Getting from Here to There: How Implementation Science Can Help Move Best Practices to the Real World Karen Blase, PhD with Dean Fixsen, PhD, Leah Bartley,

Getting from Here to There: How Implementation Science Can Help Move Best Practices to the Real World Karen Blase, PhD with Dean Fixsen, PhD, Leah Bartley, MSW, Michelle Duda, Ph.D., Allison Metz, Ph.D., Sandra Naoom, MSMPH, Barbara Sims, MA, and Melissa Van Dyke, LCSW Frank Porter Graham Child Development Institute, UNC (c) Dean Fixsen and Karen Blase, 2004

Inclusion For young children with disabilities and their families, a resounding theme for the 2lst century is that “programs, not children, have to be ’ready for inclusion”; (Early Childhood Research Institute on Inclusion, 1998). Thirty years of research and practice have produced a knowledge base that informs policy and practice. ~ Sam Odom (2000)

There are Challenges Science to Service Gap Implementation Gap
What is known is generally not what is adopted Implementation Gap There are not clear pathways to implementation What is adopted often is not used with fidelity and good effect What is implemented disappears over time and with staff turnover (c) Dean Fixsen and Karen Blase, 2008 3

What Do We Mean by Implementation?
A specified set of activities designed to put into practice a policy, activity, or program of known dimensions. Implementation processes are purposeful and defined in sufficient detail such that independent observers can detect the presence and strength of these “specified activities”

The National Implementation Research Network (NIRN)
Craft knowledge EBP purveyors (program developers) EBP implementation site managers Implementation researchers Scientific information Program development and replication data Qualitative study of program developers Synthesis of the implementation evaluation and research literature Download all or part of the monograph at: (c) Dean Fixsen and Karen Blase, 2004

Working in the Real World
Some NIRN Projects: Working at the Federal and State Level on the current EBHV Initiative Infusing Implementation Science into Head Start Evaluations Working in developing countries in early childhood education Developing Implementation Capacity for EBPs in Education - OSEP Implementation informed work with ACF Grantees to reduce long stays in foster care.

There are Shared Challenges!!
Implementation is implementation in: Agriculture and Forestry Manufacturing and Business Substance abuse Child welfare, Education, Engineering, Health and Medicine Juvenile Justice, Mental health, Nursing, …and more They have similar implementation problems They have similar implementation solutions We can learn more …more quickly Fixsen, D., Naoom, S., Blase, K., Friedman, R., & Wallace, F. (2005). Implementation Research: A synthesis of the literature. The National Implementation Research Network, (c) Dean Fixsen and Karen Blase, 2008 7

Positive Intervention Outcomes ≠ Implementation
Implementation has not been achieved by doing more or better research on interventions or on curricula materials. The usability of a program or practice has nothing to do with the weight of the evidence regarding that program “Evidence” on effectiveness helps you select what to implement for whom “Evidence” on these outcomes does not help you implement the program or practice (c) Dean Fixsen and Karen Blase, 2009

Business as Usual ≠ Impact Necessary But Not Sufficient
Data Show These Methods, When Used Alone, Do Not Result In Implementation As Intended: Diffusion/ Dissemination of information Training Passing laws/ mandates/ regulations Providing funding/ incentives Organization change/ reorganization Paul Nutt (2002). Why Decisions Fail Necessary But Not Sufficient

Policy Implications I didn't have potatoes, so I substituted rice.
WHAT WORKS ~ IMPLEMENTING PROPERLY MATTERS I didn't have potatoes, so I substituted rice. Didn't have paprika, so I used another spice. I didn't have tomato sauce, so I used tomato paste. A whole can not a half can - I don't believe in waste. My friend gave me the recipe - she said you couldn't beat it. There must be something wrong with her, I couldn't even eat it! ~ Senior Center Newsletter Higher Fidelity is correlated with better outcomes across a wide range of programs and practices Policy Implications IF THERE IS NOT THE “WILL” OR “MEANS” TO DO IT RIGHT YOU WON’T GET RESULTS 2. YOU CAN’T DO A COST-BENEFIT ANALYSIS IF THERE IS NO BENEFIT! (c) Karen Blase, 2005

What Works IMPLEMENTATION – The HOW Effective NOT Effective
Performance Implementation(High Fidelity) Paper Implementation Procedural Implementation (Low Fidelity) Effective INTERVENTION The WHAT NOT Effective Land in upper left hand quadrant is challenging Even when effective interventions are chosen – then we have ineffective implementation strategies Paper Implementation Process Implementation Getting Here and Staying Here is the Challenge! (c) Dean Fixsen and Karen Blase, 2009

