakeholder meaningful engagement), and create enabling contexts (infrastructure).
What we’ve learned: Onboarding process, multiple members
It takes supports: Supports such as training and coaching are needed to help develop, improve and sustain educators competencies and confidence to implement effective practices. Supports are needed to ensure sustainability and improvement at the organization and system level and finally supports are needed to guide leadership in using the right strategies for various situations.
What we’ve learned: Intentionally revisiting new learning in ways that encourages application of implementation principles
It takes communication: Communication across teams within an organization is important as well as vertically. It is also important to have communication between teams that are supporting you or with teams you are supporting. It is important to consider the connections teams have to allow sustainable systems, to address barriers, and to support scaling-up of evidence based-practices. All of this communication needs to center around data. This is the hardest aspect of the work!
Strong meeting protocols, Terms of Reference, Newsletter (rational and updates)
It takes TIME
It takes COMMUNICATION

17. Implementation Teams, Success, and Time
Expert Impl. Team
NO Impl. Team
80%, 3 Yrs
14%, 17 Yrs
Effective
INNOVATION
Balas & Boren, 2000
Effective use of Implementation Science & Practice
Letting it Happen Helping it Happen
It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice (Balas & Boren, 2000)
Balas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000.
Green, L. W. (2008). Making research relevant: if it is an evidence-based practice, where’s the practice-based evidence? Family Practice, 25,
With the use of competent Implementation Teams, over 80% of the implementation sites were sustained for 6 years or more (up from 30%) and the time for them to achieve Certification was reduced to 3.6 years.
Fixsen, D. L., Blase, K. A., Timbers, G. D., & Wolf, M. M. (2001). In search of program implementation: 792 replications of the Teaching-Family Model. In G. A. Bernfeld, D. P. Farrington & A. W. Leschied (Eds.), Offender rehabilitation in practice: Implementing and evaluating effective programs (pp ). London: Wiley.
Saldana, L., & Chamberlain, P. (2012). Supporting implementation: The role of community development teams to build infrastructure. American Journal of Community Psychology, 50(3-4), doi: /s
Fixsen, Blase, Timbers, & Wolf, 2001
Saldana & Chamberlain, 2012
Balas & Boren, 2000
Green, 2008

18. Implementation Capacity Development
It takes TEAMS
It takes SUPPORTS
Julia
There are four key ingredients or strategies that support active implementation that you can use in your work to support programs, and that programs can use to support implementation of teaching practices, and we want to share what we’ve learned in each of these areas.
It takes time: Implementation of effective education practices takes time. District and building leaders and staff need to be engaged and persist over several years to bring about meaningful changes for students. It is important to note that the stages are not as linear as they appear. It may be better to view the Stages as additive since no Stage is ever “done” in a final sense. A review of the literature and best practices indicate that it often requires 2 to 4 years for an intervention to reach the Full Implementation Stage. Few interventions ever make it that far without systematic support from an Implementation Team.
What we’ve learned: Work flow needs to monitored and adaptive as we progress through stages of implementation.  We appreciate the flexibility of the directors and superintendents in making space for the work in adaptive ways.
It takes teams: Research has shown that, without the use of implementation teams that keep a focus on implementation infrastructures, it takes an average of 17 years to achieve full implementation in only 14% of sites. However, with the support of implementation teams, we can reach full implementation in 80% of sites, in only 3 years. And that difference of 14 years is the full career of a generation of students. Implementation teams ensure support (readiness, buy-in, planning, monitor, and adjust) of evidence-based practices and engage in improvement cycles, engage the community (stakeholder meaningful engagement), and create enabling contexts (infrastructure).
What we’ve learned: Onboarding process, multiple members
It takes supports: Supports such as training and coaching are needed to help develop, improve and sustain educators competencies and confidence to implement effective practices. Supports are needed to ensure sustainability and improvement at the organization and system level and finally supports are needed to guide leadership in using the right strategies for various situations.
What we’ve learned: Intentionally revisiting new learning in ways that encourages application of implementation principles
It takes communication: Communication across teams within an organization is important as well as vertically. It is also important to have communication between teams that are supporting you or with teams you are supporting. It is important to consider the connections teams have to allow sustainable systems, to address barriers, and to support scaling-up of evidence based-practices. All of this communication needs to center around data. This is the hardest aspect of the work!
Strong meeting protocols, Terms of Reference, Newsletter (rational and updates)
It takes TIME
It takes COMMUNICATION

