2017 Global Implementation ConferenceJune 20th, 2017

Byron J. Powell1, Will Aldridge2, Renée Boothroyd2, Ron Prinz3, Wendy Morgan2, Claire Veazey2, & Desiree Murray2

1Gillings School of Global Public Health, University of North Carolina at Chapel Hill2FPG Child Development Institute, University of North Carolina at Chapel Hill

3Parenting & Family Research Center, University of South Carolina

An Integrated Implementation Support Logic Model to Achieve 

System‐wide Outcomes

Learning Objectives

1. Describe the hypothesized relationships between co‐creation partner support, local implementation capacity and performance, system‐wide implementation outcomes, and system‐wide intervention outcomes. 

2. Develop an applied understanding of this implementation support logic model through examples of its use in practice to support community‐wide scale‐up of Triple P in North Carolina.

2

Public health

 app

roach to 

parenting and family sup

port

Triple PPositive Parenting Program System of Interventions

Triple P – Positive Parenting Program in North Carolina

4

All children grow up in safe and nurturing environments, with stable relationships that promote their emotional and behavioral health. 

State’s Vision Statement:

To strengthen caregivers to become more positive catalysts of healthy child development acknowledging that every child deserves to grow‐up in safe and nurturing environments, with stable relationships that promote their emotional and behavioral health. 

State’s Mission Statement:

The North Carolina Implementation Capacity for Triple P (NCIC‐TP) Project

1. Through research and evaluation, to inform state and local planning processes for impact and sustainability. 

2. To utilize implementation and improvement sciences to help local leaders and teams practically increase sustainable capacity and the performance impact of their community‐wide Triple P initiatives. 

3. To measure and improve our provision of external implementation support to increase contributions to locally sustainable capacity and performance.

5

Scarcity of Implementation Logic Models

• Logic models can be an effective approach to plan, manage, and evaluate large‐scale implementation efforts (Goeschel et al., 2012)

• Few logic models of applied implementation work

6

Chinman et al. (2016) 

Implementation Outcome

Optimization

Population‐levelOutcomes

Co‐Creation Partner Support

Sustainment

Integrated Implementation Support Logic Model

Chinman et al. (2016); Proctor et al. (2011) 

Practitioners' Responsive & Effective Delivery of 

Triple P

NC Triple P State Learning Collaborative

Parent and Family Wellbeing & 

Self‐Regulation

Supp

ort

Feedback

Feedback

Feedback

Supp

ort

Supp

ort

Triple P America

Intermediary Organizations

Cross‐Agency State 

Leadership Team

Cascading Logic Model of 

Implementation Support

Integrated Implementation Support Logic Model

To view an animated overview of the NCIC‐TP Implementation Support Logic Model, visit: 

http://ncic.fpg.unc.edu/ncic‐tp‐simulation‐lab‐intro

10

Next Steps

• Continue to refine the logic model• Moving away from “siloed” model?

• Select candidate measures and develop a user‐friendly measurement guide 

• Complements broader evaluation effort• Suggests a menu of (hopefully) pragmatic measurement options

11

The Duke Endowmentwww.dukeendowment.org

NC Division of Public Healthhttp://publichealth.nc.gov/

NC Division of Social Serviceswww.ncdhhs.gov/divisions/dss

Other NCIC-TP Team Members

Robin Jenkins, Ph.D., Co-I, UNC-CHLaTanya Moore, Ph.D. , Co-I, UNC-CHRebecca Roppolo, MPH, Evaluation &

Improvement Specialist, UNC-CH

For More Information

Special Thanks to:

Disclosure: Ron Prinz, Ph.D., is a consultant to Triple P International, which is the technology transfer entity commissioned by the University of Queensland to disseminate the Triple P system, and to the Centers for Disease Control and Prevention, which is involved in 

implementation/dissemination projects related to Triple P.12

Will Aldridgewill.aldridge@unc.edu

Byron Powellbjpowell@unc.edu

Visit the NCIC‐TP Website: http://ncic.fpg.unc.edu

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 1

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 2

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 3

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 4

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 5

Chinman, M., Acosta, J., Ebener, P., Malone, P. S., & Slaughter, M. E. (2016). Can implementation support help community‐based settings better deliver evidence‐based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science, 11(1), 78, doi:10.1186/s13012‐016‐0446‐y. 

