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Implementation and System Change

Implementation and System Change. Dean L. Fixsen, Karen A. Blase, Michelle A. Duda, Sandra F. Naoom, Melissa Van Dyke National Implementation Research Network. NHSC 2008 . NCLB Act & IDEA 2004. Implementation of scientifically based research

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Implementation and System Change

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  1. Implementation and System Change Dean L. Fixsen, Karen A. Blase, Michelle A. Duda, Sandra F. Naoom, Melissa Van Dyke National Implementation Research Network NHSC 2008

  2. NCLB Act & IDEA 2004 • Implementation of scientifically based research • Ensure that school personnel have the skills and knowledge necessary to improve the academic achievement and functional performance of children, including the use of scientifically based instructional practices, to the maximum extent possible;

  3. High School Education • 15 million high school students • 1.2 million high school teachers • 20,000 high schools • 3,143 counties • 60 states & U.S. jurisdictions

  4. PRACTICE RESEARCH IMPLEMENTATION Improved Student Outcomes Improved Education Systems Research to Practice GAP

  5. “In theory there is no difference between theory and practice; in practice, there is.” Yogi Berra Thanks to Joanne Cashman, The National Association of State Directors of Special Education

  6. Research to Practice • Research to Practice Gap • What is known is not what is adopted to help students, families, and communities • Implementation Gap • What is adopted is not used with fidelityand good outcomes for students. • What is used with fidelity is not sustained for a useful period of time. • What is sustained is not used on a scale sufficient to impact all high school students.

  7. Teaching–Family Model Fixsen, Blase, Timbers, & Wolf (2001) 900 300 800 700 250 600 200 500 CumulativeHomes 150 400 300 100 CumulativeCouples 200 50 100 0 0 ≤1972 1974 1976 1978 1980 1982

  8. Implementation Reviews Human service prevention and treatment program literature (e.g. substance abuse, MH, justice, education, health) Literature re: advanced manufacturing technologies, business, management, agriculture, engineering Successful practices on a national scale (e.g. SW-PBS, SFA, MST, FFT, NFP, SE, IDDT, DBT, MI, PMTO, Incredible Years)

  9. Insufficient Methods • Implementation What Works Clearinghouse • Pretty small • Implementation What Does Not Work Clearinghouse • Very large

  10. Insufficient 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.

  11. Insufficient Methods Excellent evidence for what does not work • Implementation by edict/ accountability by itself does not work • Implementation by “following themoney” by itself does not work • Implementation without changing supporting roles and functions does not work Paul Nutt (2002). Why Decisions Fail

  12. What Works Effective intervention practices + Effective implementation practices = Good outcomes for students

  13. Implement Innovations IMPLEMENTATION Effective NOT Effective Student Benefits Effective INTERVENTION NOT Effective

  14. Implementation • An effective intervention is one thing • Implementation of an effective intervention is a very different thing

  15. Implementation • Letting it happen • Recipients are accountable • Helping it happen • Recipients are accountable • Making it happen • Purposeful use of implementation practices and science • Implementation teams are accountable Based on Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004

  16. Sustainable Benefits: Goal Start with the end in mind What will it take to: make statewide use of high school innovations that produce increasingly effective outcomes for the next 50 years?

  17. Sustainable Benefits: What • Rigorous curriculum and instruction • Assessment and accountability • Teacher quality/ PD • Student and family supports • Stakeholder engagement • Leadership and governance • Organization and structure • Resources for sustainability

  18. Sustainable Benefits: How • Choosing an innovation • Implementation drivers • Implementation stages • Implementation teams • System improvement

  19. Choosing an Innovation Core intervention components • Clearly described (who/what) • Fully operationalized (do/say) • Practical measure of fidelity ** • Field tested (recursive revision) • Contextualized (org./systems fit) • Effective (worth all the effort)

  20. Sustainable Benefits • Choosing an innovation • Implementation drivers • Implementation stages • Implementation teams • System improvement

  21. Implementation Drivers Reliably produce predictable outcomes for students, families, and communities

  22. Implementation Drivers STAFF PERFORMANCE EVALUATION CONSULTATION & COACHING DECISION SUPPORT DATA SYSTEMS INTEGRATED & COMPENSATORY FACILITATIVE ADMINISTRATIVE SUPPORTS PRESERVICE TRAINING RECRUITMENT AND SELECTION SYSTEMS INTERVENTIONS