19. Implementation Team
Minimum of three people (four or more preferred) with expertise in:
Innovations
Implementation
Organization change
Tolerate turnover; teams are sustainable even when the players come and go (Higgins, Weiner, & Young, 2012; Patras & Klest, 2015)
Klest, S. K. (2014). Clustering practitioners within service organizations may improve implementation outcomes for evidence-based programs. Zeitschrift für Psychologie, 222(1), doi: / /a000163
Patras, J., & Klest, S. (2015). Group size and therapists’ workplace ratings: Three is the magic number. Journal of Social Work. doi: /
Higgins, M., Weiner, J., & Young, L. (2012). Implementation teams: A new lever for organizational change. Journal of Organizational Behavior. Retrieved from doi: /job.1773
An advantage of having a well organized and persistent approach to implementation of evidence-based practices and programs may be that the purveyor can accumulate knowledge over time (Fixsen & Blase, 1993; Fixsen, Phillips, & Wolf, 1978; Winter & Szulanski, 2001). Each attempted implementation of the program reveals barriers that need to be overcome and their (eventual) solutions. Problems encountered later on may be preventable with different actions earlier in the implementation process. The Toyota Supplier and Support Center (TSSC) is a purveyor of the Toyota Production Systems for manufacturing automobiles. MST Services, Inc. is the purveyor of the Multisystemic Therapy (MST) program for serious and chronic juvenile offenders. These are clear-cut examples of purveyors and each has a set of activities designed to help new organizations ("implementation sites") implement their respective programs. In other cases, the "purveyor" is not so readily identified nor are the activities well described. For example, the Assertive Community Treatment program and the Wraparound approach seem to have several individuals who act as consultants to communities and agencies interested in adopting those programs. The Wraparound group has recognized the problem of multiple definitions of their approach being used by different purveyors and have formed a national association to develop a common definition of the approach and a common set of processes for assessing the fidelity of new implementation sites (Bruns, Suter, Leverentz-Brady, & Burchard, 2004). The literature is not always clear about the activities of a purveyor. For example, the Quantum Opportunity Program (Maxfield, Schirm, & Rodriguez-Planas, 2003) was implemented in several sites in a major, multi-state test of the program. The report of the findings simply noted that the originators of the program had received funding to provide technical assistance to the implementation sites. Given the uneven results, it is unfortunate that there was no link back to purveyor activities.
Saldana, L., & Chamberlain, P. (2012). Supporting implementation: The role of community development teams to build infrastructure. American Journal of Community Psychology. doi: /s
Aarons, G. A., Green, A. E., Palinkas, L. A., Self-Brown, S., Whitaker, D. J., Lutzker, J. R., Chaffin, M. J. (2012). Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science, 7. doi: /
© Dean Fixsen and Karen Blase, 2015

20. Linked Teaming Structures in a Transformation Zone
How We Do Our Work
Linked Teaming Structures in a Transformation Zone
Effective Implementation Teams align, integrate, and leverage:
Leading for Equity
Using Data to improve student outcomes
Coaching for systems
Supporting CRMLSS
Utilizing principles of change management/implementation

21. The System Repeats Itself
School-based
Implementation Team
District-based
Regional
State
Implementation Teams
Teams
...Make it Happen

22. Implementation Stages Initial Implementation
Exploration
Installation
Initial Implementation
Full Implementation
Assess needs
Examine intervention components
Consider Implementation Drivers
Assess Fit
Build sustainability
Acquire Resources
Prepare Organization
Prepare Implementation Drivers
Prepare Staff
Build sustainability
Adjust Implementation Drivers
Manage Change
Deploy Data Systems
Initiate Improvement Cycles
Build sustainability
Monitor & Manage Implementation Drivers
Achieve Fidelity & Outcome Benchmarks
Further Improve Fidelity & Outcomes
Sustainability
You see the key activities of each stage here.
Stages are not linear and sustainability is embeded in the activities in each stage over time, Exploration never really ends
We have a tendency to ignore the Exploration and Installation stages, and jump right into Initial Implementation. Then, when the process does not produce the outcomes we expect, we blame the program rather than our lack of preparation.
Installation:
Structural and functional changes are made
Selection protocols developed
First practitioners selected
Define and initiate training of first practitioners
Develop coaching plans
Evaluate readiness and sustainability of data systems
Initial Implementation:
Work through the Awkwardness
New skills are fragile and uncomfortable
Implementation supports are new thinking/doing
Organization/system change is scary
Provide training and coaching on the evidence-based practice, re-organization of school roles, functions and structures
Make use of improvement cycles to resolve systems issues
Full Implementation:
Maintaining and improving skills and activities throughout the system
Components integrated, fully functioning
Policies regularly changed to support improved practices and outcomes
Data systems are in use, reliable, and efficient
Ready to be evaluated for expected outcomes
2-4 Years

