Change And Implementation In Practice

OverviewChange and Implementation inPractice SeriesChild welfare agencies continuallyundertake efforts to implement newprograms and practices to producebetter outcomes for children, youth, andfamilies. Effectively implementing newapproaches and achieving sustainablechange can be challenging. The CapacityBuilding Center for States (the Center)has developed the Change andImplementation in Practice series tosupport agencies in applying a structuredapproach to implementation andovercoming common challenges.Briefs in this series provide user-friendlyinformation on implementation conceptsto strengthen the ability of child welfaresystems to implement change. These“how to” guides explain key steps andtasks for moving through a systematicchange and implementation process,from identifying a problem or needthrough finding and implementing asustainable solution and monitoringand evaluating results. The briefs drawfrom a rich collection of implementationframeworks and tools and offer examplesrelevant to child welfare agencies.Change and Implementation in Practice: OverviewWhy Follow a Change andImplementation Process?Current research indicates that the success of a new programor practice depends as much on effective implementation ason the strength of the selected intervention (Fixsen, Blase,Metz, & Van Dyke, 2013). Evidence-based and evidenceinformed solutions will fall short without two essentialconditions:uuAn understanding of organizational capacity to makelasting changeuuKnowledge of how to put identified interventions intopractice effectivelyImplementation frameworks provide stage-based approachesthat can support sustainable practice and lasting systemimprovements. A well-defined change and implementationprocess or framework offers a structured approach to helpchild welfare agencies and their system partners analyze thechallenges they face and select and implement appropriatesolutions (Aarons, Hurlburt, & Horwitz, 2011; Bertram, Blase, &Fixsen, 2015; Meyers, Durlak, & Wandersman, 2012).A change and implementation process also helps agenciesmonitor and evaluate an intervention to determine if it isachieving the desired outcomes. Through feedback loopsand quality assurance measures, agencies can continuouslyrefine the implementation process. In addition, monitoringand evaluation can help agencies institutionalize the changesthat have been put in place and sustain the intervention overtime (Framework Workgroup, 2014; Permanency InnovationsInitiative Training and Technical Assistance Project, 2016b).1

Change and Implementation inPractice BriefsThe briefs in the Change and Implementationin Practice series synthesize available research inimplementation science and provide expertise to buildknowledge and improve implementation practice in thefollowing crucial areas:uuAssessing readiness and ensuring that the necessaryorganizational capacities are in place to successfullyplan, implement, and sustain an interventionuuHelping agencies better understand the problemsor challenges they face and how to use data to “digdeeper” into the root causesuuForming teams to guide the change processuuDeveloping a theory of change to determine themost effective ways to get from the root cause(s) ofthe problem to the desired outcomesuuSelecting and adapting or designing interventionsthat meet an agency’s particular needsuuPlanning and laying a foundation for successful andsustainable implementation and evaluationuuPiloting or staging the intervention so the agency canlearn and adjust as needed before implementing ona larger scaleuuCollecting and using data to monitor progress,inform improvements, evaluate outcomes, andexpand or modify programsEach Change and Implementation in Practicebrief includes: (1) an explanation of the purposeand rationale for each part of the change andimplementation process; (2) definitions of key conceptsand terms; (3) recommendations for working througheach part of the process; (4) sample scenarios fromthe child welfare field; and (5) links to related tools,resources, and tutorials.Child welfare leaders, program managers, teams,and stakeholders can use the briefs to build theirunderstanding of implementation concepts andpractices. Drawing on existing implementationframeworks and tools, the briefs feature applicationexamples that reflect real challenges facing child welfareagencies. Though states and jurisdictions can accessthose materials that best correspond to where they arein their change and implementation process, the briefsassume that some prior milestones have been metbefore moving on to the work described in each one.Change and Implementation in Practice: OverviewKey Terms Used in the Change andImplementation in Practice SeriesProcess structure:uuPhase – a stage of the change andimplementation process common to mostimplementation frameworksuuStep – a discrete part of the change andimplementation process designed to guide usersthrough core change and implementation tasks ina meaningful wayuuMilestone – a key accomplishment that helps theteam to know whether it is ready to move to thenext phase or stepuuEssential function – a critical task that needs tobe completed to achieve a milestoneAdditional terms:uuChange and implementation process – astructured, implementation science-informed, andresearch-based approach to drive change (alsoreferred to by some as change management)uuReadiness – the extent to which an organizationis willing and able to change or implement aparticular interventionuuProblem – what needs to change to meet agencypriorities; problems may reflect identified needsor opportunities to build on successes to improveagency or system functioning and outcomesuuTeam – a group reflecting diverse expertiseand perspectives that guides a change andimplementation processuuTheory of change – a tool that illustratesthe pathway from an identified problem to adesired change in conditions among people,organizations, or systemsuuIntervention – any specific practice, service,policy, strategy, program, practice model, orcombination of these that is clearly defined,operationalized, and distinguishable from one ormore alternativesuuImplementation – a specified set of activitiesdesigned to put into practice an activity orinterventionuuPilot – a test of an intervention before widerimplementationuuEvaluation – use of data to answer questionsabout what happened during implementation,whether the intervention is being implemented asdesigned, and whether it is effective2

