Improving Systems, Practices, and Outcomes

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Stages of Implementation

The Stages of Implementation lay out the necessary steps, stage-by-stage, for full implementation of evidence-based practices, scaling-up practices, and sustaining the effort. Below are the activities in each stage organized by the essential support structures, with links to some associated tools and materials.

Stage 1: Exploration and Planning

The goals of this stage are to identify the need for change, determine what set of practices are likely to meet that need, decide whether to move ahead with the implementation process, and if so, map out a plan for the work. A State Leadership Team (SLT), supported by the State Coordinator, guides this and all other stages of implementation.

Activities by Essential Support Structures

Exploration activities by the SLT determine if there is a need to implement selected evidence-based practices, and which practices are most likely to result in the desired outcome(s).

Planning activities lay the groundwork for successful implementation of the evidence-based practices. This involves determining whether there is widespread commitment to implement the practices, and if the necessary resources are available for implement the selected practices effectively.

Exploration

  • The SLT is a group formed to review if there is a need to implement a new approach to improve outcomes and, if so, what the professional development implications are. This group:
    • determines whether there is a need for evidence-based practices to improve an outcome such as social emotional outcomes in children
    • determines which evidence-based practices will be implemented based on desired outcomes
  • Data about current outcomes drives the initial exploration

Planning

  • If an application process is used to select the program coaches, the application and scoring rubric is distributed
  • Program coaches are selected and assigned an implementation site

Stage 2: Installation

The goal of this stage is to build system capacity that will support the implementation of the new practices at the selected sites. Building system capacity requires examining and strengthening the system components necessary to assure success.

Activities by Essential Support Structures

Installation activities focus on building infrastructure, the “getting-ready" work: site and staff selection; arranging for training for each group; developing coaching resources, plans and processes; and establishing the infrastructure for data collection and evaluation.

Installation

  • SLT ensures adequate resources (financial and staffing) for:
  • SLT establishes a statewide PDN by:
    • recruiting 12-20 professionals willing to commit for a minimum of 2 years
    • selecting professionals who will participate in all aspects of training
    • providing initial training
    • documenting and evaluating the PDN program coaches’ training
  • SLT selects implementation sites and provides for the training of staff and PLT by the PDN:
    • craft Memorandums of Understanding (MOU) with all programs and program coaches to outline: responsibilities, expectations, data requirements, and supports provided
  • PDN establishes procedures for managing activities and reporting back to the SLT
  • PDN and SLT consider the expertise of the program coaches when determining assignments for:
    • training of practitioner coaches
    • technical assistance
    • program coaching for implementation and demonstration sites
  • PDN program coaches participate in training
  • Data are collected and used for making decisions both by the SLT and programs

Stage 3: Implementation: Initial to Full

The goal of initial implementation is to put the new practices in place at selected implementation sites. Site-level Program Leadership Teams (PLTs) guide the implementation process, review data, make decisions, and provide feedback to the SLT on successes and challenges.

The goals of full implementation are to assure high fidelity implementation of practices and achievement of expected outcomes at all initial sites. With a focus on both fidelity and sustainability, all professional development and organizational structures are fully functioning and working together to support practitioners.

Activities by Essential Support Structures

Initial implementation activities include: establishing feedback loops between the SLT and implementation sites; beginning training and coaching at the sites; establishing the site-level PLT; and, collecting data and using it to measure progress and make decisions.

Full implementation activities include: selecting demonstration sites from the initial implementation sites that have reached fidelity on implementation of the practices; building statewide capacity for new and continuing implementation sites; continuing the collection and use of data at all levels for making decisions, targeting assistance, and building public awareness.

Initial Implementation

  • SLT establishes communication links or feedback loops to ensure they are getting the information needed to address challenges and barriers and to provide the T/TA the sites need
  • SLT oversees the work of the PDN
  • PDN provides training and coaching to:
    • program leadership teams
    • practitioner coaches
    • practitioners
  • PDN provides coaching to support implementation site’s initial implementation
  • Sites establish a Program Leadership Team (PLT)
  • Sites participate in training
  • Sites begin implementation of the evidence-based practices and data collection
  • PLT meet at least monthly with the program coach to:
    • use the Program Benchmarks of Quality (classroom / home-visiting) to guide their efforts
    • use data for internal decision making
    • share data with SLT
    • set up data systems for measuring fidelity of practice by practitioners (classroom / home-visiting) and child outcomes
  • Site practitioner coaches are selected and trained in practice-based coaching
  • Data are collected by SLT and used for:
    • making decisions
    • targeting assistance
    • building public awareness
  • Programs use data from the Program Benchmarks of Quality to plan and measure their progress on practice fidelity and data on child outcomes
  • PLT makes plans for reporting to SLT

