1. Working Smarter: The implementation journey to improve student outcomes
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

2. Implementation Fluency Part 2

3. Science to Service
GAP
SERVICE
SCIENCE
IMPLEMENTATION

4. Science to Service Science to Service Gap Implementation Gap
What is known is not what is adopted to help students, families, and communities
Implementation Gap
What is adopted is not used with fidelity and good outcomes for consumers.
What is used with fidelity is not sustained for a useful period of time.
What is sustained is not used on a scale sufficient to impact societal outcomes.

5. Making use of Science Letting it happen Helping it happen
Recipients are accountable
Helping it happen
Making it happen
Implementation teams are accountable
Based on Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004

6. What is Implementation?
What do we mean by implementation?
A specified set of purposeful activities at the practice, program, and system level designed to put into place a program or intervention of known dimensions with fidelity.

7. In Other Words…
It’s all about changing the behavior of well intentioned people including practitioners, providers, community stakeholders, policy makers and funders!

8. Ineffective Methods Excellent evidence for what does not work
Implementation by mandate does not work
Implementation by “following the money” does not work
Implementation without changing supporting roles and functions does not work
Paul Nutt (2002). Why Decisions Fail

9. Ineffective Methods
Excellent experimental evidence for what does not work
Diffusion/dissemination of information by itself does not lead to successful implementation (research literature, mailings, promulgation of practice guidelines)
Training alone, no matter how well done, does not lead to successful implementation

10. Implement Innovations
IMPLEMENTATION
Effective
NOT Effective
Student Benefits
Effective
INTERVENTION
Placebo
NOT Effective
PLACEBO: Something of no intrinsic remedial value that is used to appease or reassure another

11. Good outcomes for consumers
What Works
Effective intervention practices +
Effective implementation practices =
Good outcomes for consumers

12. Common Components of Fidelity Measures
Adherence
Dosage/Exposure
Quality of Program Delivery

13. Fidelity Data Collection Methods
Direct Observation
Practitioner Self-report
Consumer Self-report

14. Why are programs not implemented with fidelity?
Lack of teacher training,
Lack of required materials
Use of some (but not all) of the required lessons and teaching strategies l
Limited time
_____________________________
Lack of funding
Inadequate infrastructure
Decentralized decision making
Lack of administrative support

15. Why are programs adapted?
Inadequate training/lack of understanding of program’s underlying theory
Barriers (time, money, resources, accessing target population)
Programs that are not user-friendly
Lack of perceived efficacy, relevance, acceptance
Brian Bumbarger, Prevention Research Center

16. Strategies for Maintaining Fidelity
Creating awareness around the importance of maintaining fidelity
Improving practitioner understanding of program’s underlying theory and rationale
Developing sustainable infrastructure and processes for monitoring implementation and fidelity
Monitoring fidelity continually

17. Evidence-Based Movement
The “evidence-based movement” is an international experiment to make better use of research findings in typical service settings.
The purpose is to produce greater benefits to students and society.

18. EBPs & Implementation Core intervention components
Clearly described (who/what)
Practical measure of fidelity
Fully operationalized (do/say)
Field tested (recursive revision)
Contextualized (org./systems fit)
Effective (worth the effort)
Nielsen, J. (2000). Why You Only Need to Test With 5 Users. Retrieved April 22, 2007, from
Rubin, J. (1994). Handbook of usability testing: How to plan, design, and conduct effective tests. New York: John Wiley & Sons.
Frick, T., Elder, M., Hebb, C., Wang, Y., & Yoon, S. (2006). Adaptive usability evaluation of complex web sites: How many tasks? Unpublished manuscript, Indiana University, W.W. Wright Education 2276, 201 N. Rose Ave., Bloomington, IN
Allen, B. L. (1996). Information tasks: Toward a user-centered approach to information systems. New York: Academic Press.

19. EBPs & Implementation
The usability of a program/practice has little to do with the quality or weight of the evidence regarding that program
Evidence on intervention effectiveness for specific populations helps us choose what to implement
Evidence on the effectiveness of the intervention does not help implement the program or practice successfully

20. EBPs & Implementation
From an implementation perspective, what do we need to know about innovations such as evidence-based programs?
Successful and sustainable implementation of evidence-based programs always requires organization and systems change.

21. Implementation Frameworks
In order to ensure that an EBP maintains and sustains producing benefits to students over time, it is critical to ensure that the system is both multi-dimensional and fully integrated through :
Implementation Stages (PART 3)
Implementation Drivers (PART 4)
Improvement Cycles (PART 5)

22. Dean L. Fixsen, Ph.D. 919-966-3892 fixsen@mail.fpg.unc.edu
For More Information
Michelle A. Duda, Ph.D.
Dean L. Fixsen, Ph.D.
At the Frank Porter Graham Child Development Institute
University of North Carolina
Chapel Hill, NC

23. 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).
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