Sunday, December 14, 2008

Questions to Ask When Designing and Implementing a Change or New Program

This document is meant to be used to help frame an initial conversation when planning to adopt a new practice or develop a new program. The implementation driver framework allows the opportunity to choose the direction of your system change efforts in a planful and purposeful manner and in doing so be good stewards of limited resources. This document is not intended for use as a performance indicator but rather as a planning guide. The National Implementation Research Network (NIRN) is working on a tool that will facilitate an in-depth performance analysis of implementation and sustainability throughout the life of a new practice/program. These 7 implementation drivers are integrated and compensatory. Thus, a discussion of the components could start with any one.

IMPORTANT: Before you begin, identify who the “participant” is. There may be a single participant that will be involved with implementation or there may be multiple types or levels of participants that you will take into consideration as you are having this initial planning conversation.

Participant Selection:

• Who is qualified to carry out this practice or program?
• What methods of participant recruitment and selection are you going to use?
• Beyond academic qualifications or experience factors, what personal characteristics must be a part of the selection process (e.g., knowledge of the field, common sense, social justice, ethics, willingness to learn, willingness to intervene, good judgment, etc.)?
• How will these personal characteristics be assessed during the selection interview (e.g. vignettes, role plays)?
• Are there workforce development issues that need to be taken into account? (e.g., availability of participants; ability to recruit new participants; ability to train existing participants; ability to “grow your own” staff; etc.)
• Are there extra demands on the participants beyond the scope of this practice/program that need to be taken into account? (e.g., transportation issues to and from work; family/personal stressors; safety concerns; etc.)

Pre-service and In-service Training:
• How will you assure that background information, theory, philosophy and values of this new practice/program are provided? Who will you provide this information to?
• Do you have a formal introduction to the key components and rationales of this practice/program? Who will you provide this introduction to?
• How will you provide opportunities for participants to practice new skills and receive ongoing feedback in a safe environment?

• How will you use coaching and consultation to support and monitor behavior change:
o at the participant level?
o at the supervisory level?
o at the administrative support level?
• How will you maintain this coaching and consultation throughout the life of this practice/program?

Participant Evaluation: (Formal and Informal)
• How will your participant evaluation process assess the use and outcomes of the skills:
o that you determined were important in your selection criteria?
o that are taught in training?
o that you want to have reinforced and expanded through consultation and coaching?
o in order to assist with determining the effectiveness of the coaches and consultants?
• Are there existing fidelity tools that can be used to evaluate the above skills and/or effectiveness?

Decision Support Data Systems:

• What data will be used by the coaches and supervisors to determine the progress of practice/program implementation efforts (including the information from the participant evaluation)?
• How will data be used by the coaches and supervisors to determine the usefulness of the training and coaching?
• Is there an overall assessment of the agency/organization’s performance to help assure continuing implementation and outcomes of the core components of this practice/program over time?

Facilitative Administration:

• Who provides the strong leadership for this practice/program (internal and external to your agency/organization)?
• Who provides strong leadership as a “connector” to external systems?
• How will the leadership use data to inform their decisions and support the overall processes of this practice/program?
• How will the leadership work to integrate and keep improving the implementation drivers throughout the life of this practice/program?

Systems Interventions:

• In order to support the implementation and sustainability efforts, what strategies are in place or will need to be created for the practice/program to work with external systems in order to obtain:
o financial support?
o agency/organizational support?
o human resource support?

This instrument was adapted from a tool developed by the Kentucky Division of Mental Health and Substance Abuse.

I went to a presentation by staff from the Kentucky Division of Mental Health and Substance Abuse and they were so excited. Using this tool and others they tailored to different components of their program resulted in greater success in the implementation of their programs and greater sustainability - which is one of my favorite topics. Cassandra at

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