Implementing for Success
The Implementation drivers and core components required to successfully deliver evidence-based interventions and approaches
Implementation drivers set out the changes that are required by an organisation to introduce new ways of working. In order to do this successfully, it is not just practitioners that have to change their ways and learn to deliver the new intervention; the organisation needs to ensure that robust systems are in place to support the innovation. The components of implementation drivers are, therefore, categorised into organisational drivers and competency drivers. These ensure that the key elements required for the new intervention or practice are in place to support the intervention being delivered with fidelity.
Systems need to be developed and in place well before the introduction of the new programme or practice. This includes the establishment of an implementation team to support and oversee the systems change. To attain strong local support, it is helpful if the implementation team is comprised of members of partnership agencies who are in leadership positions with decision making powers. This allows opportunity for sharing resources, improved communication, interagency working and can quickly resolve any challenges that may arise.
The implementation team should include an Implementation Support Practitioner to co-ordinate staff training and roll out the programme in the locality, as well as identifying those practitioners who can take on a programme Champion role. They also have a role in overseeing the targeting of the programme and ensuring equity. The Implementation Support Practitioner provides liaison between the practitioners delivering the programme and the implementation team and wider organisation. This involves organising regular team meetings with practitioners to support staff to ease any implementation problems that arise. This role is ideal for a skilful practitioner with experience of managing and motivating others.
The development of an implementation framework will set out the processes and desired outcomes for the new programme or practice change and ensure equity to the targeted population group. There also needs to be a dedicated system in place for data collection and analysis to generate reports to allow data driven decision making.
The competency drivers focus on the selection and preparation required to develop a well prepared practitioner, who will be able to deliver the intervention or approach with high levels of fidelity. Selecting the right staff to deliver the programme is one of the core elements in achieving successful implementation.
It is important to consider the practitioner’s capacity to deliver the programme and have this incorporated into their current role. This may mean that practitioners may have to give up an existing duty in order to fully commit to delivering the programme. As well as the time required for training, practitioners will need regular planning and administration time. They will also need ring fenced time for supervision/ coaching and any additional training that will help to build the skills and competence required to ensure they meet the fidelity criteria of the programme.
Helpful characteristics of practitioners
It is essential that appropriately qualified and motivated practitioners with a genuine interest in working with children, young people and families are selected to deliver the intended programme. In addition, practitioners should demonstrate a collaborative, strengths- based approach to engaging and working with children, young people and families. This includes having an ability to engage the individual or family for whom the programme is targeted.
Once practitioners gain experience with the programme, it may be worth considering employing their skills as a Champion. This can help with advertising the programme to encourage referrals and sharing knowledge and expertise with others.
Support for staff
Practitioners will need extensive support from the implementation team, especially at the early stages of the implementation of the programme. As previously noted, this may involve changing the way practitioners work.
Some specific programmes offer implementation support with one of their programme experts to support the implementation team and the practitioners delivering the intervention. There may also be support systems in place such as supervision and coaching models and fidelity assessments and measures. Whilst these may come at an additional cost, it is important that staff have access to these supports which will help them gain confidence, develop expertise and ensure that fidelity does not drift. As well as programme supervision, participants will require on-going support from a manager in their organisation to support them with process issues and practical difficulties that may arise.
Coaching is hugely advantageous to the practitioner on their journey towards skill development. The process may involve observation of the practitioner in action, either directly or via recording sessions to measure their progress. It should be a safe, positive learning experience for the practitioner. Supportive coaching allows the practitioner the opportunity to reflect upon their learning and performance, further enhancing their skills and helps to achieve and maintain fidelity to the programme. The coach / supervisor needs to facilitate problem solving and identify clear learning objectives. It is also helpful that practitioners have the opportunity to attend additional training or network events that complement the programme, for example, training that will develop strength-based communication skills or group work skills.
Practitioners may need access to equipment and technology to participate in fidelity assessments and coaching/ supervision. These should all be considered and identified in the local implementation framework.
The implementation team should be aware of and support practitioners with any challenges that arise during delivery of the programme. This includes a variety of practical difficulties, such as access to venues to deliver the programme or provide resources. The practitioner’s role is to deliver the intervention with confidence and fidelity and the responsibility to ensure this happens smoothly sits with the implementation team.
Support for participants
Starting any intervention intended to bring about change in one’s life can be overwhelming and daunting. This can prove challenging for both the recipient of the intervention and the practitioner looking to support them. This can be especially challenging if the intervention is a group activity. It is important to help participants access an intervention or programme in a way that maintains their autonomy.
Many programmes promote the development of a nurturing relationship with participants, for example parenting interventions. It, therefore, goes without saying that the participant should feel respected and valued when accessing support and the service should make it easy for the participant to seek that help.
Providing practical support for participants may also need to be considered such as providing transport to access the programme for those where access to travel is a barrier, as well as creche facilities for parents who struggle with child- care. Some group programmes may wish to consider providing refreshments if the group intervention is a lengthy one.
The practitioner may need to do preparatory work with the participant to help overcome motivational factors that act as a barrier to seeking support. This can include meeting the participant beforehand and providing accurate information about the intervention. More importantly, working in partnership with the participant by investing in building a strong relationship, acknowledging their worries and ambivalence. It may take several attempts to engage the participant to the programme with several preparatory meetings. Practitioners should, therefore, be skilled in strength-based communication.
Strength based approaches
Strength based approaches are inherently person centred and promote a respectful, collaborative relationship. Using strength-based communication when interacting with others can be empowering and have been shown to be effective when working with others who are considering change. These skills are frequently used in counselling and motivational interviewing.
Strength based techniques encourage conversations and are helpful to explore the ambivalence an individual may feel when considering making a change, such as engaging in an intervention or programme. It can be helpful to use these techniques to identify an individual’s strengths and affirm their values. Practitioners considering training in an evidence-based intervention or manualised intervention would benefit from additional training in strength- based approaches.
The goal is to improve outcomes for the child, young person or family that the intervention is targeting and this is achieved by ensuring the organisational and competency drivers are identified and in place before the delivery starts.