Full Implementation

  • SLT selects 3-4 implementation sites to serve as demonstration sites. The additional criteria for demonstration sites includes:
    • reaching fidelity on the Program Benchmarks of Quality and on practitioner implementation of the practices
    • willingness to provide: feedback, data, tours, and public awareness
  • SLT plans for scale-up by building statewide capacity (funding, staffing) for supporting new implementation sites while supporting the high-fidelity implementation at demonstration sites
  • SLT uses data for making decisions
  • SLT oversees the work of the PDN
  • PDN provides recognition and support to potential demonstration sites evidencing high-fidelity implementation
  • PDN actively help to:
    • build statewide capacity
    • develop fidelity implementation in sites
  • PDN expands awareness of the use of evidence-based practices
  • Sites continue to provide data and feedback to PDN and SLT
  • Sites determine whether to become a demonstration site
  • Sites use the BoQ to guide all work; and assessing twice a year
  • News release is issued about the new demonstration sites
  • Sites provide tours and descriptions of program efforts for prospective implementers to show process and benefits
  • Sites provide data and feedback to PDN and SLT
  • Sites ensure that PLT has written sustainability plan
  • Sites use the BoQ to guide all work; assessing twice a year
  • Data are collected and used for:
    • making decisions
    • targeting assistance
    • building public awareness

Stage 4: Scale Up

The goals of this stage are to increase the number of sites using the selected practices with fidelity, while maintaining the existing implementation sites. By increasing the number of sites across the state, more children and their families will have access to effective interventions and supports.

Activities by Essential Support Structures

Scale-up activities focus on taking the initiative statewide. The SLT will plan for and provide the infrastructure needed to support new implementation sites, and maintain and support existing sites. All aspects of the initiative are affected by scaling-up in terms of needed resources.

Scale Up

  • SLT has written sustainability and scale-up plans including budgeting and resource allocations
  • SLT institutionalizes and embed evidence-based practices within state initiatives such as Quality Rating Systems and Early Learning Guidelines
  • SLT establishes criteria and procedures for site selection of new implementation sites and PDN
  • SLT creates a website, newsletter, or other means to:
    • report on the outcomes of high-fidelity implementation
    • raise interest and commitment from programs, policy makers, funders, and other stakeholders
  • SLT prepares an annual evaluation report describing:
    • extent of adoption, implementation, and scale-up
    • impact on child, provider, and program outcomes
    • impact of training and coaching
  • SLT organizes annual public celebration of outcomes; accomplishments; and work of high-fidelity programs, PDN staff, and funders
  • SLT oversees the work of the PDN
  • With each expansion effort, the SLT must revisit the stages of implementation. This means:
    • a return to planning for the scale-up effort
    • installation: get everyone trained, organizations on board, and materials developed or purchased for the new sites
    • extra support at new sites during initial implementation and ongoing monitoring and support until full implementation is reached
    • sustaining support to existing implementation sites to ensure the maintenance of high-fidelity implementation
  • PDN supports attrition and expansion plans for PDN
  • PDN expands training and coaching to new sites
  • SLT and program coaches continue to provide support and communication with all implementation sites to ensure continued fidelity of implementation and positive child outcomes. If needed, additional training and support is provided to bring a program to fidelity
  • Sites continue to train staff and advocate for expansion of evidence-based practices use
  • Sites continue tours and data collection and reporting to SLT
  • Use evaluation report for progress monitoring and planning and the public reporting of outcomes, e.g., annual reports

Learn More

The stages above show how to use a specific implementation process, but to learn more about implementation in general, see ECTA Center's Guide to the Implementation Process: Stages, Steps and Activities. This interactive module takes a comprehensive look at implementation science.

You may also gain insights from this video of MN’s experience in implementing evidence based practices (EBPs) statewide:


Tools

See: Tools