7/8/2014. Purpose. Active Implementation Frameworks. Cross Cutting Themes. Introduction and Overview (Darren s slides)

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1 Strategies for Implementing Evidence Based s for Transitional Aged Youth, Adolescents, Children and Families Affected by Substance Use and Co Occurring Mental Health Disorders DISCUSSANT: Darren Fulmore, Ph.D., SAMHSA CSAT Faculty: Oscar Fleming, Investigator/ Specialist, National Research Network SAT ED Awardee: MIchelle Kilgore MA, CADC Adolescent Substance Abuse Program Administrator Division of Behavioral Health PPW Grantee: Sylvia Barnard, Program Director, Good Samaritan Shelter Introduction and Overview (Darren s slides) ive Frameworks Improving Results through ive Oscar Fleming, Investigator/ Specialist, National Research Network Purpose Provide a brief overview of the ive Frameworks and their use to achieve improved program outcomes Agenda: Why Applied Science? What are the ive Frameworks? Discussion/ivity Cross Cutting Themes science can inform the entire spectrum of program activities Why Focus on? Children, youth, young adults and families cannot benefit from interventions they do not experience. is not linear (though some graphics are) The work is complex and adaptive RESEARCH IMPLEMENTATION PRACTICE is defined as a specified set of activities designed to put into practice an activity or program of known dimensions. 1

2 Formula for Success Cascading Accountabilities Children, adolescents, youth, young adults, and families live and thrive in healthy communities Intervention Outcomes! Effective Interventions Effective Enabling Contexts Served by a competent public health workforce providing high quality services Supported by organizational management & leadership to learn, improve and sustain effective programs Outcomes Socially Significant Outcomes Supported by state public health leadership shaping the system to support and sustain enabling contexts Supported by SAMSHA and other federal resources, technical assistance and conducive policy. ive Frameworks Effective interventions: The What Clear Description Clear description of the program Philosophy, values, principles (guidance) Inclusion exclusion criteria (beneficiaries) Performance Assessment Essential Functions Clear essential functions that define the program (core components) Operational Definitions Operational definitions of essential functions (practice profiles; do, say) Practical performance assessment Highly correlated with desired outcomes Making It Happen Effective : The How Stages Stage-related work necessary for successful change result in competence and sustainability Exploration Installation Initial Full Improvement cycles support learning and change at multiple levels 2

3 The Hexagon An EBP Exploration Tool The Hexagon can be used as a planning tool to evaluate evidence based programs and practices during the Exploration Stage of. wnload available at: and resources EBP: Capacity to Implement Staff meet minimum qualifications Able to sustain Imp Financially Structurally Buy in process operationalized Practitioners Families Need in agency, locality, state Mental health & other socially significant Issues Parent & community perceptions of need Data indicating need NEED CAPACITY FIT Fit with current Initiatives Local, organizational, regional, state priorities Organizational structures Community values Careful Assessment and Selection Effective, Usable Interventions What are the needs of children, youth, young adults, families in your service area? What interventions are available to address those needs? What is the strength of the evidence of those interventions? 5 Point Rating Scale: High = 5; Medium = 3; Low = 1. Midpoints can be used and scored as a 2 or 4. High Med Low Need Fit Resource Availability Evidence Readiness for Replication Capacity to Implement Readiness for Replication Qualified purveyor Expert or TA available Mature sites to observe Several replications How well is it operationalized? Are Imp operationalized? READINESS EVIDENCE Evidence Outcomes Is it worth it? Fidelity data Cost effectiveness data Number of studies Population similarities Diverse cultural groups Efficacy or Effectiveness RESOURCES Resources and supports for: Program/service Materials Technology supports (IT dept.) Staffing Training Data Systems Coaching & Supervision Administration & system Which interventions are a good fit for local communities? providers have what is required to fully and effectively implement these strategies? Are there usable intervention criteria? Total Score National Research Network Adapted from work by Laurel J. Kiser, Michelle Zabel, Albert A. Zachik, and Joan Smith at the University of Maryland Check In Who is accountable for implementation in your organization? How does this resonate with your experience? Have you been attentive to fit of intervention with population needs? Organizational needs? : Infrastructure Selection Training Consistent Uses of Innovations Coaching Performance Assessment (Fidelity) Integrated & Integrated Compensatory & Compensatory Technical Reliable Benefits Leadership Systems Intervention Adaptive Facilitative Administration Decision Support Data System Organizational : Enabling Contexts Putting it Together: Stages & Existing System Existing System Is Changed To Support The Effectiveness Of The Innovation Exploration Installation Initial Full Effective Innovations Are Changed to Assess needs Examine intervention components Consider Assess fit Acquire Resources Prepare Organization Prepare Prepare staff Strengthen Manage change ivate Data Systems Initiate Improvement Cycles Monitor & manage Achieve and improve Fidelity and Outcomes Fit The System Effective Innovation 2-4 Years 3

4 Rapid cycle (PDSA) problem solving Shewhart (1931); Deming (1986) Usability testing Rubin (1994); Nielsen (2000) -policy communication loop Fixsen, Blase, Metz, & Van Dyke (2013) - Communication Cycle External Support Enables Informs Structure Procedure ive Frameworks: The Who s with specific competencies make it happen Minimum of three people (four or more preferred) with expertise in: Innovations Organization change Making It Happen Why s? Letting it happen Diffusion; networking; communication Helping it happen Dissemination; manuals; websites Making it happen Purposeful and proactive use of implementation practice and science Based on Hall & Hord (1987); Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou (2004); Fixsen, Blase, Duda, Naoom, & Van Dyke (2010) s Simultaneous, Multi-Level Interventions Practitioner/Staff Competence Organization Supports Management (leadership, policy) Administration (HR, structure) Supervision (nature, content) State Public Health Leadership Federal and National Supports 4

5 Linked s - Example Site/Local District Regional State Putting it Together: Communication Loops and s External Support Enables Informs Structure Procedure Discussion: Next Steps Think individually of an opportunity(s) in your context where you could apply implementation tools. What s needed? What can you do? (2 min.) For More Information Oscar Fleming, MSPH oscar.fleming@unc.edu Find a partner and share your ideas. Discuss: What support will you need? What allies do you have? Where you might find additional resources? (7 min) You cannot cross the sea merely by standing and staring at it. R. Tagore Frank Porter Graham Child Development Institute University of North Carolina Chapel Hill, NC Science Research: A Synthesis of the Literature Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Research Network (FMHI Publication #231). Copyright Dean Fixsen and Karen Blase This content is licensed under Creative Commons license CC BY- NC-ND, Attribution-NonCommercial-NoDerivs. You are free to share, copy, distribute and transmit the work under the following conditions: Attribution You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work); Noncommercial You may not use this work for commercial purposes; No Derivative Works You may not alter or transform this work. Any of the above conditions can be waived if you get permission from the copyright holder. 5