System and Practice
Change Through an
Implementation Lens
Ohio Alternative Response
Summit
Presentation on
Implementation Science
May 14, 2010
Allison Metz, PhD
Karen Blase, PhD
Melissa Van Dyke, LCSW
Frank Porter Graham Child Development Institute
University of North Carolina at Chapel Hill
Common Goal
To build capacity in child welfare
agencies and to support Counties in
achieving the sustainable
implementation infrastructure and
systemic change necessary for an
effective Alternative Response
model….
. . . To improve outcomes for
families and children
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Overall Challenge
Science to Service Gap
What is known often is not what is adopted
to help children, families, and caregivers
Implementation Gap
There are not clear pathways to
implementation
What is adopted often is not used
with fidelity and good effect
What is implemented often disappears
with time and staff turnover
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
From the Synthesis of the Literature
We Know That…
Implementation issues are common
across widely diverse domains
Human service prevention and intervention
(e.g. child welfare, substance abuse, mental
health, violence prevention, education)
Advanced manufacturing technologies
Research-based clinical guidelines
Engineering (e.g. bridge maintenance)
Hotel management
National franchise operations
Cancer prevention and treatment
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Positive Intervention Outcomes
≠ Implementation
Implementation has not been achieved by
doing more or better research on
interventions or on curricula
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Problem
Children and families cannot
benefit from interventions they
do not experience
“In a study of real world practice in
addiction treatment settings…found
that many clinicians reported that they
were doing CBT. However, an
independent analysis of treatment
sessions found that CBT strategies
showed up in just 3 percent of them.”
Journal of Substance Abuse Treatment (Vol. 35, No. 4)
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Insufficient Methods
Diffusion/dissemination of information by
itself does not lead to successful
implementation
Training alone, no matter how well done,
does not lead to successful implementation
Policies and funding alone do not lead to
successful implementation
Fixsen, Naoom, Blase, Friedman, Wallace, 2005
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
What Works?... Fidelity Matters
IMPLEMENTATION – The HOW
INTERVENTION
The WHAT
Effective
Effective
NOT Effective
BENEFITS
Paper Implementation
(High Fidelity)
(Low Fidelity)
NOT Effective
Getting Here and Staying Here is the Challenge!
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
What Works?...Purveyor
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 (Affiliated
Private, Funded TA Centers, Intermediaries)
Purveyors accumulate data & experiential
knowledge & become more effective and
efficient over time
Purveyors differ in what they offer and how
they help
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Purveyor AND Intermediary Structures
and Strategies
Simultaneous, Multi-Level Interventions
Intermediary
Purveyor and
Practitioners
Agency/Provider
Management (leadership, policy)
Administration (HR, structure)
Supervision (nature, content)
Local, County, & State Context
Federal Context
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
What Works? …Implementation
Best Practices
There are intervention and prevention “best
practices” and EBPs
Practices
Motivational Interviewing, Appropriate Risk
Assessment, Social Skills Training Programs
and Programs
Nurse Family Partnership, MST, PCIT, TF-CBT,
Strengthening Families, Incredible Years
There are implementation best practices to
make the principles and programs come to
life in communities and agencies.
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Change What?….Practice?
Program? Organization? Systems?
From more limited and focused changes (e.g.
targeted new policy, new program implemented
by a provider agency) to more sweeping
practice change (e.g., systems of care) all will
require…
Organizational and systems change
Organizational and systems change are “in
service” to the new or improved “future state” and
“desired outcomes”
The organization changes in order to….
The system needs to change in order to…
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Cascading Logic Model
For systems to change, we need individuals to
change their activities, patterns, behavior
How do we identify, create change in, and measure
changes in people’s behavior, knowledge, and attitudes
that relate to better outcomes for children and families?
How do we measure the products and processes that
are created to support the service or system change?
