Starting Small: Transformation Zones and Initial Implementation

The period of initial implementation is a sensitive time for a new program. Its success depends upon close attention to installation stage activities and implementation drivers. To enhance efficiency and success, initial implementation should begin in a small portion of the organization, a transformation zone, where many of the common concerns discussed in this chapter can be experienced, learned from, and addressed before scaling up the new practice to include all staff. Practical challenges during initial implementation are common. In this chapter, we review several strategies to overcome such challenges including staff confidence and competence, low or inappropriate referrals, low service delivery rates, perceived clinical barriers, and other organizational challenges.

[1]  D. Julian.  A Community Practice Model for Community Psychologists and Some Examples of the Application of Community Practice Skills from the Partnerships for Success Initiative in Ohio , 2006, American journal of community psychology.

[2]  J. Unützer,et al.  Improving practice in community-based settings: a randomized trial of supervision – study protocol , 2013, Implementation Science.

[3]  Dean L. Fixsen,et al.  Improving Programs and Outcomes , 2015 .

[4]  Andrew Booth,et al.  Implementation Science BioMed Central Debate A conceptual framework for implementation fidelity , 2007 .

[5]  K. M. Tan.  Influence of educational outreach visits on behavioral change in health professionals. , 2002, The Journal of continuing education in the health professions.

[6]  S. Kerns,et al.  Predicting post-training implementation of a parenting intervention , 2017 .

[7]  J. R. Cook,et al.  Assessment Practices of Child Clinicians , 2017, Assessment.

[8]  J. Sandberg,et al.  The scientist-practitioner model in marriage and family therapy doctoral programs: current status. , 2002, Journal of marital and family therapy.

[9]  S. Schoenwald,et al.  Toward Effective Quality Assurance in Evidence-Based Practice: Links Between Expert Consultation, Therapist Fidelity, and Child Outcomes , 2004, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[10]  R. Beidas,et al.  Training as Usual: Can Therapist Behavior Change After Reading a Manual and Attending a Brief Workship on Cognitive Behavioral Therapy for Youth Anxiety? , 2009 .

[11]  J. Williams,et al.  Competence in Teaching Mindfulness-Based Courses: Concepts, Development and Assessment , 2011, Mindfulness.

[12]  J. Kirchner,et al.  A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project , 2015, Implementation Science.

[13]  Abraham Wandersman,et al.  Getting to outcomes: a results-based approach to accountability , 2000 .

[14]  Julianne M. Smith-Boydston,et al.  Transportability of Multisystemic Therapy to Community Settings: Can a Program Sustain Outcomes Without MST Services Oversight? , 2014 .

[15]  Aaron R. Lyon,et al.  Developing the Mental Health Workforce: Review and Application of Training Approaches from Multiple Disciplines , 2011, Administration and Policy in Mental Health and Mental Health Services Research.