Concept Document: Triple P International Implementation Framework

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Concept Document: Triple P InternationalImplementation FrameworkTriple P International Pty Ltd. 2013

Table of ContentsINTRODUCTION .3OVERVIEW OF TPI IMPLEMENTATION FRAMEWORK .4Figure 1. Triple P International Implementation Framework .4PHASE 1: ENGAGEMENT .5PHASE 2: COMMITMENT AND CONTRACTING .6PHASE 3: IMPLEMENTATION PLANNING .8PHASE 4: TRAINING AND ACCREDITATION .9PHASE 5: IMPLEMENTATION AND MAINTENANCE .11Table 1. Triple P International Implementation Framework . 12Triple P Implementation FrameworkCopyright Triple P International Pty Ltd2

INTRODUCTIONSuccessful application and sustainability of anyimplementation of evidence-based practicesevidence-based intervention depends not only(EBPs), with a specific focus on the growingon an effective and proven intervention thatbody of research on the implementation of Tripleaddresses the needs identified but also on howP (e.g. Asgary-Eden & Lee, 2011; Turner,that intervention is implemented and sustained.Nicholson & Sanders, 2011; Shapiro, Prinz &Sanders, 2010; Sanders & Turner, 2005;Triple P International Pty Ltd. (TPI) utilizes animplementation and sustainability framework toSanders & Murphy-Brennan, 2010; Sanders,Prinz & Shapiro, 2009).assist and support implementing agencies andcommunities. The TPI ImplementationThe TPI implementation team will work with anFramework (the TPI Framework) is adaptedimplementing organization or collaborative usingfrom current evidence-based implementationthe TPI Framework to support successfulmodels including RE-AIM (Glasgow, Vogt &implementation of the Triple P System.Boles, 1999) and the National ImplementationResearch Network (NIRN) (Fixsen, Blasé et al.,2007); additionally, it is guided by the Ten StepBlueprint for Successful Implementation of theTriple P System (Sanders, 2011). The TPIFramework is flexible and follows the keyprinciples of Triple P – self-regulation andminimal sufficiency (i.e. it is a guiding frameworkfor support of those implementing Triple P andthe level of support may be decreased orincreased to match the needs and availableresources for a given agency or community.) Forthis reason, the TPI Framework supports the fullrange of potential implementation possibilitiesfrom small, single organization implementationsto complex multi-sector public healthapplications. The TPI Framework draws on theemerging field of research into theTriple P Implementation FrameworkCopyright Triple P International Pty Ltd3

OVERVIEW OF TPIIMPLEMENTATIONFRAMEWORKThe TPI Framework specifies five phases:community. For each set of activities, guidingEngagement; Commitment and Contracting;questions and discussion areas, tools, andImplementation Planning; Training andresources are available. In its implementationAccreditation; and Implementation andsupport capacity, TPI works in partnership withMaintenance. The five phases correspond to keyorganizations to ensure that the implementationdecision-making and activity sequences thatprocess is smooth, timely, and responsive to thereflect the flow of effective implementation ofcontextual needs and constraints of theTriple P. Each phase contains a set of criticalimplementing organization and community.activities to be addressed by an organization orFigure 1. Triple P International Implementation FrameworkTriple P Implementation FrameworkCopyright Triple P International Pty Ltd4

PHASE 1:ENGAGEMENTFollowing the point of initial contact between theTPI will also provide information about the Tripleinterested organization and Triple P, a dialogueP established focusing on mutual informationgathering and sharing. This is a fundamentalfirst step in the process of implementing theFor example: What is the Triple P System; and The evidence base supporting Triple P. The support available for implementationTriple P System and involves moving from apoint of initial interest or curiosity to building anunderstanding of the Triple P System. Twoimportant items to be considered during initialdiscussions are: The scope and fit of the potentialimplementation; andand sustainabilityDuring the Engagement Phase the organizationand TPI will begin to develop an understandingof how the Triple P System may best suit the The context within an organization orneeds of the organization and community ( that may contribute to or impedetraining and resources requirements, evaluationimplementation.plan) and what may need to be considered foreffective implementation and sustainability.Throughout Engagement, in order to ensurethere is a good fit between the organizationsneeds and the Triple P System, TPI focuses onlearning more about the interested organizationor collaborative.For example: The mission and vision; How work with families is approached; and The aims and values of the organization orcollaborative.Triple P Implementation FrameworkCopyright Triple P International Pty Ltd5