Clarity regarding leverage points and focus of the
work for foundations and their beneficiaries at
different points in the change process
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Cascading Logic Model
Population
Children at Risk of Child Abuse and
Neglect
Children and Families with
substantiated issues
Intervention
Strategies and Measures (WHAT)
Alternative Response Model
Intervention
Outcomes
Increased family engagement in
services
Improved safety at home
Reduced incidents of recurrence
Cascading Logic Model
Population
Young Children at Risk of Child
Abuse
Children and Families with
substantiated issues
Populations
Front-line Practitioners and
Case Managers
Intervention
Strategies and Measures (WHAT)
Alternative Response Model
Intervention
Outcomes
Increased family engagement
in services
Improved safety at home
Reduced incidents of
recurrence
Practice, Organizational and Systems
Change Strategies (HOW)
Implementation Related
Outcomes
Carefully selected staff and the provision of
skillful, timely training, coaching, performance
assessments , use of data in supportive
administrative and state /county
environments
Competent use of selected
Interventions & approaches
Alternative Response (fidelity
measures or staff performance
assessments)
Cascading Logic Model
Population
Young Children at Risk of Child
Abuse
Children and Families with
substantiated issues
Intervention
Strategies and Measures (WHAT)
Alternative Response Model
Intervention
Outcomes
Increased family engagement
in services
Improved safety at home
Reduced incidents of
recurrence
Practice, Organizational and Systems
Change Strategies (HOW)
Implementation Related
Outcomes
Front-line Practitioners and
Case Managers
Carefully selected staff and the provision of
skillful, timely training, coaching, performance
assessments , use of data in supportive
administrative and state /tribal environments
Competent use of selected
Interventions & approaches
Alternative Response (fidelity
measures or staff performance
assessments)
Personnel in Child Welfare
Training Systems, Supervisors,
Data System Managers, Agency
Administrators, State/Tribal
Administrators
Agreements with Program Developers and Consultants
Training and coaching for Trainers – capacity building
Release time for Supervisors to learn to coach
Installation of fidelity monitoring systems
Skillful, timely training,
coaching, performance
assessments , data systems in
supportive administrative and
regulatory environments
Populations
Cascading Logic Model
Population
Young Children at Risk of Child
Abuse
Children and Families with
substantiated issues
Populations
Intervention Strategies and Measures (WHAT)
Alternative Response Model
Practice, Organizational and Systems Change
Strategies (HOW)
Intervention Outcomes
Increased family engagement in
services
Improved safety at home
Reduced incidents of recurrence
Implementation Related
Outcomes
Front-line Practitioners and Case
Managers
Carefully selected staff and the provision of skillful,
timely training, coaching, performance
assessments , use of data in supportive
administrative and state /county environments
Competent use of selected
Interventions & approaches
Alternative Response (fidelity
measures or staff performance
assessments)
Personnel in Child Welfare Training
Systems, Supervisors,
Data System Managers, Agency
Administrators
Agreements with Program Developers and Consultants
Training and coaching for Trainers – capacity building
Release time for Supervisors to learn to coach
Installation of fidelity monitoring systems & outcome data
Skillful, timely training, coaching,
performance assessments , data
use in supportive administrative
environments
Program and Agency Administrators,
Child Welfare Agency Personnel at
the Tribal/ State/County/Local
level/External Partners/Courts
Common mission, vision developed
Stages of Implementation utilized
Linked Implementation Teams created
Formal structures created to develop practice informed
policy loops
Changes in Funding Streams support new functions
and relationships
Fidelity and outcome data systems developed and
maintained
Collaboration among providers to pool funding for
infrastructure
Sustainable infrastructure developed
Relationships with consultants &
Program Developers formalized
Training and coaching for Trainers
(pre/post)
Release time for Supervisors to
learn to coach
Fidelity monitoring systems exist
and are used
Outcome measures exist and are
used
Funding and regulatory changes
occur to support infrastructure
Cascading Logic Model
Population
Young Children at Risk of Child
Abuse
Children and Families with
substantiated issues
Populations
Intervention Strategies and Measures (WHAT)
Alternative Response Model
Practice, Organizational and Systems Change
Strategies (HOW)
Intervention Outcomes
Increased family engagement in
services
Improved safety at home
Reduced incidents of recurrence
Implementation Related
Outcomes
Front-line Practitioners and Case
Managers
Carefully selected staff and the provision of skillful,
timely training, coaching, performance
assessments , use of data in supportive
administrative and state /tribal environments
Competent use of selected
Interventions & approaches
Alternative Response (fidelity
measures or staff performance
assessments)
Personnel in Child Welfare Training
Systems, Supervisors,
Data System Managers, Agency
Administrators
Agreements with Program Developers and T/TA Centers
Training and coaching for Trainers – capacity building
Release time for Supervisors to learn to coach
Installation of fidelity monitoring systems & outcome data
Skillful, timely training, coaching,
performance assessments , data
use in supportive administrative
environments
Program and Agency Administrators,
Child Welfare Agency Personnel at
the Tribal/ State/County/Local
level/External Partners/Courts
Common mission, vision developed
Stages of Implementation utilized
Linked Implementation Teams created
Formal structures created to develop practice informed
policy loops
Changes in Funding Streams support new functions
and relationships
Fidelity and outcome data systems developed and
maintained
Collaboration among providers to pool funding for
infrastructure
Sustainable infrastructure developed
Relationships with consultants &
Program Developers formalized
Training and coaching for Trainers
(pre/post)
Release time for Supervisors to
learn to coach
Fidelity monitoring systems exist
and are used
Outcome measures exist and are
used
Funding and regulatory changes
occur to support infrastructure
Stages of Implementation
Major Implementation Initiatives occur
in stages:
Exploration
Installation
Two to Four Years
Initial Implementation
Full Implementation
Innovation
Sustainability
Fixsen, Naoom, Blase, Friedman, & Wallace, 2005
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Exploration
“Many implementation efforts fail
because someone underestimated the
scope or importance of 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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Exploration
Exploration Goals:
Examine degree to which the EBP, best
practice, systems change meets the needs
in the settings identified
Determine whether moving ahead with the
initiative and implementation is desirable
and feasible
Create readiness for change at many
levels
“Pay now or pay later.”
