Implementation Research: A Synthesis - USF

Implementation

Research:

A Synthesis

of the

Literature

Dean L. Fixsen Sandra F. Naoom Karen A. Blase Robert M. Friedman Frances Wallace

Dean L. Fixsen Sandra F. Naoom Karen A. Blase Robert M. Friedman Frances Wallace

Tampa, Florida 2005

Acknowledgments

We want to thank the William T. Grant Foundation for funding this project (Grant Number 2487, Synthesizing EvidenceBased Program Dissemination and Implementation, to Dean Fixsen, Karen Blase, and Robert Friedman). We appreciate the patient instruction in search techniques and sources provided by Ardis Hanson who heads the library at the Louis de la Parte Florida Mental Health Institute. We are grateful to Michael Haines, Beverly Crockett, and Yvonne Frazier for their diligence in helping to review articles and write cogent summaries. We are indebted to Jonathan Baron, Barbara Burns, William Carter, Patrick Kanary, Robert Paulson, Sonja Schoenwald, and Phillip Strain for their thoughtful and encouraging comments on earlier drafts of this monograph. We also appreciate what we have learned from the many discussions about implementation with Melanie Barwick, David Chambers, Vijay Ganju, Mario Hernandez, Sharon Hodges, John Petrila, Jeanne Rivard, David Shern, Greg Teague, and Jim Wotring who have patiently shared their wisdom. Finally, we want to thank Cindy Liberton, Dawn Khalil and Storie Miller for editing and preparing the document for distribution.

This publication was produced by the National Implementation Research Network at the Louis de la Parte Florida Mental Health Institute,

University of South Florida with financial support from the William T. Grant Foundation (Synthesizing Evidence-Based Program Dissemination and Implementation,

grant #2487).

The opinions expressed in this publication are those of the authors and do not necessarily reflect those of the William T. Grant Foundation.

? 2005 Louis de la Parte Florida Mental Health Institute Publication #231

Tampa, Florida

Recommended citation:

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

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Implementation Research: A Synthesis of the Literature

Contents

Chapter 1 Introduction ................................................................................................................... 1 Review Methods .............................................................................................................3 An Implementation Headset ...........................................................................................4 Implementation Defined ................................................................................................5 Degrees of Implementation.............................................................................................6

Chapter 2 Implementation in the Context of Community................................................................. 7 Research on Community Context...................................................................................8 Measuring Readiness.......................................................................................................9

Chapter 3 A Conceptual View of Implementation............................................................................11 Conceptual Framework.................................................................................................12 Purveyors ......................................................................................................................14 Stages of Implementation Defined ................................................................................15 Exploration and Adoption .....................................................................................15 Program Installation ..............................................................................................16 Initial Implementation ..........................................................................................16 Full Operation.......................................................................................................16 Innovation .............................................................................................................17 Sustainability .........................................................................................................17 What We Know about Implementation Stages..............................................................18 Stages of Implementation and the Literature .........................................................18 Research on Stages of Implementation...................................................................18 Experimental Analyses of Implementation Strategies.....................................................20 Experimental Research: Ineffective Implementation Strategies ...............................20 Experimental Research: Effective Implementation Strategies..................................21

Chapter 4 Core Implementation Components .................................................................................23 Core Components Defined...........................................................................................24 Core Components for Interventions .............................................................................24 Evidence-Based Practices and Evidence-Based Programs .......................................26 Implementing Practices within Organizations .......................................................27 Core Components for Implementation.........................................................................28 Overview and Definitions......................................................................................28 Sources of Core Implementation Components ......................................................31 Developing Self-Sustaining Implementation Sites .........................................................32 National Implementation Efforts ..................................................................................34

Chapter 5 Research on Core Implementation Components ..............................................................35 Staff Selection ...............................................................................................................36 Experimental Research on Selection ......................................................................36 Practitioner Selection: Additional Evidence ...........................................................37 Organization Staff Selection: Additional Evidence .................................................38 Purveyor Staff Selection: Additional Evidence........................................................39 Staff Selection Summary........................................................................................39

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Implementation Research: A Synthesis of the Literature

Staff Training ................................................................................................................39 Factors that Impact Training..................................................................................40 Experimental Research on Training Outcomes ......................................................40 Experimental Research on Training Methods.........................................................41 Training Practitioners: Additional Evidence ...........................................................41 Training Organizational Staff: Additional Evidence ...............................................43 Staff Training Summary .........................................................................................43

Staff Coaching ..............................................................................................................44 Factors that Impact Coaching................................................................................45 Experimental Research on Coaching .....................................................................46 Additional Evidence for Coaching .........................................................................46 Staff Coaching Summary .......................................................................................47

Evaluation and Fidelity .................................................................................................47 Staff Evaluation for Performance Improvement .....................................................48 Organization-Level Fidelity Assessments ...............................................................51 Factors that Impact Staff Evaluation for Performance Improvement ......................53 Experimental Research on Evaluation ....................................................................53 Staff Evaluation for Performance Improvement: Additional Evidence ....................53 Organization-Level Fidelity Assessments: Additional Evidence ..............................54 Staff Evaluation to Measure Adherence to Research Protocols................................54 Evaluation and Fidelity Summary..........................................................................55

Chapter 6 Organizational Context and External Influences..............................................................57 Literature Related to Organizational Components and External Influence ....................60 Influence Factors at Work ......................................................................................62 Organizational Change and Development ....................................................................64 Evaluations of Core Organizational Components ..................................................65 Summary .....................................................................................................................66

Chapter 7 Conclusions and Recommendations................................................................................67 Findings & Conclusions ...............................................................................................70 Implementation and the Status Quo .............................................................................71 Recommendations ........................................................................................................72 Recommendations for State and National Policy Makers .......................................72 Recommendations for Research on Implementation..............................................74 Recommendations for Effectiveness Research on Practices and Programs...............76 Recommendations for Purveyors of Well-defined Practices and Programs..............77

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Implementation Research: A Synthesis of the Literature

Appendices Appendix A Review Methods.......................................................................................80 Appendix B W.T. Grant Project Literature Review Codebook......................................84 Appendix C Experimental Studies ...............................................................................91 Appendix D Hypotheses for Advancing Implementation Science.................................95

References ..................................................................................................................................101

List of Figures

Figure 1 A Conceptual Framework for Implementation of Defined Practices and Programs .......................................................................12

Figure 2 Implementation Framework Applied to Developing Evidence-based Intervention Practices within Organizations. ...............................28

Figure 3 Core Implementation Components ....................................................................29 Figure 4 Implementation Framework Applied to Developing Self-sustaining

Implementation Sites within Organizations in Communities ...............................33 Figure 5 Multilevel Influences on Successful Implementation ............................................59

List of Tables

Table 1 Table 2 Table 3

Table 4 Table 5

A Summary of a Meta-analysis of the Effects of Training and Coaching on Teachers' Implementation in the Classroom .............................30

Examples of Different Types of Fidelity Measures Across Programs ......................49

Postulated Relationships Among Core Implementation Components, Organizational Components, and External Influence Factors that may Help Explain Various Implementation Outcomes .................................59

Factors Deemed to be Critical to the Operation of a Residential Treatment Program......................................................................66

The Interaction of Intervention Effectiveness and Implementation Effectiveness. .......................................................................69

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