Sustaining Innovation: Using Implementation Drivers to Ensure Sustainability

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Sustaining InnovationUsing Implementation
Drivers to Ensure Sustainability

• NCHSD Fall Conference
• September 16, 2009
• Kari Collins, LCSW
• Kentucky Division of Behavioral Health

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Joyce and Showers, 2002
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Ask Yourselves

• When we are investing time and money in a new
  program, practice or initiative are we
• simply wanting to provide Continuing Education
  Credits and Certifications?
• or
• wanting to change practice and human behavior ?

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Implementation Research A Synthesis of the
Literature

• Fixsen, D. L., Naoom, S. F., Blase, K. A.,
  Friedman, R. M. Wallace, F. (2005).

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• 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 does not help you implement the
  program, practice or initiative

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• Identification
• Dissemination
• of a Positive Intervention
• ? Implementation

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• 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

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What Works?
Effective Programs, Practices or Initiatives

Effective Implementation Practices
Good Outcomes
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Implementation and Sustainability Drivers
PARTICIPANT EVALUATION - DATA TO SUPPORT
PERFORMANCE MANAGEMENT
PROGRAM EVALUATION - DATA TO SUPPORT DECISION
MAKING
CONSULTATION, COACHING, MENTORING
Internal ADMINISTRATIVE SUPPORTS - THAT
FACILITATE IMPLEMENTATION
INTEGRATED COMPENSATORY
PREPARATION TRAINING
External SYSTEMS INTERVENTIONS
PARTICIPANT RECRUITMENT SELECTION
Adapted from Fixsen, D.L., Naoom, S.F., Blase,
K., Friedman, R.M., Wallace, F. (2005).
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Implementation Drivers Initial
ConversationPlanning Tool
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• Initial Team Work
• What are you implementing?
• What levels of system change will you be your
  primary focus (local, regional, state)?
• Who are the primary participants you will focus
  on?
• Who are some secondary participants you will want
  to keep in mind?

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Participant Recruitment and Selection Family
Peer Support Specialists(Existing Liaisons,
Emerging Leaders, Coaches, Supervisors and
Administrators, Family/Youth Organizations)

• What measurable qualifications or experience?
• What personal characteristics?
• What methods to recruit and select?
• Pre-selected?
• Workforce development issues?
• Extra demands?

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• Preparation and TrainingFamily Peer Support
  Specialists(Existing Liaisons, Emerging Leaders,
  Coaches, Supervisors and Administrators,
  Family/Youth Organizations)
• How can you prepare participants?
• How can you provide formal training?
• How can you provide opportunities for practice
  and feedback in a safe environment?

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Coaching, Consultation or MentoringFamily Peer
Support SpecialistsExisting Liaisons, Emerging
Leaders, Supervisors and Administrators,
Family/Youth Organizations, Coaches

• Who can be the coaches, consultants and/or
  mentors (roles, positions or names)?
• How can they support and monitor behavior change?
• How can this be maintained?
• What ongoing role can they play with the
  administrators, whose support is necessary?

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Participant EvaluationFamily Peer Support
Specialists(Existing Liaisons, Emerging Leaders,
Supervisors and Administrators, Family/Youth
Organizations, Coaches)

• How can you evaluate the effective use of
• The identified qualities and characteristics?
• The skills taught in training?
• The skills reinforced and expanded through
  coaching, consultation or mentoring?
• How can you evaluate the participants view of
  the effectiveness of the coaches, consultants, or
  mentors?
• Are their existing fidelity tools?

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Program EvaluationFamily Peer Support
Specialists(Existing Liaisons, Emerging Leaders,
Supervisors and Administrators, Family/Youth
Organizations, Coaches)

• What types of program data can be used to
  determine and monitor progress?
• Who should use the program data?
• How can the data be used to assist with awareness
  and marketing strategies?
• How can the data be used to determine the
  usefulness of the training, coaching,
  consultation or mentoring
• Is there an overall and ongoing assessment of the
  performance over time?