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Assess Feasibility
Needs
Fit
Resource availability
Evidence
Readiness for replication or degree to
which it is operationalized
Capacity
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Need in Tribal/ State, Agency,
Assessing Fit and Feasibility of Initiatives
Setting
Socially Significant Issues
Parent & Community Perceptions
of Need
Data indicating Need
Need
Fit with current -
Capacity
Staff meet minimum qualifications
Able to sustain Imp Drivers
• Financially
• Structurally
Buy-in process operationalized
• Practitioners
• Families
• Agency and Departments
Fit
•Initiatives
• Tribal//State, County,
Agency Priorities
• Organizational structures
• Community Values
Capacity to Implement
Readiness
Qualified purveyor
Expert TA available
Mature sites to observe
# of replications
How well is it operationalized?
Are Imp Drivers operationalized?
Resource
Availability
Intervention Readiness
for Replication
Initiative :
5 Point Rating Scale: High = 5; Medium =
3; Low = 1. Midpoints can be used and
scored as a 2 or 4.
High
Medium
Low
Need
Evidence
Fit
Resources Availability
Resources
Staffing
Training
Data Systems
Coaching & Supervision
Administrative & system
supports needed
Time
Evidence – is there any?
Outcomes – Is it worth it?
Fidelity or process data
Cost – effectiveness data
Number of studies
Population similarities
Diverse cultural groups
Efficacy or Effectiveness
Evidence
Readiness for Replication
© National Implementation Research Network 2009
Capacity to Implement
Total Score:
Adapted from work by Laurel J. Kiser, Michelle Zabel,
Albert A. Zachik, and Joan Smith at the University of Maryland
Assess Buy-in and Create
Readiness
Determine “buy-in” process and measures
Prepare decision makers, agency leads, and
partners for implementation
and….
Operationalize the policy, evidence-based
innovation, or systems change
Describe benefits and risks and help interested
parties gain confidence in managing risk
Assess agencies’ and/or collaborating partners’
comfort with ability to manage risk
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Resistance to Change
There is no such thing – only
inadequate preparation
It is not “their” problem, it is
ours.
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Creating Readiness for Change
Individual readiness for change
Transtheoretical Model or Stages of
Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
Prochaska and DiClemente
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Stages of Change
Stage of Change for Pre-Action
Individuals:
Precontemplation – 40%
Contemplation – 40%
Preparation – 20%
“If only 20% of employees in organizations
are prepared to take action. . . .”
Janice M. Prochaska, James O. Prochaska, and Deborah A.
Levesque (2001)
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Working with the “Not Quite Ready”
Provide Information
What is the change, why now, and what might it mean for me?
“Reflect” Concerns
In a neutral way, acknowledge and validate the person’s
concerns (e.g. “It sounds like you need more information…”, “It
makes sense to me that you are wondering about whether this is
a passing fad…”)
Roll with Resistance
Resistance is a signal to change strategies
New perspectives are invited but not imposed (e.g. “Would you
like the opportunity to learn more about this?”)
