Using Evidence-Based Constructs to Assess Extent of Implementation of Evidence-Based Interventions. Developing Confidence: How do feelings, emotion, and motivation develop as interventions are being implemented?

09/01/2014

Charting feelings and perceptions represents a third way to establish implementation milestones. Change science scholars have identified and described the different concerns that people can have when engaged with a change process; these can be used to chart movement across the Implementation Bridge. Four major categories of concern have been identified (Cheung, Hattie, & Ng, 2001; George, Hall, & Stiegelbauer, 2008; Hall & Hord, 2015; Yan & Huang, 2008):

Unconcerned—At the beginning of a change process, practitioners will not be concerned about an intervention; they will be more concerned about other things. “I think I heard something about it, but I'm too busy right now with other priorities to be concerned about it.”

Self—As practitioners get close to implementation, concerns about what the change could mean for them personally become intense. “I don’t know whether I can do this.”

Task—After implementation has begun, concerns about time, organizing tasks, and fitting everything in become intense. “I have to spend a lot of time preparing to use this tomorrow.”

Impact—Ultimately, as practitioners become more familiar with the intervention, they have more intense concerns about how well the intervention is working for clients and what can be done to produce even better outcomes. “I just heard about this app that might be useful with several clients who don’t seem to be making good progress.”

Different TTA and coaching are needed for each area of concern. For example, consider the resistance often experienced during change processes that can occur at any time. The source of the resistance will vary by concern. For example, Self-Concerns (e.g., “Well, I don’t see how this is better than what I have been doing) can lead to disagreement with engaging the change at all. When overwhelmed by complexities (Task Concerns, e.g., “It takes too much time to get ready and nothing works out as it is supposed to”), the resistance will have a different theme. Table 1 presents examples of different types of concern-based resistance that might occur and some possible resolutions. Understanding the sources of resistance helps inform the development of more targeted solutions.

Table 1. Examples of Resistance and Solutions for Difference Stages of Concern

Concern Source of Resistance Solution
Unconcerned “I don’t think this intervention will last.” Document leadership’s long-term commitment to the intervention.
Self “I don’t know whether I can do this. Will it be worth the effort?” Describe the supports that will be provided and the benefits to be gained.
Task “This is taking too much time away from what’s important.” Provide how-to-do-it TTA; simplify schedules and structures; provide joint planning and problem-solving time for staff.
Impact “This new way is terrific, but it’s not working for certain populations.” Target TTA and coaching to discuss how the intervention can reach these populations.

 

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