Implementation Components That Are Integrated and Compensatory

 
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Implementing evidence-based programs and interventions requires systematic attention to changing the behavior of adult professionals; whether they are agency heads, project directors, supervisors, teachers, practitioners, clinicians, or other front line staff. It takes significant effort and a systematic approach to ensure that adult professionals learn, adopt, adapt, and sustain effective ways of doing.

In addition to changing the behavior of individuals, implementation also requires changing the behavior of systems. Policies, funding streams, workforce development, education systems, provider organizations, and advocacy organizations all have a role to play in either facilitating the adoption of evidence-based programs and practices or creating barriers to innovation and practice change.

An infrastructure is needed to support and sustain such changes. The infrastructure, referred to as the Active Implementation Drivers, includes developing staff competencies, creating hospitable organization environments, and assuring engaged leadership.  These implementation components must all be focused on the implementation of the program or practice and must connect to one another and the program or practice in a logical way.

The Active Implementation Drivers represent a dynamic and interactive set of variables that need to be understood during the Exploration Stage and then used as the program is installed, fully implemented, improved, and sustained over time.  To be effective, the Implementation Drivers are integrated and can be compensatory. They should be integrated so that there is internal consistency among selection variables, skills training, coaching, staff evaluation, etc. This means that selection procedures focus on skills and attitudes that will be needed but cannot be easily trained. And training and coaching go hand in hand as this integrated approach avoids the all too common “spray and pray” training. Staff performance assessment relates directly to what has been taught and coached. Integration means having the implementation components work together to produce high fidelity practitioner behavior and consistently good results for consumers.

The Implementation Drivers also can be compensatory. That is, if a particular Implementation Driver is weak (e.g. training) the rest of the components can compensate by being particularly strong, precise, and integrated. For example, if an agency has limited training resources, they may need to be highly selective in choosing staff that already have many of the actual skills needed. Then the program or agency can use frequent coaching along with staff performance assessments to further ensure that the procedures or programs are operated with fidelity. Or if training and coaching are very strong, then the selection ‘door’ may be open wider to a more diverse workforce with a broader range of minimum skill sets. However, this compensatory quality likely can only take a program so far. While there may be exceptions, it is unlikely that any implementation driver can be at ‘zero’. After all, zero times any number is zero! And the resulting fidelity of the implementation effort will reflect this result.

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