Implementation Math Effective Implementation Effective Interventions
The “WHAT” Effective Implementation The “HOW” Positive Outcomes for Children As a quick reminder, it is this combination CLICK TWICE of effective interventions - the WHAT CLICK with effective implementation – the How - that is most likely to result in positive outcomes CLICK TWICE for children and their families. CLICK And we need Implementation Teams, the “who” to build implementation capacity and ensure that policies, funding, and support systems are aligned. You’ll notice that this “formula” indicates that the strength of the “What” multiplied by the effectiveness of implementation will indicate the strength of the positive outcomes you might expect. Remember that any number times 0 is 0

from Mark Lipsey’s 2009 Meta-analytic overview of the primary factors that characterize effective juvenile offender interventions – “. . . in some analyses, the quality with which the intervention is implemented has been as strongly related to recidivism effects as the type of program, so much so that a well-implemented intervention of an inherently less efficacious type can outperform a more efficacious one that is poorly implemented.” Effective Interventions The “WHAT” Effective Implementation The “HOW” Positive Outcomes for Children As a quick reminder, it is this combination CLICK TWICE of effective interventions - the WHAT CLICK with effective implementation – the How - that is most likely to result in positive outcomes CLICK TWICE for children and their families. CLICK And we need Implementation Teams, the “who” to build implementation capacity and ensure that policies, funding, and support systems are aligned. You’ll notice that this “formula” indicates that the strength of the “What” multiplied by the effectiveness of implementation will indicate the strength of the positive outcomes you might expect. Remembering that any number times 0 is 0

Operationalizing the WHAT
Who will do what differently? Who will help change occur? AND How will change happen? At all levels…. Practice Agency Community Education System Early Childhood System PD System

What is “it”? 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 The “it” must be operationalized whether it is: An Evidence-Based Practice or Program A Best Practice Initiative or New Framework A Systems Change Initiative Practice Profiles Help Operationalize Practice, Program, and Systems Features We love Webster’s and the on-line dictionary is the best thing since sliced bread. Webster’s says that Operationalize is a verb that means to define a concept or variable so that it can be measured or expressed quantitatively. And if you are going to successfully implement then the “it” must be operationalized, whether you are supporting an evidence-based practice of program, a best practice or evidence-informed initiative or a systems change One mechanism for operationalizing your initiative is the development of Practice Profiles - To get a feel for Practice Profiles, I’m first going to describe the elements of a Practice Profile and then we’ll go through an example.

Practice Profile Defining “it” Through the Development and Use of Practice Profiles Guiding Principles identified Critical Components articulated Many of you may use the term Innovation Configurations from the work of Gene Hall and Shirley Hord as another term for Practice Profiles. We’re going to refer to them in this presentation as practice profiles. Practice Profiles help define the “it”. Through the process of developing the Practice Profile, the Guiding Principles of the initiative - those broad overarching principles are identified - then Critical Components are articulated that carry out the Guiding Principles. Hall and Hord, 2010 Implementing Change: Patterns, Principles, and Potholes (3rd Edition) and Adapted from work of the Iowa Area Education Agency

Practice Profile Defining “it” Through the Development and Use of Practice Profiles Guiding Principles identified Critical Components articulated For each critical component: Identify implementation as intended Identify acceptable variations in practice Identify ineffective practices and undesirable practices Once the critical components are articulated then they have to be fully operationalized by identifying the behaviors and activities that represent the “gold standard” - the very best expression of the critical component acceptable variations in the practice ----and ineffective and undesirable practices that are not aligned with the critical component or that may even be counter productive Hall and Hord, 2010 Implementing Change: Patterns, Principles, and Potholes (3rd Edition) and Adapted from work of the Iowa Area Education Agency

Professional Problem Solving 9 Critical Components
Parent Involvement Problem Statement Systematic Data Collection Problem Analysis Goal Development Critical Component Implementation As Intended Acceptable Variation Unacceptable Variation Critical Component 1: Description Description of implementer behavior Intervention Plan Development Intervention Plan Implementation Progress Monitoring Decision Making Let’s focus on Parent Involvement and play out the practice profile related to parent involvement Professional Practices in Problem Solving: Benchmarks and Innovation Configurations Iowa Area Education Agency Directors of Special Education, 1994 (c) Dean Fixsen and Karen Blase, 2004