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Internal Administrative SupportsFamily Peer
Support Specialists(Existing Liaisons, Emerging
Leaders, Supervisors and Administrators,
Family/Youth Organizations, Coaches)

• Who provides the strong leadership?
• Who can be a connector to the external
  agencies/organizations/systems?
• How can the administrative leadership use data
  (participant and program) to inform their
  decisions and support the infrastructure
  necessary for the ongoing implementation and
  sustainability?
• How can the leadership be involved in integrating
  and improving these implementation drivers
  throughout the life of the program?
• How could awareness and marketing strategies be
  utilized to develop and/or support these
  administrators?

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External Systems InterventionsFamily Peer
Support Specialists(Existing Liaisons, Emerging
Leaders, Supervisors and Administrators,
Family/Youth Organizations, Coaches)

• Who (role or name) currently provides or can
  provide the strong external agency/organization/sy
  stems leadership for this program? (Consider
  current and future supports.)
• In order to support the implementation and
  sustainability efforts, what strategies for
  awareness and marketing techniques are in place
  or will need to be created to work with external
  systems
• To obtain financial support?
• To obtain other necessary agency/organizational/sy
  stem support?
• To obtain human resource support?

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Next StepsAction Planning Tool

• The Next Steps Action Planning Tool is designed
  to follow the Initial Conversation.
• It helps you determine the perceived readiness of
  each driver and begin to frame your
  implementation and sustainability action plan.

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Next StepsAction Planning Tool

• Review each driver and come to a consensus as to
  the readiness to develop an action plan for your
  program, practice or initiative based on each of
  the three considerations
• The existence of a template model process or
  structure that can be used to guide the process
  to implement the driver, and
• The awareness of knowledge that could be
  available to implement the driver
• Anticipated presence of resources and supports
  that are necessary to implement the driver.
• Score each 1 (weak) to 5 (strong)

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Consensus Readiness ScoresFamily Peer Support
Specialist Program
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Next Steps Action Planning Family Peer Support
Specialist Program
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Family Peer Support Specialist Program

• Where are they in implementation?

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Kentuckys Use of theImplementation Drivers

• Peer Family Support Network
• Seven Challenges
• Transition to Independence Program (TIP)
• Substance Abuse and Co-occurring Family Network
• Wraparound with Fidelity
• Dual Diagnosis Capable Assessment Tool (DDCAT)
• Seeking Safety
• Trauma Informed Care
• Reclaiming Futures and
• Green Dot Adolescent Violence Prevention
• Local Implementation Facilitator Training

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Kentucky is Moving Implementation Forward
State Team
Regional or Collaborative Implementation Team
Agency Team
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Summary

• We need to invest in what works
• Research (national and locally defined) results
  help us choose what to implement
• But implementation and the science of systems
  change are practices and science unto themselves
• Materials and training alone wont work
• Policy and Mandates alone wont work
• Fidelity Matters
• When working with systems change and best
  practices, the it needs to be operationalized

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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
• Administrative practices systems interventions
  create hospitable environments
• Policy enables new practice AND practice needs to
  inform policy
• Purveyors, Organizations, and Implementation
  Teams to help with system and service change
  Knowledge wont get there of its own volition
• You are never done The environment is in motion
• Process Improvement Cycles are Critical
• The right leadership strategies are needed for
  the issues at hand

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• Effective Practice
• Effective Implementation
• ______________________
• Good Outcomes

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• Children, adolescents, and families cannot
  benefit from good interventions
• if they dont experience them!

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For More Information
Kari Collins, LSCW Kentucky Division of
Behavioral Health Frankfort, Kentucky 502-564-7610
Kari.Collins_at_ky.gov
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Implementation Research A Synthesis of the
Literature

• Download the monograph at
• http//www.fpg.unc.edu/nirn/resources/publication
  s/Monograph
• Fixsen, D. L., Naoom, S. F., Blase, K. A.,
  Friedman, R. M. Wallace, F. (2005).