Michelle A. Duda, Ph.D., BCBA,Dean L. Fixsen, Ph.D.

& Karen A. Blase Ph.D.,

Melissa Van Dyke, LCSWFrank Porter Graham Child Development Institute

University of North Carolina – Chapel Hill

Working Smarter: The implementation journey to

improve student outcomes

Implementation FluencyPart 2

Science to Service

SCIENCE SERVICEGAPIMPLEMENTATION

Science to Service

• Science to Service Gap What is known is not what is adopted to help

students, families, and communities

• Implementation Gap o What is adopted is not used with fidelity and good

outcomes for consumers.o What is used with fidelity is not sustained for a useful

period of time. o What is sustained is not used on a scale sufficient to

impact societal outcomes.

Making use of Science

• Letting it happeno Recipients are accountable

• Helping it happeno Recipients are accountable

• Making it happeno Implementation teams are accountable

Based on Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004

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.

In Other Words…

It’s all about changing the behavior of well intentioned people including practitioners, providers, community stakeholders, policy makers and funders!

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

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

Implement Innovations

Effective NOT Effective

Effective

NOT Effective

IMPLEMENTATION

INT

ER

VE

NT

ION Student

Benefits

PLACEBO: Something of no intrinsic remedial value that is used to appease or reassure another

Placebo

What Works

Effective intervention practices

+Effective implementation practices

=

Good outcomes for consumers

Common Components of Fidelity Measures

• Adherence

• Dosage/Exposure

• Quality of Program Delivery

Fidelity Data Collection Methods

• Direct Observation

• Practitioner Self-report

• Consumer Self-report

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

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,

acceptanceBrian Bumbarger, Prevention Research Center

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

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.

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)

EBPs & Implementation

• The usability of a program/practice has little to do with the quality or weight of the evidence regarding that programo Evidence on intervention effectiveness

for specific populations helps us choose what to implement

o Evidence on the effectiveness of the intervention does not help implement the program or practice successfully

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.

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)

For More Information

Dean L. Fixsen, Ph.D.• 919-966-3892• fixsen@mail.fpg.unc.edu

Michelle A. Duda, Ph.D.• 919-636-0843• duda@mail.fpg.unc.edu

At the Frank Porter Graham Child Development InstituteUniversity of North Carolina

Chapel Hill, NC

www.scalingup.org http://nirn.fpg.unc.edu/

http://www.fpg.unc.edu/~nirn/resources/publications/Monograph/ 

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/ To order the monograph go to:https://fmhi.pro-copy.com/