Unacceptable Variation
Professional Problem Solving Parent Involvement as a Critical Component Critical Component Implementation As Intended Acceptable Variation Unacceptable Variation Critical Component 1: Description of Parent Involvement and Rationales for its importance Parents are informed at all decision –making points and invited to participate by phone, letter, or . Parents “choose” to participate. Parents are informed at all decision –making points and invited to participate by phone, letter, or . Parents “choose” not to participate. Parents are informed of decisions at all decision –making points. But parents are not invited to participate. Parents are not informed or invited to participate at decision-making points. And unacceptable variations include: Parents are informed of decisions at all decision-making points. But parents are not invited to participate. Or Parents are not informed or invited to participate at decision-making points. Professional Practices in Problem Solving: Benchmarks and Innovation Configurations Iowa Area Education Agency Directors of Special Education, 1994 (c) Dean Fixsen and Karen Blase, 2004

What Works in the “How” Box
Successful implementation on a useful scale requires a purveyor An individual or group of individuals representing a program or practice who actively work to implement that practice or program with fidelity and good effect Purveyors accumulate data & experiential knowledge, & become more effective and efficient over time What is one (c) Dean Fixsen and Karen Blase, 2008 22

Active Purveyor Role Simultaneous, Multi-Level Interventions Purveyor
Agencies/Providers Management (leadership, policy) Administration (HR, structure) Supervision (nature, content) Practitioners Federal Context Local, County, State Context Purveyor Experienced quickly learn…. (c) Dean Fixsen and Karen Blase, 2008 23

Purveyor AND Intermediary Structures and Strategies
Simultaneous, Multi-Level Interventions Agency/Provider Management (leadership, policy) Administration (HR, structure) Supervision (nature, content) Practitioners Federal Context Local, County, & State Context Purveyor and Intermediary Emergence of intermediary organizations at state and regional levels (c) Dean Fixsen and Karen Blase, 2008

Implementation Frameworks
Multi-dimensional, Fully integrated Implementation Stages Implementation Drivers Implementation Teams Improvement Cycles (c) Dean Fixsen and Karen Blase, 2008 25

Implementation Takes Time
Major Implementation Initiatives occur in stages: Exploration (Sustainability) Installation (Sustainability) Initial Implementation (Sustainability) Full Implementation (Sustainability & Effectiveness) Fixsen, Naoom, Blase, Friedman, & Wallace, 2005 2 - 4 Years As home visitation starts to roll out – Can’t skip stages, they will drag you back Effectiveness isn’t going to be fairly judged until 2 to 4 years into the process There are also implications related to the intensity and kind of TA needed – Proactive, Sustained, Directive 26

Stages of Implementation
2 – 4 Years EXPLORATION INSTALLATION INITIAL IMPLEMENTATION FULL IMPLEMENTATION Stages of Implementation

Stages of Implementation: Policy and Practice Implications
You don’t get to skip any! If you make a judgment about “effectiveness” too early you might be making a mistake. Activities need to match the stage. Stages will need to be “revisited” – important! New providers, new practitioners, new communities, new partners, new government officials, new families Different stages for multiple initiatives “Where are we now with this initiative?”

Successful Inclusion & Child Development Outcomes
Why: What: Program/Initiative/Frameworks Core Implementation Components Professional Development/ Professional Learning Staff capacity to support children/families through inclusion practices and strategies Institutional capacity to support staff in implementing inclusion practices with fidelity Competency Drivers Organization Drivers How: There are two categories of Implementation Drivers: Competency and Organization. When these core components are in place they provide the support to a successful implementation that will be sustained. Competency Drivers are mechanisms that help to develop, improve, and sustain one’s ability to implement an intervention to benefit students. Competency Drivers include: Selection, Training, Coaching, and Performance Assessment Organization Drivers are mechanisms to create and sustain hospitable organizational and systems environments for effective educational services. Organization Drivers include: Decision Support Data System, Facilitative Administration, and Systems Intervention Leadership Capacity to provide direction/vision of process © Fixsen & Blase, 2008