The person’s perspective is a valuable resource in learning more
about what is concerning or challenging about the change
initiative
Miller and Rollnick, 1991
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Engaging Stakeholders: Rationales
 A Rationale is a statement of
 Naturally or logically occurring outcomes
 Associated with current or future goals and/or
behavior (“if…..then”).
 Benefits
 Data indicate that providing rationales:
Copyright © Dean L. Fixsen and Karen A. Blase, 2008

Is respectful and supportive of honest
exploration of issues

Promotes choice and “buy-in”

Increases confidence in decision-making

Promotes understanding of “functions” of the
decisions being made rather than fostering
compliance
Developing Rationales
 Brief
 Aligned with Stage of Change
 Relevant to the Individual
 Pre-Contemplation and Contemplation

Promote or provide assurance about the
“upside” of taking risks

Points out the “downside” of not moving forward
– a different view of ‘risk’
 Requires a leader to be “on purpose”
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Installation
Installation Stage Goal
To make the structural and instrumental
changes necessary to initiate services
“If you build it, they will come”. . . but you
actually have to build it!
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Installation
Activities
Mutual Selection of Provider Organization
(Community, Organization, Program Experts)
Initial training provided for practitioners and
provider organization staff
Negotiate and enact structural and instrumental
changes needed to initiate the program or
practice
(write new job descriptions, recruit,
hire/redeploy staff, make special purchase of
equipment, arrange for space, organize billing
procedures)
Establish referral flow, develop ancillary
contacts
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Initial Implementation
Initial Implementation Goal
Survive the awkward stage!
Learn from mistakes
Continue “buy-in” efforts
Manage expectations
“Anything worth doing…is worth doing
poorly.”
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Initial Implementation
Activities
Provide new services
Manage staff turnover
Manage change process
Change practice
Change organizational and community
structure and culture
Put infrastructure components in place
Overcome fear and inertia
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Full Implementation
Full Implementation Goals
Maintaining and improving skills, activities,
linkages throughout the system
Components integrated, fully functioning
Skillful practices by front line staff, supervisors,
administrators
Changes in policy that are reflected in practice
at all levels
Ready to be evaluated for expected outcomes
“The only thing worse than failing and not knowing why you failed,
is succeeding and not knowing why you succeeded.”
~ Jane Timmons-Mitchell
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Innovation
Innovation
First do it right (high fidelity) or “as intended”
Then do it differently and better
Consult with content experts
Evaluate impact
Ability to retain function while changing form
given turnover, changing needs and context
Ability to adhere to the underlying theory of
change
“Innovation needs to equal improvement.”
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Sustainability
Goals of Sustainability
Financial:
Ensure funding streams for service and infrastructure
Programmatic:
Ensure high fidelity and positive outcomes through
infrastructure improvement and maintenance
Plan for turnover
“The only thing harder than getting there
is staying there.”
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Reflection: Stages
What might this information tell us about how
Alternative Response is implemented in the
remaining counties? Should we build in time for
“exploration” and planning for these change
initiatives?
Does this inform our work as we attempt to promote
the scaling up of Alternative Response statewide in
Ohio?
What lessons have pilot counties learned regarding
exploration work? installation work? initial
implementation?
What might the State or TA provider do to facilitate
the new counties’ work during the stages of
implementation?
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Improved outcomes for
children and families
Implementation
Drivers
Performance Assessment
Systems
Intervention
Coaching
Training
Selection
Adaptive
Integrated &
Compensatory
Technical
Facilitative
Administration
Decision Support
Data System
Leadership
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Improved outcomes for
children and families
Implementation
Drivers
Performance Assessment
Coaching
Training
Implementation Lens
Selection
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008
Sobering Observations
"All organizations [and systems] are
designed, intentionally or unwittingly,
to achieve precisely the results they
get."
R. Spencer Darling
Business Expert
Copyright © Dean L. Fixsen©and
Karen Fixsen,
A. Blase, 2008
Dean
Karen
Blase, Robert Horner, George Sugai, 2008
Improved outcomes for
children and families
Implementation
Drivers
Performance Assessment
Coaching
Training
Selection
Graphics by Steve Goodman,2009
Systems
Intervention
Facilitative
Administration
Decision Support
Data System
© Fixsen & Blase, 2008
Decision-Support Data Systems
Measure Fidelity AND Outcomes
BECAUSE you need to know:
Are we having an implementation
problem?
Low fidelity & Poor outcomes =
Implementation problem
Are we having an effectiveness
problem?