PHASE 2: COMMITMENTAND CONTRACTINGThroughout the Commitment and Contractingcost of attrition). Once there is agreementphase information sharing continues to be bi-between the organization and TPI on thedirectional and exchanges intensify in their levelspecific configuration of the above elements,of complexity and operational details. Asdetails are incorporated into a contract.information is reviewed and consolidated todetermine the relative importance and fit for theproposed implementation it is essential that TPIand the implementing organization develop ashared understanding of each other’scontribution to the implementation and theIt is critical that the organization beginconsidering the level of implementation supportrequired to ensure that Triple P can bemaintained. Organizations will differ in the levelof experience and capacity for implementation.Some organizations have extensive experienceproject supporting implementation and scaling upFor this reason, TPI will work withEBPs and these agencies may require minimalorganizations/collaborative to ensure there is ainvolvement. Other organization may bemutual understanding of the goals of theadopting an EBP for the first time and may seekinitiative (e.g. Reach – target population,a greater level of implementation support fromparameters and region; Adoption – practitioners,TPI.agencies, benchmarks) as a means foraddressing community needs. During thisphase, a proposed training and support plan isdeveloped as well as an estimate forimplementation resource usage.Requirements of funding agencies should be afurther consideration, some may wish to see acomprehensive implementation plan included ina request for funding or prior to dispersing funds.In all scenarios the Contracting phase will The TPI Capacity Calculator is a MS Excelenable key stakeholders (including partnerplanning tool that will estimate the workforceorganizations) and roles to be clarified andcapacity needed by an organization to meet its intended reach (e.g. thenumber of practitioners to be trained, the levelsof training required, the costs of trainingprograms and materials, and the anticipatedTriple P Implementation FrameworkCopyright Triple P International Pty Ltd6

Other essential considerations include: How will the various stakeholders (e.g.parents, potential practitioners and theirmanagers, potential referral agencies, theleadership team within the implementingorganization, and partner organizations) beengaged; What is the capacity for local coordination;and What are the potential obstacles and barriersto implementation.The conclusion of the Commitment andContracting Phase is when commitments areagreed upon and a contract is signed.Triple P Implementation FrameworkCopyright Triple P International Pty Ltd7

PHASE 3:IMPLEMENTATIONPLANNINGIt is important to develop an effectiveNIRN key drivers: Recruitment and Selection,implementation plan before training begins.Training, Coaching, Performance Measurement,Frequently organizations move directly fromDecision-Support Data Systems, Facilitativedeciding upon what they want to do, to doing it,Administrative Systems, and Systemsengaging only in training practitioners and thenInterventions and Leadership (Fixsen, Blasé etexpecting them to deliver the service within theal 2007).unchanged context of the organization. Thisapproach does not support the sustainability andlong-term success of the program. Forpractitioners to successfully achieve the provenoutcomes from Triple P, an organization musthave the appropriate supports and infrastructurerequired to sustain the program (e.g. providingtime for practitioners to adequately prepare,engage in peer support, and establish effectivedata collection systems). Another essentialconsideration during this phase is establishing acommunications strategy.TPI will assist organizations and collaborativesto assess their existing capacity and resourcesas well as their expertise. TPI can also assistorganizations and communities in thedevelopment of an implementation plan if thereis limited experience in successfulimplementation of evidence-based practices.The TPI Organizational Assessment Guidedeveloped on the basis of the above NIRNimplementation drivers focuses on key elementsof organizational activity using a selfassessment process to identity strengths andAn effective implementation plan addresses allgaps within the implementing organization orthe key organizational elements required tocollaborative. This assessment informs thesupport practitioners delivering Triple P anddevelopment of activities required to supportincludes an evaluation plan for both theeffective implementation. Support andintervention and the implementation.facilitation provided by TPI will also promotecapacity building and a general level ofAn organization or set of partner organizations(collaborative) must examine the match betweenits organizational practices and the requirementsexpertise that will generalize to other evidencebased practices that an agency may adopt in thefuture.of the levels of Triple P to be implemented. Thisexamination is best effected by looking at theTriple P Implementation FrameworkCopyright Triple P International Pty Ltd8

Developing the implementation plan can beaccomplished within two to three months andshould occur as other activities are on-going butprior to the practitioners delivering the service toparents.Triple P Implementation FrameworkCopyright Triple P International Pty Ltd9