Implementation Drivers
Successful Inclusion & Child Development Outcomes Implementation Drivers Program/Initiative/Frameworks Performance Assessment (Fidelity) Coaching Implementation Lens Training Competency Drivers Organization Drivers Integrated & Compensatory There are two categories of Implementation Drivers: Competency and Organization. When these core components are in place they provide the support to a successful implementation that will be sustained. Competency Drivers are mechanisms that help to develop, improve, and sustain one’s ability to implement an intervention to benefit students. Competency Drivers include: Selection, Training, Coaching, and Performance Assessment Organization Drivers are mechanisms to create and sustain hospitable organizational and systems environments for effective educational services. Organization Drivers include: Decision Support Data System, Facilitative Administration, and Systems Intervention PD is not a panacea to address every problem PD must be housed in a systems to support this effective practices resulting in successful sustainable student outcomes. Selection Leadership © Fixsen & Blase, 2008

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% Coaching is critical to getting new practices implemented. The 2002 meta-analysis of training and coaching data by Joyce and Showers makes a compelling case for the need for skillful coaching. You can see that even very good training that included demonstration, practice, and feedback resulted in only 5% of teachers using the new skills in the classroom. Only when training was accompanied by coaching in the service setting – in this case a classroom, was there substantial and dramatically improved implementation in the practice setting. These findings move supervision from systems that monitor billable units of service, react to crises, fill in for staff, and advise around case specifics to active coaching systems that monitor adherence to evidence-based practices, are purposeful in developing practitioner skills and offer support in trying out new approaches during that “awkward stage” just after training. Joyce and Showers, 2002 (c) Dean Fixsen and Karen Blase, 2004

Successful Inclusion & Child Development Outcomes Implementation Drivers Program/Initiative/Frameworks Performance Assessment (Fidelity) Coaching Systems Intervention Training Facilitative Administration Competency Drivers Organization Drivers Integrated & Compensatory There are two categories of Implementation Drivers: Competency and Organization. When these core components are in place they provide the support to a successful implementation that will be sustained. Competency Drivers are mechanisms that help to develop, improve, and sustain one’s ability to implement an intervention to benefit students. Competency Drivers include: Selection, Training, Coaching, and Performance Assessment Organization Drivers are mechanisms to create and sustain hospitable organizational and systems environments for effective educational services. Organization Drivers include: Decision Support Data System, Facilitative Administration, and Systems Intervention PD is not a panacea to address every problem PD must be housed in a systems to support this effective practices resulting in successful sustainable student outcomes. Selection Decision Support Data System Leadership © Fixsen & Blase, 2008

Effective System Change
EXISTING SYSTEM Effective Innovations are Changed to Fit the System Or Operate in the Shadows (Ghost System) EXISTING SYSTEM IS CHANGED TO SUPPORT THE EFFECTIVENESS OF THE INNOVATION (Host System) EFFECTIVE INNOVATION

Successful Inclusion & Child Development Outcomes Implementation Drivers Program/Initiative/Frameworks Performance Assessment (Fidelity) Coaching Systems Intervention Training Facilitative Administration Competency Drivers Organization Drivers Integrated & Compensatory There are two categories of Implementation Drivers: Competency and Organization. When these core components are in place they provide the support to a successful implementation that will be sustained. Competency Drivers are mechanisms that help to develop, improve, and sustain one’s ability to implement an intervention to benefit students. Competency Drivers include: Selection, Training, Coaching, and Performance Assessment Organization Drivers are mechanisms to create and sustain hospitable organizational and systems environments for effective educational services. Organization Drivers include: Decision Support Data System, Facilitative Administration, and Systems Intervention PD is not a panacea to address every problem PD must be housed in a systems to support this effective practices resulting in successful sustainable student outcomes. Selection Decision Support Data System Leadership Adaptive Technical © Fixsen & Blase, 2008

The Leadership Environment
The Leadership Environment changes over time and across initiatives Simple Complicated Complex Westly, Zimmerman, Patton, Getting to Maybe: How the World is Changed, 2006

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

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

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

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. In adaptive work

Implementation Supports Processing Activity: Analyzing the Drivers
Think about what early childhood practitioners & other staff will need to know and do in order to implement an evidence-based approach to inclusion How will the Drivers related to Competency, Organization and Leadership be installed, maintained, and improved over time so that professional development is provided in a “host environment” that supports sustainability and promotes fidelity? Successful Inclusion & Child & Family Outcomes Early childhood practitioners with improved knowledge and skills around Evidence-Based Inclusion Practices and Strategies There are two categories of Implementation Drivers: Competency and Organization. When these core components are in place they provide the support to a successful implementation that will be sustained. Competency Drivers are mechanisms that help to develop, improve, and sustain one’s ability to implement an intervention to benefit students. Competency Drivers include: Selection, Training, Coaching, and Performance Assessment Organization Drivers are mechanisms to create and sustain hospitable organizational and systems environments for effective educational services. Organization Drivers include: Decision Support Data System, Facilitative Administration, and Systems Intervention PD is not a panacea to address every problem PD must be housed in a systems to support this effective practices resulting in successful sustainable student outcomes.

