Using Evidence-Based Constructs to Assess Extent of Implementation of Evidence-Based Interventions. Developing Competence: How do practitioners progress from nonusers to expert users?


Another set of implementation milestones describes practitioners’ increasing competence in using an intervention. Studies conducted from the practitioners’ perspective suggest that developing the knowledge and skill to implement an intervention effectively requires time and experience (Bellg et al., 2004; Durlak & DuPre, 2008). As practitioners approach and move across the bridge, different levels of expertise can be described:

Nonuser—Is not engaged in using the change and is using the “old” way. (In other words, is not on the bridge.)

Novice—Is applying the change but struggling to use all pieces in effective ways. (Is on the bridge.)

Expert—Has mastered the complexity and understands everything entailed in full use. (Is across the bridge.)

Change process researchers have identified eight unique behavioral profiles, called “Levels of Use” (LoUs), which include three behavioral profiles of nonusers and five profiles of users (Hall & Hord, 2015). Each of these profiles describes a different level of understanding and degree of skill in using (or not using) an intervention. The LoUs range from the nonuser, who knows nothing and is taking no action to learn about an intervention (LoU 0, Nonuse), to the novice, whose use is inefficient and disjointed (LoU III, Mechanical Use), to the skilled expert who makes deliberate efforts to coordinate with others in using the intervention (LoU V, Integration).

LoUs can be used to identify several important implementation milestones and to ensure that progress continues toward full implementation and sustainability. For example, one very important milestone is LoU III Mechanical Use, in which practitioners have begun to implement certain practices but their use is disjointed, inefficient, and incomplete. During this phase, practitioners might plan lessons 1 day in advance, follow the user’s manual very closely, and possibly be uncomfortable with the technology involved in the program.

These stages have important implications for training and technical assistance (TTA) providers, administrators, and evaluators. In the LoU III Mechanical Use stage, the TTA should focus on “how to do it,” not on philosophy or theory. Administrators should plan problem-solving meetings with staff to understand the challenges being encountered. Evaluators should be documenting the extent and duration of this stage and what facilitates progress.

View full report


"ib_Milestones.pdf" (pdf, 421.66Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®