  23. Integrated & Compensatory OUTCOMES (% of Participants who Demonstrate Knowledge, Demonstrate new Skills in a Training Setting, and Use new Skills in the Classroom) TRAINING COMPONENTS Knowledge Skill Demonstration Use in the Classroom Theory and Discussion 10% 5% 0% ..+Demonstration in Training 30% 20% 0% …+ Practice & Feedback in Training 60% 60% 5% …+ Coaching in Classroom 95% 95% 95% Joyce and Showers, 2002

  24. Sustainable Benefits • Choosing an innovation • Implementation drivers • Implementation stages • Implementation teams • System improvement

  25. 2 – 4 Years Stages of Implementation Implementation occurs in stages: • Exploration • Installation • Initial Implementation • Full Implementation • Innovation • Sustainability Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

  26. Implementation Outcomes 2 – 4 Years Intervention Outcomes 0% 100% Stages of Implementation Implementation occurs in stages: • Exploration • Installation • Initial Implementation • Full Implementation • Innovation • Sustainability Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

  27. Sustainable Benefits • Choosing an innovation • Implementation drivers • Implementation stages • Implementation teams • System improvement

  28. Implementation • Letting it happen • Recipients are accountable • Helping it happen • Recipients are accountable • Making it happen • Purposeful use of implementation practices and science • Implementation teams are accountable Based on Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004

  29. Implementation Team • A group that knows the innovation very well (formal and craft knowledge) • A group that knows how to implement that innovation with fidelity and good effect • A group that accumulates data & experiential knowledge -- more effective and efficient over time (information economics, K. Arrow)

  30. Implementation Team Teachers & Staff • School • Management (leadership, policy) • Administration (HR, structure) • Supervision (nature, content) District State and Community Context Simultaneous, Multi-Level Interventions Implementation Team

  31. Implementation Team Prepare schools faculty, staff Prepare Communities Implementation Team Prepare Districts Work with Researchers Assure Implementation Assure Student Benefits

  32. Sustainable Benefits • Choosing an innovation • Implementation drivers • Implementation stages • Implementation teams • System improvement

  33. A Sobering Observation "All organizations [and systems] are designed, intentionally or unwittingly, to achieve precisely the results they get."R. Spencer Darling Business Expert

  34. System Change To scale up interventions we must first scale up implementation capacity Building implementation capacity is essential to maximizing the use of EBPs and other innovations Large scale, real time change

  35. System Change

  36. Policy Enabled Practice (PEP) System Change Practice Informed Policy (PIP) State Transformation Team (STT) Implementation Team #1 (Up to 50 Schools) Management Group

  37. System Change • Transformation Zones • Focus on one thing – do it well • Amend the usual rules • Establish the first operating example of an innovation & system change • Manage change, reduce risks • A zone may be a region, a school, a part of a system • Depends on where you choose to start

  38. Transformation Zone Management Group and Practice Group meet monthly in order to bring about system change (urgent, real time) The first Implementation Team begins the implementation process in 5 – 10 schools (Transformation Zone) Repeat the process in subsequent sets of 5 – 10 schools CAPACITY DEVELOPMENT GOAL: Maximize opportunities for Implementation Team members to learn

  39. Implementation Cost

  40. Systems Change Implementation Teams Federal Departments State Department Districts ALIGNMENT Schools Teachers/ Staff Effective Practices FORM SUPPORTS FUNCTION

  41. Scale Up Website New OSEP Center (Fixsen, Blase, Horner, Sugai) State Implementation and Scaling up of Evidence-based Practices (SISEP) www.scalingup.org

  42. Thank You We thank the following for their support • Annie E. Casey Foundation (EBPs and cultural competence) • William T. Grant Foundation (implementation literature review) • Substance Abuse and Mental Health Services Administration (implementation strategies grants; NREPP reviews; SOC analyses of implementation; national implementation awards) • Centers for Disease Control & Prevention (implementation research contract) • National Institute of Mental Health (research and training grants) • Juvenile Justice and Delinquency Prevention (program development and evaluation grants • Agency for Children and Families (child welfare leadership development contract) • Office of Special Education Programs (implementation capacity development center contract)

  43. Dean L. Fixsen 813-974-4446 dfixsen@fmhi.usf.edu Karen A. Blase 813-974-4463 kblase@fmhi.usf.edu For More Information National Implementation Research Network At the Louis de la Parte Florida Mental Health Institute University of South Florida http://nirn.fmhi.usf.edu

  44. 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://nirn.fmhi.usf.edu/resources/publications/Monograph/index.cfm Implementation Research: A Synthesis of the Literature

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