Implementation Science
Letting it happen Recipients are accountable Helping it happen Making it happen Implementation teams are accountable Based on Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004 (c) Dean Fixsen and Karen Blase, 2008 (c) Dean Fixsen and Karen Blase, 2008 43 43

Core Competency for Implementation Teams
A Team that: Knows the innovation very well (formal and practice knowledge) Knows implementation very well (formal and practice knowledge) Knows improvement cycles to make intervention and implementation methods more effective and efficient over time Promotes systems change at multiple levels to create hospitable cultures, policies, and funding streams 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. Slavin, R. E., & Madden, N. A. (1999). Disseminating Success for All: Lessons for Policy and Practice (No. 30). Baltimore, MD: Center for Research on the Education of Students Placed at Risk (CRESPAR)- Johns Hopkins University. Honig, M. I. (2004). The new middle management: Intermediary organizations in education policy implementation. Educational Evaluation and Policy Analysis, 26(1), Stetler, C. B., Legro, M. W., Rycroft-Malone, J., Bowman, C., Curran, G., Guihan, M., et al. (2006). Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science, 1(23). Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Harvey, G. (2002). Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing, 37(6), (c) Dean Fixsen and Karen Blase, 2008 44 44

Initiating and Managing Change
Implementation Team(s) General Definition: Core group of individuals, who are representative of the stakeholders and “systems” and who are charged with guiding the overall implementation from exploration through to full implementation Benefits: Provides a focused and accountable structure to increase the likelihood that this effort will not be abandoned or derailed. Scope of the initiative determines the scope of authority and the need for linked Implementation Teams If systems don’t change but people do, there must be a focal point for systems change. In the Practice Change section we introduced you to the idea of an implementation team at a local or agency level as the group that carries the torch, engages the broader community and shepherds the initiative through the stages of implementation. Now we are going to broaden the concept of Implementation Teams and go into a bit more detail about the functions and the about the value of linked teams at multiple levels when larger system change efforts are underway.

Linked Implementation Teams
State Team When states or regions take on service change, then there may be a need for multiple Implementation Teams, each with their own set of functions, and linked through information sharing protocols and through formal liaisons. Regional or Collaborative Implementation Team Agency Team

Implementation Teams Integrated and Interlocking at Multiple Levels
Agency or “Setting-Based” Teams Community or Collaborative Teams State Team Represents the stakeholders and the ‘system’ Focus is on Installing and Sustaining the Drivers Fidelity & outcomes, Alignment (funding and policy) Problem-Solving and Sustainability

Implementation Team Implementation Teams
Prepare Communities Prepare staff & administrators Work with TA & Researchers Assure Implementation Prepare Agency & State Systems Assure Consumer Benefits Blase, K. A., Fixsen, D. L., & Phillips, E. L. (1984). Residential treatment for troubled children: Developing service delivery systems. In S. C. Paine, G. T. Bellamy & B. Wilcox (Eds.), Human services that work: From innovation to standard practice (pp ). Baltimore, MD: Paul H. Brookes Publishing. Slavin, R. E., & Madden, N. A. (1999). Disseminating Success for All: Lessons for Policy and Practice (No. 30). Baltimore, MD: Center for Research on the Education of Students Placed at Risk (CRESPAR)- Johns Hopkins University. Leonard-Barton, D., & Kraus, W. A. (1985). Implementing new technology. Harvard Business Review, 6, Parents & Stakeholders Create Readiness (c) Dean Fixsen and Karen Blase, 2008 48 48 48

Why Improvement Cycles?
It’s a hallmark of a Learning Culture Learning is Good! Perfection is impossible Avoid having the “perfect” become the enemy of the good In a complex environment your “solution” will change the problem – You need to see what “emerges” from implementation (c) Dean Fixsen and Karen Blase, 2004

What do they have in Common?
Improvement Cycles Rapid Cycle Improvement Teams Problem-solving Practice Improvement Transformation Zones PEP – PIP Cycles What do they have in Common?