PHASE 4: TRAININGAND ACCREDITATIONDeveloping a detailed Training and Accreditationdeciding which practitioners are eligible forplan is foundational to moving from deciding totraining in which levels of Triple P, the length ofadopt any or all levels of the Triple P System tothe training courses, and the combination ofdelivering the program, and a key component ofcourses required to deliver the agreed uponan effective implementation plan.levels of Triple P. TPI Training Consultantsdeliver all training courses and complete theThe Training and Accreditation planoperationalizes the expectations agreed uponduring the Commitment and Contracting Phase,including: accreditation process with the trainedpractitioners. TPI provides the training expertiseand practitioner materials for the practitionersbeing trained.The reach determined for theimplementation (i.e. who will be served inwhat numbers and by which levels); Who will be delivering the service (i.e. whichpractitioners, what levels of Triple P); and The number of seminars/groups/individualsessions each practitioner will be expectedto provide over the determined period(usually between 1-5 years).Further aspects that need to be consideredwhen creating a Training and Accreditation Planinclude, but are not limited to: who will besupervising the practitioners, how will peercoaching/supervision occur, and what quantityof parent resources will be required.As the training plan is developed, TPI canprovide information to assist an organization inTriple P Implementation FrameworkCopyright Triple P International Pty Ltd10

PHASE 5:IMPLEMENTATION ANDMAINTENANCEDuring the Implementation phase, theimplementation plan is put into action and therecently trained practitioners start delivering theservice. It is essential through this phase toactively evaluate the impact of theimplementation (Plan, Do, Study, Act Cycle;Deming, 1986) and utilize the information toimprove and refine the effectiveness of theimplementation.As practice takes hold, an organization entersinto an implementation evaluative stage forabout six months to one year in order toaccumulate enough service delivery data foranalyses. Ideally, the resulting performanceevaluations will demonstrate which systems andsupports can effectively sustain the successfuldelivery of Triple P. The data will also showthose areas that need refinement or revision foreffective service delivery to continue over time.This can provide a basis for determining if anexpansion of the service delivery would beuseful or is needed to ensure that a communityobtains the maximum benefits from the Triple PSystem.Triple P Implementation FrameworkCopyright Triple P International Pty Ltd11

Table 1. Triple P International Implementation FrameworkEngagementThis is the initial interaction between an interested organization and TPI, which will lead to a decision about contracting towork together or disengaging.Key Outcomes:Interested organization has an increased understanding of the Triple P system.TPI has an understanding of the level of interest and potential scope of the organization’s interest.Both have developed clarity about the scope of interest and capacity.Engagement phase transitions to the next phase when there is enough knowledge to make a commitment to continue todevelop a work plan and/or sign a contract describing the services and levels of training that will be provided.CommitmentandContractingThis is the phase through which the scope of the Triple P Implementation is confirmed and a contractual agreement issigned between the organization and TPI.Key Outcomes:Assigned TPI contact person.Agreement of necessary steps to establish the capacity to implement Triple P.Clarification of capacity for implementation.Clarification of the level of support required from TPI for successful implementation.Identification of local capacity for Triple P coordination.Signed contract.ImplementationThis is the phase in which a detailed implementation plan is developed.PlanningKey Outcomes:An effective and comprehensive implementation plan.An effective evaluation plan.Training and Accreditation Plan has been confirmed (dates, participants, resources and supports).Budget/financial commitments and funding are confirmed.Training andThis is the phase when the agreed upon training and subsequent accreditation is completed.AccreditationKey Outcomes:Organization/community has adequate number of trained providers to offer the planned service.Training/accreditation sessions are experienced as high-quality.ImplementationandMaintenanceThis is the phase when the program is delivered, feedback cycles provide information for on-going development andsustainability, and maintenance mechanisms are put in place.Key Outcomes:Effective delivery of Triple P components for which staff have been trained.Active evaluation process with feedback loops.Participation in Triple P Networks (practitioner/organizational/community).This phase is on-going and should include mechanisms to support sustainability of effective delivery with performancemeasures.Triple P Implementation FrameworkCopyright Triple P International Pty Ltd12

implementation and sustainability framework to assist and support implementing agencies and communities. The TPI Implementation Framework (the TPI Framework) is adapted from current evidence-based implementation models including RE-AIM (Glasgow, Vogt & Boles, 1999) and the National Implementation Research Network (NIRN) (Fixsen, Blasé et al.,

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