Full Implementation

Full implementation of an innovation can occur once the new learning becomes integrated into practitioner, organizational, and community practices, policies, and procedures. At this point, the implemented program becomes fully operational with full staffing complements, full client loads, and all of the realities of “doing business” impinging on the newly implemented evidence-based program. Once an implemented program is fully operational, referrals are flowing according to the agreed upon inclusion/exclusion criteria, practitioners carry out the evidence-based practice or program with proficiency and skill, managers and administrators support and facilitate the new practices, and the community has adapted to the presence of the innovation.

Over time, the innovation becomes “accepted practice” and a new operationalization of “treatment as usual” takes its place in the community (e.g., Faggin, 1985). The anticipated benefits should be realized at this point as the new evidence-based program staff members become skillful and the procedures and processes become routinized. Once fidelity measures are above criterion levels most of the time, the effectiveness of the fully operational evidence-based program implementation site should approximate the effectiveness of the original evidence-based program.

After the intensity of establishing a fully implemented evidence-based program implementation in a new community (often requiring 2 to 4 years), the implementation site needs to be sustained and improved in subsequent years.

Skilled practitioners and other well trained staff leave and must be replaced with other skilled practitioners and well-trained staff. Leaders, funding streams, and program requirements change. New social problems arise; partners come and go. External systems change with some frequency, political alliances are only temporary, and champions move on to other causes.

Through it all the implementation site leaders and staff, together with the community, must be aware of the shifting ecology of influence factors and adjust without losing the functional components of the evidence-based program or dying due to a lack of essential financial and political support.