PDSA Cycles Shewhart (1924); Deming (1948); Six-Sigma (1990)
Plan – Develop specific things to do Do – Do them (make sure) Study – See what happens Act – Make adjustments Cycle – Do over and over again until the goal is reached or the problem is clear (again) Shewhart, W. A. (1931). Economic control of quality of manufactured product. New York: D. Van Nostrand Co. Deming, W. E. (1986). Out of the Crisis: MIT Press. (c) Dean Fixsen and Karen Blase, 2008 (c) Dean Fixsen and Karen Blase, 2008 52 52

Improvement Cycle Uses
Rapid Cycle Teams Problem-solving Practice Improvement Transformation Zones PEP – PIP Cycles

Rapid Cycle Improvement Teams
Problem-solving during early efforts Team Lead identified Right people on the team Time-limited to address the problem Team disbands Practice Improvement On – going efforts to improve practices and competencies Use data to achieve better outcomes for children and “embed” solutions

Transformation Zone A representative “sample” (area, geography, demographics) in which you “try out” the new ideas and “suspend usual rules” so that: You make a small “mess” You can rapidly learn from your mistakes and make course corrections You can experience intended and unintended consequences You can document “what works” You can think about the implications of scaling-up (c) Dean Fixsen and Karen Blase, 2008

“External” System Change Support
Policy Practice “External” System Change Support Policy (Plan) Policy Practice Policy Enabled Practices (PEP) Structure Procedure Practice (Do) (c) Dean Fixsen and Karen Blase, 2008 58

Policy Practice Feedback Loops
“External” System Change Support Policy (Plan) Structure Procedure Policy Practice Policy Enabled Practices (PEP) Practice Informed Policy (PIP) Feedback Study - Act Practice (Do) Form Supports Function at every level (National, State, District, Region, Agency, Practitioner) (c) Dean Fixsen and Karen Blase, 2008 59

FORM SUPPORTS FUNCTION
System Alignment Federal Departments Implementation Teams State Department Communities, Regions ALIGNMENT Provider Agencies 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). Chao, S. (Ed.). (2007). The state of quality improvement and implementation research: Expert views workshop summary. Washington, D.C.: Institute of Medicine of the National Academies: The National Academies Press. Change is difficult, resistant, and often feels wrong. Inducing major change in large organizations is much more difficult than simple behavioral changes because organizations themselves are problematic. Additionally, most organization designs are outdated and do not reflect current environments, requiring more comprehensive organizational change. Freund, A. M., & Baltes, P. B. (2000). The orchestration of selection, optimization and compensation: An action - theoretical conceptualization of a theory of developmental regulation. In W. J. Perrig & A. Grob (Eds.), Control of human behavior, mental processes, and consciousness (pp ). Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. Selection, optimization, compensation (SOC) theory conceptualizes the processes of adaptive development for individuals, organizations, and systems. Selection refers to narrowing the range of alternative domains of functioning or goals from the pool of available options. Optimization involves the acquisition and coordination of the means (resources) required for goal attainment. Compensation refers to managing loss or decline in goal-relevant means (resources) through substitution of means or use of external aids. Practitioners Effective Practices FORM SUPPORTS FUNCTION (c) Dean Fixsen and Karen Blase, 2008 (c) Dean Fixsen and Karen Blase, 2008 60 60 60

Summary We need to invest in “what works” – science matters
Research results help us “choose” what to implement But “implementation” is a practice and science unto itself Materials and training alone won’t work Policy and Mandates alone won’t work Fidelity Matters (c) Dean Fixsen and Karen Blase, 2004 61

Summary Competence needs to be Developed and Sustained
Selection, Training, Coaching, Fidelity Measures help change and support new practitioner behavior and skills Organizations and Systems need to change Data systems need to be used to make decisions Facilitative administrative practices & systems interventions create hospitable environments Policy enables new practice but practice needs to inform policy Purveyors and Implementation Teams help with system and service change You are never done – The environment is in motion Improvement Cycles are Critical The ‘right’ leadership strategies are needed for the issues at hand (c) Dean Fixsen and Karen Blase, 2004 62

For More Information Karen A. Blase, Ph.D. Dean L. Fixsen, Ph.D.
Dean L. Fixsen, Ph.D. At the Frank Porter Graham Child Development Institute University of North Carolina Chapel Hill, NC (c) Dean Fixsen and Karen Blase, 2004

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

Getting from Here to There: How Implementation Science Can Help Move Best Practices to the Real World Karen Blase, PhD with Dean Fixsen, PhD, Leah Bartley,

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Getting from Here to There: How Implementation Science Can Help Move Best Practices to the Real World Karen Blase, PhD with Dean Fixsen, PhD, Leah Bartley,

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