High fidelity and Poor outcomes =
Effectiveness Problem
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Improved outcomes for
children and families
Implementation
Drivers
Performance Assessment
Coaching
Training
Selection
Graphics by Steve Goodman,2009
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Systems
Intervention
Facilitative
Administration
Decision Support
Data System
© Fixsen & Blase, 2008
System Stability
EXISTING SYSTEM
Effective Innovations are
Changed to Fit the
System
Or Operate in the Shadows
(The Ghost System)
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Effective System Change
EXISTING SYSTEM
EXISTING SYSTEM IS
CHANGED TO SUPPORT
THE EFFECTIVENESS OF
THE INNOVATION
Effective Innovations are
Changed to Fit the
System
Or Operate in the Shadows
(Ghost System)
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
(Host System)
EFFECTIVE INNOVATION
Improved outcomes for
children and families
Implementation
Drivers
Performance Assessment
Systems
Intervention
Coaching
Training
Selection
Adaptive
Integrated &
Compensatory
Technical
Facilitative
Administration
Decision Support
Data System
Leadership
Graphics by Steve Goodman,2009
© Fixsen & Blase, 2008
Reflection: Implementation Drivers
How is the information related to
Implementation Drivers relevant to scaling
up Alternative Response?
How do you see using the information
regarding the Drivers in your work to
support the continued implementation of
Alternative Response in pilot counties?
How do you see using the information
regarding the Drivers in your work to
support implementation of Alternative
Response in new counties?
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Implementation Teams
Integrated and Interlocking at Multiple
Levels
Agency or “setting-based” teams
Community or collaborative teams
Tribal or state team
Represents the stakeholders and the
‘system’
Focus is on
Ongoing “buy-in” and readiness
Installing and sustaining the drivers
Fidelity & outcomes
Alignment (funding and policy)
Building the new system – linkages
Problem-solving and sustainability
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Catawba County Child Well-Being
Project
Consumers
Key DSS Leaders
Design
Team
Sector Leads
Stakeholders
Funders
Providers
Meta- Team
Leads + Design
Team Rep’s
EBP
Area,
Agency,
or Unit
EBP
Area,
Agency,
or Unit
EBP
Area,
Agency,
or Unit
IMPLEMENTATION TEAMS
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Senior Mgmt
Team
EBP
Area,
Agency
or Unit
Reflection – Implementation Teams
What implications does the information
regarding implementation teams have
for work with pilot and new counties?
How can the State and counties ensure
that implementation teams are in place,
clear on their roles, and linked to
support the implementation of
Alternative Response?
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Improvement Cycles
Policy to Practice to Policy Cycles
Transformation Zones
Rapid Cycle Teams
Problem-solving
Practice Improvement
Usability Testing
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Practice
Policy (Plan)
Policy
Policy Enabled Practices
(PEP)
“External” System Change Support
Policy
Practice (Do)
Structure
Procedure
Practice
Practice Feedback Loops
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Practice (Do)
Policy
Policy Enabled Practices
(PEP)
Feedback
Practice Informed Policy
(PIP)
Policy (Plan)
Study - Act
“External” System Change Support
Policy
Structure
Procedure
Practice
Reflection – Improvement Cycles
Are policy-practice feedback loops currently in
place in pilot counties? What form do they
take?
How can policy-practice feedback loops be
established in each county and statewide?
What processes are in place to ensure
“lessons learned” are shared?
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Summary
Stage related activities prepare the system for a
successful change process
Competence needs to be developed and
sustained
Selection, training, coaching, fidelity measures help
d… new practitioner behavior and skills
change and support
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
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
Summary
Purveyors and implementation teams help
with system and service change
Scaling up requires establishing
implementation capacity and tending to
necessary “scale-up shifts”
You are never done – The environment is
in motion
Improvement cycles are critical
The ‘right’ leadership strategies are
needed for the issues at hand
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
For More Information
Allison Metz, PhD
919-218-7540
allison.metz@unc.edu
At the Frank Porter Graham Child Development Institute
University of North Carolina
Chapel Hill, NC
www.scalingup.org
http://nirn.fpg.unc.edu/
http://www.fpg.unc.edu/~nirn/resources/publications/Monograph/
Copyright © Dean L. Fixsen and Karen A. Blase, 2008
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:
http://www.fpg.unc.edu/~nirn/resources/publications/
Monograph/
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https://fmhi.pro-copy.com/
Copyright © Dean L. Fixsen and Karen A. Blase, 2008