Using Evidence-Based Constructs to Assess Extent of Implementation of Evidence-Based Interventions. Supporting Implementation: What supports can help advance progress in implementing interventions?

09/01/2014

Another use of implementation milestones is as diagnostics for determining which supports will advance the implementation of interventions. The idea of “implementation drivers” proposed by Fixsen, Naoom, Blase, Friedman, and Wallace (2005) represents one way to think about actions and processes to support implementation at different levels (organization, local, and state). Their model of support is based on a set of implementation drivers, which have three main areas of focus: (a) drivers that build competence (selection, training, coaching); (b) drivers that support that competence through organizational structures (systems interventions, administrative facilitation, decision support data systems); and (c) leadership drivers (technical drivers such as time, and adaptive drivers like motivation; see http://nirn.fpg.unc.edu/learn-implementation/implementation-drivers).

These drivers can be applied to each level of the system. For example, if state mental health providers are providing multisystemic therapy, they might rely on regional TTA providers, who in turn rely on state agency personnel to offer them the training, guidance, and facilitative policies that help them do their work. Staff at the state, regional, and local levels need appropriate training and coaching and the use of a data system (that can provide an assessment of fidelity, use, and concerns) to help them make decisions about how to change or continue to do their work.

Collecting information about implementation milestones and context supports the diagnostic assessments that identify the implementation supports needed for each level, system, subunit, and individual. In combination, these constructs and perspectives provide a complex yet coherent understanding of what is involved in moving implementation forward.

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