Exhibit 1 illustrates the change and implementation process and highlights the relationships among the topicscovered in the Change and Implementation in Practice briefs. Assessing organizational readiness (outer ring) isongoing throughout the process, while teaming (inner ring) is a key consideration during all other activities. Eachicon in the second ring represents an important activity in the change and implementation process. While the iconsare represented sequentially, in practice there often will be overlap and movement back and forth among theactivities. The icons shown here will be used throughout the briefs and related materials in the series.Exhibit 1: Key Change and Implementation TopicsThe Change and Implementation ProcessThe Change and Implementation in Practice series describes common steps in several implementation andcontinuous quality improvement frameworks.1 The Change and Implementation Process—used by the Child WelfareCapacity Building Collaborative (Collaborative) in much of its work—depicts 5 overlapping phases and 12 steps thatguide organizations from problem exploration through sustainable implementation (Child Welfare Capacity BuildingCollaborative, 2015). While the briefs align with the Collaborative’s approach to supporting agencies and courts withimplementation, they can be used with other similar implementation frameworks.Table 1 illustrates the relationship between key topics in the Change and Implementation in Practice series andthe phases and steps in the Change and Implementation Process.1 The change and implementation process described in the series synthesizes evidence-informed implementation frameworks, including: the ActiveImplementation Framework and associated work developed by the National Implementation Research Network (Bertram, Blase, & Fixsen, 2015;Metz & Bartley, 2012); A Framework to Design, Test, Spread, and Sustain Effective Practice in Child Welfare (Framework Workgroup, 2014); and theEvidence-Based System for Innovation Support (Wandersman, Chien, & Katz, 2012). It also reflects guidance provided in: A Guide for ImplementingImprovement Through the CFSP and CFSR (Children’s Bureau, 2014); Guide to Developing, Implementing, and Assessing an Innovation (PermanencyInnovations Initiative Training and Technical Assistance Project, 2016a); CQI Training Academy (JBS, 2015), and related resources.Change and Implementation in Practice: Overview3

Table 1: The Change and Implementation in Practice Briefs and Their Connection to theCollaborative’s Change and Implementation ProcessChange and Implementationin Practice BriefFocusGaining an understanding of the Change andImplementation in Practice seriesOverviewReadiness(Organizational andPractice-Specific)Evaluating initial and ongoing readiness forchange and implementationProblemExplorationIdentifying a need or opportunity tobe addressedGathering data and exploring the problemin depthTeamingForming teams to guide the change processTheory of ChangeDeveloping a theory of Phase I:1,3Identify and AssessNeeds and Opportunities2Phase II:4Develop Theory ofChangeInterventionSelection andAdaptation/DesignIdentifying, researching, and selecting frompossible interventionsAdapting existing interventions or designingnew onesImplementationPlanning andCapacity BuildingAssessing readiness and planning forimplementation of the intervention(s)InterventionTesting, Piloting,and StagingPiloting and/or staging implementationMonitoring,Evaluating, andApplying theFindingsCollecting and using data to adjust theintervention and/or implementation strategies*Phase III:Phase IV:7-8Plan, Prepare, andImplementBuilding capacity to support implementationof the intervention(s)Evaluating to measure implementation quality,as well as short- and long-term outcomes*5-6Select and Adapt/DesignIntervention9Phase V:10-12*Evaluate and ApplyFindings*These activitiesalso occurthroughout theprocessMaking decisions to further spread, adjust, ordiscontinue the intervention*Access other Change and Implementation in Practice briefs and related resources areas/cqi/change-implementationChange and Implementation in Practice: Overview4