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 6

Aldridge, W. A., II, Boothroyd, R. I., Veazey, C. A., Powell, B. J., Murray, D. W., & Prinz, R. J. (2016, December). Ensuring Active Implementation Support for North Carolina Counties Scaling the Triple P System of Interventions. Chapel Hill, NC: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.

Chinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science. 2016;11(1):78.

Co-CreationMetz & Albers (2014) What does it take? How federal initiatives can support the implementation of evidence-based programs to improve outcomes for adolescents. Journal of Adolescent Health, 54, 592-596.

Metz A. Implementation brief: The potential of co-creation in implementation science. Chapel Hill, NC: National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill;2015.

Local Implementation Capacity & PerformanceChinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science. 2016;11(1):78.

Aldridge, W. A., II, Boothroyd, R. I., Fleming, W. O., Lofts Jarboe, K., Morrow, J., Ritchie, G. F., & Sebian, J. (2016). Transforming community prevention systems for sustained impact: Embedding active implementation and scaling functions. Translational Behavioral Medicine, 6, 135-144. doi:10.1007/s13142-015-0351-y

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 7

Metz, A., & Bartley, L. (2012). Active Implementation Frameworks for Program Success. Zero to Three, 32, 11-18.

Hawkins, J. D., Catalano, R. F., & Arthur, M. W. (2002). Promoting science-based prevention in communities. Addictive Behaviors, 27, 951-976.

Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER community–university partnership model for public education systems: Capacity-building for evidence-based, competence-building prevention. Prevention Science, 5(1), 31-39.

Triple P System OptimizationProctor E, Silmere H, Raghavan R, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Administration and Policy in Mental Health and Mental Health Services Research. 2011;38(2):65-76.

Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychology Review. 1998;18(1):23-45.

Mihalic S. The importance of implementation fidelity. Emotional and Behavioral Disorders in Youth. 2004;4:83 - 105.

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation Science : IS, 8, 1-11, doi:10.1186/1748-5908-8-117.

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 7

Aldridge, W. A., II, Boothroyd, R. I., Veazey, C. A., Powell, B. J., Murray, D. W., & Prinz, R. J. (2016, December). Ensuring Active Implementation Support for North Carolina Counties Scaling the Triple P System of Interventions. Chapel Hill, NC: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.

Chinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science. 2016;11(1):78.

Co-CreationMetz & Albers (2014) What does it take? How federal initiatives can support the implementation of evidence-based programs to improve outcomes for adolescents. Journal of Adolescent Health, 54, 592-596.

Metz A. Implementation brief: The potential of co-creation in implementation science. Chapel Hill, NC: National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill;2015.

Local Implementation Capacity & PerformanceChinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science. 2016;11(1):78.

Aldridge, W. A., II, Boothroyd, R. I., Fleming, W. O., Lofts Jarboe, K., Morrow, J., Ritchie, G. F., & Sebian, J. (2016). Transforming community prevention systems for sustained impact: Embedding active implementation and scaling functions. Translational Behavioral Medicine, 6, 135-144. doi:10.1007/s13142-015-0351-y

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 8

Metz, A., & Bartley, L. (2012). Active Implementation Frameworks for Program Success. Zero to Three, 32, 11-18.

Hawkins, J. D., Catalano, R. F., & Arthur, M. W. (2002). Promoting science-based prevention in communities. Addictive Behaviors, 27, 951-976.

Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER community–university partnership model for public education systems: Capacity-building for evidence-based, competence-building prevention. Prevention Science, 5(1), 31-39.

Triple P System OptimizationProctor E, Silmere H, Raghavan R, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Administration and Policy in Mental Health and Mental Health Services Research. 2011;38(2):65-76.

Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychology Review. 1998;18(1):23-45.

Mihalic S. The importance of implementation fidelity. Emotional and Behavioral Disorders in Youth. 2004;4:83 - 105.

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation Science : IS, 8, 1-11, doi:10.1186/1748-5908-8-117.

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 8

Concept of a Cascading Logic Model: Metz, A., & Bartley, L. (2012). Active Implementation Frameworks for Program Success. Zero to Three, 32, 11-18.

REVISIT:1. Through research and evaluation, to inform state and local planning processes for impact and

sustainability. • Talk about the measures we’re trying to make available on the website for the NC Learning

Collaborative and State Leadership Team, which is re-designing the Statewide Triple P Evaluation.

• Talk about helping Community Triple P Coalitions in two demonstration counties ask relevant questions based on the logic model and utilize appropriate measures to conduct feasible evaluation for local improvement.

2. To utilize the implementation and improvement sciences to help local leaders and teams practically increase sustainable capacity and the performance impact of their community-wide Triple P initiatives. • Talk about helping (via direct implementation support) Community Triple P Coalitions in

two demonstration counties build local implementation capacity and performance, and optimize outcomes.

3. To measure and improve our provision of external implementation support to increase contributions to locally sustainable capacity and performance.• Talk about how we’re conceptualizing and will be piloting core practice components of

direct implementation support, as a co-creation partner, to build local implementation capacity and performance within Community Triple P Coalitions in two demonstration counties.

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 9

Aldridge, W. A., II, Boothroyd, R. I., Veazey, C. A., Powell, B. J., Murray, D. W., & Prinz, R. J. (2016, December). Ensuring Active Implementation Support for North Carolina Counties Scaling the Triple P System of Interventions. Chapel Hill, NC: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.

Chinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science. 2016;11(1):78.

Co-CreationMetz & Albers (2014) What does it take? How federal initiatives can support the implementation of evidence-based programs to improve outcomes for adolescents. Journal of Adolescent Health, 54, 592-596.

Metz A. Implementation brief: The potential of co-creation in implementation science. Chapel Hill, NC: National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill;2015.

Local Implementation Capacity & PerformanceChinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science. 2016;11(1):78.

Aldridge, W. A., II, Boothroyd, R. I., Fleming, W. O., Lofts Jarboe, K., Morrow, J., Ritchie, G. F., & Sebian, J. (2016). Transforming community prevention systems for sustained impact: Embedding active implementation and scaling functions. Translational Behavioral Medicine, 6, 135-144. doi:10.1007/s13142-015-0351-y

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 10

Metz, A., & Bartley, L. (2012). Active Implementation Frameworks for Program Success. Zero to Three, 32, 11-18.

Hawkins, J. D., Catalano, R. F., & Arthur, M. W. (2002). Promoting science-based prevention in communities. Addictive Behaviors, 27, 951-976.

Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004). PROSPER community–university partnership model for public education systems: Capacity-building for evidence-based, competence-building prevention. Prevention Science, 5(1), 31-39.

Triple P System OptimizationProctor E, Silmere H, Raghavan R, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Administration and Policy in Mental Health and Mental Health Services Research. 2011;38(2):65-76.

Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychology Review. 1998;18(1):23-45.

Mihalic S. The importance of implementation fidelity. Emotional and Behavioral Disorders in Youth. 2004;4:83 - 105.

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation Science : IS, 8, 1-11, doi:10.1186/1748-5908-8-117.

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 10

Chinman, M., Acosta, J., Ebener, P., Malone, P. S., & Slaughter, M. E. (2016). Can implementation support help community‐based settings better deliver evidence‐based sexual health promotion programs? A randomized trial of Getting To Outcomes®. Implementation Science, 11(1), 78, doi:10.1186/s13012‐016‐0446‐y. 

Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 11

12Powell, Aldridge, Boothroyd, Prinz, Morgan, Veazey, & Murray (2017, June) 12