23. Stakeholders Stakeholders
How will you transfer new skills into the applied setting?
Upper
Mid-Level Team
Site-Based Team
Stakeholders
Learned Helplessness
What new skills do you need to develop?
Stakeholders
For which characteristics should you select?
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, National Implementation Research Network. (FMHI Publication No. 231).
Which characteristics should you avoid?
Right data, right format, when needed to inform work 23

24. Active Implementation Stages
Exploration
Installation
Initial Implementation
Full Implementation
Assess need;
Examine fit and feasibility
Assure resources;
Develop supports
Initiate practice; use data to improve supports
Practice is consistent; positive outcomes
1-2 key characteristics of each stage
Exploration: Assess need, examine fit and feasibility
Installation: Assure resources and team; develop infrastructure
Initial Implementation: Initiate practice: Use data to improve infrastructure supports
Full Implementation: Stabilized, consistent practice; positive outcomes

25. No Implementation Team
Teams Take responsibility for Stage Based Implementation
No Implementation Team
Implementation Team
From “Letting it Happen”
To “Making it Happen”
14%
17 Years
80%
3 Years
Implementation Teams have been called a new lever for organization change in education (Higgins, Weiner, & Young, 2012)
Research has shown that, without the use of implementation teams that keep a focus on implementation infrastructures, it takes an average of 17 years to achieve full implementation in only14% of sites.
However, with the support of implementation teams, we can reach full implementation in 80% of sites, in only 3 years. And that difference of 14 years is the full career of a generation of students
Improvement in Outcomes
Sources: Fixsen, Blase, Timbers, & Wolf, 2001 Balas & Boren, 2000
Green & Seifert, 2005
Saldana & Chamberlain, 2012

26. Process to Effective Practice
Effective Innovations
Effective Implementation
Enabling Contexts
Teams assess need;
Examine fit, feasibility, infrastructure elements
Exploration
Installation
Initial Implementation
Full Implementation
Teams assure resources;
develop infrastructure to support practice & organizational change
Teams initiate practice; use data and Improvement Cycles to improve supports
Teams use Improvement Cycles, institutionalize practice and produce positive outcomes
Identify
Plan
Get Started
Get Better

27. Process to Effective Practice
Effective Innovations
Effective Implementation
Enabling Contexts
Teams assess need;
Examine fit, feasibility, infrastructure elements
Exploration
Identify

28. Process to Effective Practice
Effective Innovations
Effective Implementation
Enabling Contexts
Installation
Teams assure resources;
develop infrastructure to support practice & organizational change
Plan

29. Effective Innovations Effective Implementation Initial Implementation
Process to Effective Practice
Effective Innovations
Effective Implementation
Enabling Contexts
Initial Implementation
Teams initiate practice; use data and Improvement Cycles to improve supports
Get Started

30. Effective Innovations Effective Implementation
Process to Effective Practice
Effective Innovations
Effective Implementation
Enabling Contexts
Full Implementation
Teams use Improvement Cycles, institutionalize practice and produce positive outcomes
Get Better

31. Exploration, Mutual Selection, Partnership Agreement
Enabling Context
Where & Who We Are:
Team Development
Stage-based Implementation
Capacity building
SEA-RIT-DIT-BIT
Selection Criteria
Exploration, Mutual Selection, Partnership Agreement
AIF Implementation training, coaching, and capacity development
Imple Mapping
Implementation Team Development
Selection criteria and mutual selection
Baseline Capacity Assessment and Action Plan
Repeat every 6 months
Bi-Monthly Meeting
On-site training and coaching
Next Right Step
Meet between training and coaching
Independent Learning Plan
Action Plan Review
Preparation for team you support
Installation Stage Activities
Terms of Reference
Communication Protocol
Select a focus of the work

33. Capacity to Implement and Sustain
Evaluating Effective Implementation

35. Change is great... Get started… Get better

36. For more on Implementation Science
Get Connected!
@SISEPcenter
SISEP
For more on Implementation Science 36

37. This document is based on the work of the National Implementation Research Network (NIRN). © Allison Metz and Dean Fixsen
This content is licensed under Creative Commons license CC BY-NC-ND, Attribution-NonCommercial-NoDerivs . You are free to share, copy, distribute and transmit the work under the following conditions: Attribution — You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work); Noncommercial — You may not use this work for commercial purposes; No Derivative Works — You may not alter, transform, or build upon this work. Any of the above conditions can be waived if you get permission from the copyright holder.
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The mission of the National Implementation Research Network (NIRN) is to contribute to the best practices and science of implementation, organization change, and system reinvention to improve outcomes across the spectrum of human services.