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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
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
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;
high school education
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
research to practice

PRACTICE

RESEARCH

IMPLEMENTATION

Improved Student Outcomes

Improved Education Systems

Research to Practice

GAP

in theory there is no difference between theory and practice in practice there is
“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

research to practice6
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.
teaching family model
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

implementation reviews
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)

insufficient methods
Insufficient Methods
  • Implementation What Works Clearinghouse
    • Pretty small
  • Implementation What Does Not Work Clearinghouse
    • Very large
insufficient methods10
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.
insufficient methods11
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

what works
What Works

Effective intervention practices

+

Effective implementation practices

=

Good outcomes for students

implement innovations
Implement Innovations

IMPLEMENTATION

Effective

NOT Effective

Student Benefits

Effective

INTERVENTION

NOT Effective

implementation
Implementation
  • An effective intervention is one thing
  • Implementation of an effective intervention is a very different thing
implementation15
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

sustainable benefits goal
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?

sustainable benefits what
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
sustainable benefits how
Sustainable Benefits: How
  • Choosing an innovation
  • Implementation drivers
  • Implementation stages
  • Implementation teams
  • System improvement
choosing an innovation
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)
sustainable benefits
Sustainable Benefits
  • Choosing an innovation
  • Implementation drivers
  • Implementation stages
  • Implementation teams
  • System improvement
implementation drivers
Implementation Drivers

Reliably produce

predictable outcomes

for students, families,

and communities

implementation drivers22
Implementation Drivers

STAFF PERFORMANCE

EVALUATION

CONSULTATION & COACHING

DECISION SUPPORT DATA SYSTEMS

INTEGRATED & COMPENSATORY

FACILITATIVE ADMINISTRATIVE SUPPORTS

PRESERVICE TRAINING

RECRUITMENT AND SELECTION

SYSTEMS

INTERVENTIONS

slide23

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

sustainable benefits24
Sustainable Benefits
  • Choosing an innovation
  • Implementation drivers
  • Implementation stages
  • Implementation teams
  • System improvement
stages of implementation

2 – 4 Years

Stages of Implementation

Implementation occurs in stages:

  • Exploration
  • Installation
  • Initial Implementation
  • Full Implementation
  • Innovation
  • Sustainability

Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

stages of implementation26

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

sustainable benefits27
Sustainable Benefits
  • Choosing an innovation
  • Implementation drivers
  • Implementation stages
  • Implementation teams
  • System improvement
implementation28
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

implementation team
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)
implementation team30
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

implementation team31
Implementation Team

Prepare schools faculty, staff

Prepare Communities

Implementation Team

Prepare Districts

Work with Researchers

Assure Implementation

Assure Student Benefits

sustainable benefits32
Sustainable Benefits
  • Choosing an innovation
  • Implementation drivers
  • Implementation stages
  • Implementation teams
  • System improvement
a sobering observation
A Sobering Observation

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

Business Expert

system change
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

slide36

Policy Enabled Practice (PEP)

System Change

Practice Informed Policy (PIP)

State Transformation Team (STT)

Implementation Team #1

(Up to 50 Schools)

Management Group

system change37
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
transformation zone
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

systems change
Systems Change

Implementation Teams

Federal Departments

State Department

Districts

ALIGNMENT

Schools

Teachers/ Staff

Effective Practices

FORM SUPPORTS FUNCTION

scale up website
Scale Up Website

New OSEP Center (Fixsen, Blase, Horner, Sugai)

State Implementation and Scaling up of Evidence-based Practices (SISEP)

www.scalingup.org

thank you
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)
for more information
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

for more information44
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