The School of Nursing and Midwifery

1. The School of Nursing and Midwifery Rapid Assessment & Response & Implementation Science • Professor Catherine Comiskey

2. Rapid Assessment and Response • “Rapid assessment and response (RAR) is a way of making a comprehensive assessment of a specific public health issue. It involves focusing on the characteristics of the health problem, the population groups affected, key settings and contexts, health and risk behaviour and social consequences. It identifies existing resources and opportunities for intervention and helps in planning, developing and implementing interventions and programmes” (WHO, 2004, p.3)

3. RAR • Practical public health tool: investigate problems in areas in which policymakers, planners, and practitioners need to make decisions in contexts of limited resources. Where conventional social science and public health assessment methods are inappropriate (Stimson et al. 2006) • Used in fields as diverse as substance use, nutrition, reproductive health, water hygiene, environmental disasters, and HIV/AIDS • Raise awareness of public health problems • Planning, developing, and implementing public health programs and projects

4. RAR • The rapid assessment approach is characterized by speed and the use of multiple methods • E.g. analysis of existing data, key informant interviews, focus groups, observations, mapping, and population estimation and multiple data sources. • Promotes an investigative orientation—involving data triangulation and inductive modes of analysis—and multilevel evaluations of the ways in which health problems are influenced at the individual, community, and structural levels. • The method is designed to ensure that responses are strengthened through community involvement.

5. WHO RAR • WHO RAR guides include information on community participation, capacity building, advocacy, methods of formulating recommendations, and ways to develop and plan interventions • They also include basic information on prevention, harm reduction, and treatment interventions

6. Example: Comiskey, O’Sullivan & Milnes (2011) • Regional Drug User Services in Times of Scarce Financial Resources: Using a Rapid Assessment Response Approach to Evaluate, Plan, and Prioritize Essential Services

7. References • Stimson GV, Fitch C, Rhodes T. The Rapid Assessment and Response Guide on Psychoactive Substance Use and Prevention. Geneva, Switzerland: World Health Organization; 1998. • Stimson, G. V., Fitch, C., Jarlais, D. D., Poznyak, V., Perlis, T., Oppenheimer, E., & Rhodes, T. (2006). Rapid assessment and response studies of injection drug use: knowledge gain, capacity building, and intervention development in a multisite study. American Journal of Public Health, 96(2), 288-295. • Malcolm A. (2004). Rapid assessment and response - World Health Organization.

8. Whatisimplementation? • Burke et al., defines implementation as ‘the carrying out of a plan for doing something. It focuses on operationalising the plan – the How, rather than the What’ (2012, p. 2). • Delivering a specific programme is an example of implementation, e.g. the Healthy School Programme (HSP) which was implemented by Childhood Development Initiative (CDI) (see Comiskey et al., 2012). • The delivery of a programme is a specific set of activities which is aimed bringing positive change into a service or in a community setting (Burke et al., 2012).

9. Policy Implementation • Implementation is not limited to programmes, it also consists of policy implementation • Policy implementation has three stages within a ‘policy cycle’. The three stages are; • Policy design • Policy delivery • Policy review

10. Why does it matter? • There has been enormous effort put into researching innovation however implementation of this innovative knowledge is lacking. • Best practice is informed by knowledge; however this is not sufficient for effective change as it requires effective implementation (Burke et al., 2012). • Knowledge advancement does not seem to impact client outcomes, and this gap between knowledge and outcome is known as the implementation gap.

11. Implementation in Ireland • Implementation in Ireland has been managed successfully in many programmes. Examples of successful implementations include: • Road Safety Policy (2001) • The Early Childhood Care and Education (ECCE) Scheme (2010) • Incredible Years Programme (Burke et al., 2012).

12. Implementation Gap • “the difference between the evidence of what works in theory and what is delivered in practice” (Burke, Morris, & McGarrigle, 2012, p. 2)

13. Stages of Implementation • Developed by Fixsenet al., (2005): • Stage 1 Exploring and Preparing: begins by deciding what innovation to implement. The activities involved at stage one are focused on (i) assessing the needs of people who might be affected by the innovations, (ii) the fit and feasibility, (iii) and the organisation’s capacity or readiness to conduct the implementation. • Stage 2 Planning and resourcing: • At stage two, a clear plan of implementation must be put in place and a team of qualified must be selected to implement the innovation. The plan must consist of a delivery model, outlines of inputs, outputs and outcomes. At this point responsibilities must be assigned and planning resources must begin e.g. securing funding, training staff etc…

14. Stages of Implementation • Stage 3 – Implementing and operationalising • The programme / innovation can be implemented as a pilot before the roll out. Stage three consists of the following: • Providing on-going coaching and assistance to staff • Monitoring on-going implementation • Changing systems / culture, as necessary • Explaining and communicating why the innovation is necessary and what it will look like when implemented. • Creating feedback mechanisms to inform future actions (Burke et al., 2012, p. 8). • Stage 4 – Business as usual • At stage four, the programme is fully operational. It has become part of the organisations culture and is ready to be evaluated. Evaluation is conducted when the main components of the implementation are in place, adequate time and resources have been spent on the programme. Stage four allows people to learn from the implementation process and inform future decisions.

15. Intervention Assessment Tool: Adapted by CES from the Intervention Assessment Tool developed by the National Implementation Research Network, USA, 2009

17. Implementation Barriers • There are three main barriers • external environment (i.e. existing processes may not be in line with the programme), • resistance to change and • vested interests (i.e. the interests of staff members who are directly involved in the implementation process can have a negative effect on the implementation)

18. References • Burke, K., Morris, K., & McGarrigle, L. (2012). An introductory guide to implementation: terms, concepts and frameworks. • Comiskey, C.M., O’Sullivan, K., Quirke, M.B., Wynne, C., Kelly, P., & McGilloway, S. (2012). Evaluation of the Effectiveness of the Childhood Development Initiative’s Healthy Schools Programme. Dublin: Childhood Development Initiative (CDI). • Fixsen, D.L., Naoom, S.F., Blase, K.A, Friedman, R.A. & Wallace, F. (2005) Implementation Research: A Synthesis of the Literature. Tampa, Florida: University of South Florida.

19. Thank YouCatherine.Comiskey@tcd.ie