Chapter V:
Implementation Stage
“The Action Stage”
Various Models
• Mental Health
– Possible
interventions are
based on whether
the problem is due to
the client or
consultee.
• Behavioral
– Which types of
reinforcement are
most effective with a
given client.
• Organizational
– Determine at what
level of the
organization to
intervene and then
select an intervention
appropriate to that
level.
Stage III: Implementation
• Phase One: Choosing an Intervention
• Phase Two: Formulating a Plan
• Phase Three: Implementing the Plan
• Phase Four: Evaluating the Plan
Stages
Entry
Diagnosis
Implementation
Choosing an
Intervention
Formulating a Plan
Implementing the Plan
Evaluating the Plan
Disengagement
Stage 3: Implementation
Choosing an
Intervention
• “What are we going to do?
Formulating a
Plan
• How are we going to do it?
Implementing
the Plan
• Actively try to solve the problem.
Evaluating the
Plan
• How did we do?
The Implementation Phase is
Critical!
An Error Here =
Wrong
Solution but
Right Problem
Right Plan but
Wrong
Intervention
Phase One: Choosing an
Intervention
• The client (system) is ready for some form of
direct assistance from the consultee or
indirect service from the consultant.
• Select one or two interventions that
have a high probability of being
successful
– Evidence-based? –Social Factors?
– Costs/Benefits? –Fit?
The Stump
Approaching a
problem with
your mind
already made
up is like plowing
a field full of
stumps.
Decision Consultation:
To what degree has the consultee
…
• developed a wide range of alternative interventions?
• considered the objectives & related values of the possible
interventions?
• weighed the potential negative consequences risks & potential
payoffs of each intervention?
• searched for new information relative to each interventions?
• processed the consultant’s comments about potential positive and
negative factors related to the interventions?
• made a final determination of the interventions’ potential positive and
negative consequences as well as the driving & inhibiting forces that
affect their implementation?
• does the consultee have the capacity to successfully execute the
chosen intervention?
• Which interventions have been set aside for use in contingency
Imagine that!!
• Consultees do not
always follow through on
the implementation of the
intervention they are
supposed to implement.
• Relates to
– perception of the “Fit”
– Difficulty level
– Quality of the
relationship
– Consultees values
– Routines in the setting
To avoid the “D’Oh! (failure to follow
through) consider the following
together
• Do we believe that the intervention will really
work?
• Can the consultee implement with high levels of
treatment integrity?
• Does the consultee see it as a part of their duties
to carry out the intervention?
• Is the intervention in line with the consultee’s
perception of what needs to be done?
• Does the intervention fit relatively easily with the
consultee’s routine?
Obstacles
• A large amount of data to process in
section
• Outcomes are difficult to predict
– Keep a list of alternatives
• Support needed (e.g. $, staff, time, etc)
Guidlines
• Try to use positive interventions 1st
• Avoid the complex
• Fit skill learning into daily routine
• Promote the less time-costly
Types of Interventions
“When your only tool is a hammer, everything looks like
a nail.”
• Individual Interventions
– Academic
– Behavioral
• Consultee-Centered Case
Consultation (Ch 9)
• Dyadic & Triadic Interventions
– 3rd Party Peacemaking – conflict resolution
Types of Group Interventions
• Interventions for Groups & Teams
– Team Building
– Nominal Group Technique
– Quality Circles
– Work Teams
Types of Group Interventions
• Interventions for use between groups
– Intergroup Team Building
– Organizational Mirroring
• Interventions for the entire organization
– Total Quality Management (TQM or TQI)
– Survey Feedback/Action Research
– Parallel Learning Structures
– Strategic Planning
Phase Two: Formulating
the Plan
• Plan- a detailed step-by-step method,
formulated before hand, for doing
something.
• Considerations– What (objective)
– Where (locale of implementation)
– When (time frame)
– How (methods, procedures, sequence)
– Who (who is responsible for what)
Egan’s pitfalls
•
•
•
•
•
•
•
Trying to accomplish too much
Formulating too large a plan
Overanalyzig the plan
Under-analyzing
Failing to consider system-wide impact
Poorly defined desired outcomes
Failure to consider human-side factors
Phase Three:
Implementing the Plan
• Help consultee be flexible
• Reassure and prepare consultee –stuff
happens
• Offer technical assistance during this
time – be available & monitor in brief
bites
• Exercise caution toward dependency
Treatment Integrity
• The degree to which the intervention is
implemented as intended.
– Why? Objective and subjective costs
– Assessment methods
• Functional Outcome Analysis (FOA)
• Interviews, observations, training, scripted
plans
Treatment Integrity
• Treatment Integrity is enhanced by
– High Probability Interventions
– Promotion of Correct Implementation
– Social Validity
– Treatment Acceptability
– Social Importance
Phase Four: Evaluating
the Plan
• Evaluation- the collection of
data/information about the
implementation to determine its
effectiveness in meeting the
specified goal
– implementation evaluation
– outcome evaluation
Techniques used in
outcome evaluation
• Individualized goal attainment measures
• Standardized outcome assessment
devices
• Consumer satisfaction survey
Multicultural Implications:
Implementation Stage
• Cultural differences can impact the
perception of the type of intervention selected
and these differences should be taken into
account when selecting and implementing an
intervention
• The question of responsibility during
implementation may be based on cultural
differences
• During evaluation it is important to have
multicultural input
Application for Multicultural
Implications during
Implementation
• Some cultural groups choose to focus
on using groups rather than focusing on
time factors
• Some cultural groups may see the
efficiency of the plan as most beneficial
during evaluation; whereas, other
groups may evaluate the social impact
of the plan