local capacity for triple p scale up and sustainability · the impact center at fpg child...
TRANSCRIPT
Helping Families Change Conference
Friday March 2nd, 2018
William A. Aldridge IIThe Impact Center at FPG Child Development Institute
University of North Carolina at Chapel Hill
Local capacity for Triple P scale‐up and sustainability
Collaborative applications of implementation science over the next decade
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The reason we’re all here
• Implementation Site
• Program Purveyor
• Funder
Child & Family Outcomes
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“Is the infrastructure being put into place to sustainably support the Triple P system of
interventions, or is this another example of ‘when the grant funding goes away, the services fade away?’”
Phil Redmond, Director of Child Care
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Service Agency Capacity & Practitioner Fidelity
Agency Leadership & Implementation Team Capacity
Agency Leadership & Implementation Team Capacity
Agency Implementation Infrastructure &
Practices
Agency Implementation Infrastructure &
Practices
Practitioner Adherence to Triple P Session Protocols
Practitioner Adherence to Triple P Session Protocols
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These relationships are not only significant, but characterized by moderate to large effect sizes!
How many implementation science models and strategies does it take to
screw in a light bulb?
61Models
(Tabak et al., 2012)
73Strategies(Waltz et al., 2015)
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Jargon, Concepts, & Pointy Heads
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Who are we trying to reach?
State, regional, and local EBP coordinators
State, regional, and local administrators
Funders, policymakers, and other statewide partners
Intermediary support or technical assistance providers
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Trans‐theoretical Model of Change
Research comparing stage distributions across a range ofbehaviors and populations found that about 40% of pre‐action individuals are in Precontemplation, 40% inContemplation, and only 20% in Preparation... If only 20%of employees in organizations are prepared to takeaction, it should come as no surprise that a majority ofaction initiatives fail. People in Precontemplation andContemplation Stages are likely to see such change asimposed and can become resistant if forced to take actionbefore they are prepared. When a majority of staff are inPrecontemplation and Contemplation, organizations needto prepare their employees by creating the conditions forchange.
‐ Prochaska et al. (2001), p. 249
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Existing Service SystemsAll organizations are designed, intentionally or unwittingly, to
achieve precisely the results they get.R. Spencer Darling, Leadership Institute, Inc.
The reality is that any social system is the way it is because the people in that system want it that way.
Heifetz, Grashow, & Linsky (2009, p.17)
Systems trump programs.Patrick McCarthy, Annie E. Casey Foundation
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Don’t Forget “Fit & Feasibility” Issues
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Sound familiar? Remind you of anything?
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…and, we’re right back where we started!
Evidence‐Based Programs
Implementation Science
Adult Behavior Change
Public Health & Multi‐level System
Approaches
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Integrated Theory of Change for the supporting the implementation and scale‐up of the Triple P system of interventions
(Aldridge, Boothroyd, Veazey, Powell, Murray, & Prinz, 2016)
Triple P SystemOptimization
Population‐level Child & Family Outcomes
Co‐Creation Partner Support
Sustainment
Implementation Science
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Local Implementation Capacity & Performance
Leadership & Implementation Teams
Workforce DevelopmentInfrastructure
Quality & Outcome Monitoring System
Media & NetworkingCapacity
System‐wide learning& improvement
Developing competent & confident practitioners
Leading & supporting implementation
Gathering, analyzing,& reporting data
Mobilizing knowledge & behavior change
(Aldridge, Boothroyd, Fleming, Lofts‐Jarboe, Morrow, Ritchie, & Sebian, 2016)
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Implementation Science in Action
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To view animated overview of our Theory of Change for the supporting the implementation and scale‐up of the
Triple P system of interventions, visit: http://ncic.fpg.unc.edu/ncic‐tp‐simulation‐lab‐intro
(Aldridge, Boothroyd, Veazey, Powell, Murray, & Prinz, 2016)
Primary Goals of External Implementation Support
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Implementation Support
(Aldridge, Brown, Bumbarger, & Boothroyd, under review)
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3.
4.
5.6.
9.
10.
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Core Practice Components of Implementation Support
Adult Behavior Change
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Public Health & Multi‐level
System Approaches
Practitioners' Responsive & Effective Delivery of
Triple P
NC Triple P State Learning Collaborative
Parent and Family Wellbeing &
Self‐Regulation
Supp
ort
Feedback
Feedback
Feedback
Supp
ort
Supp
ort
Triple P America
Intermediary Organizations
Cross‐Agency State
Leadership Team
Ideal Support Model for the Triple P System in
North Carolina
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Co-Creation of Visible ImplementationInfrastructure and Practice
Implementation Infrastructure & Best Practices
Leaders & Staff Members ‐
Implementing Sites
Active Involved Community Members
Funders & Policymakers
Researchers & Program
Developers
Purveyors & Intermediaries (innovation &
implementation)
Co‐Creation (Metz & Albers, 2014; Metz, 2015)Community Members (Boothroyd et al., 2017)
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As in nature, a successful adaptation allows an organization or community to take the best from its traditions, identity, and history
into the future.
Heifetz, Grashow, & Linsky (2009, p.23)
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The reasons we’re all here
(Image courtesy of Triple P America)
Members of The Impact Center at
FPG
Thank You & Disclosure
Special Thanks to:
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William A. Aldridge II+1‐919‐966‐4713
Will AldridgeLaTanya MooreRebecca RoppoloWendy MorganJenna BarnesKimberly Ruck
Jennifer Robinette
Renée BoothroydRobin JenkinsJessica ReedSimon PipkinJulie Chin
Ximena Franco
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Disclosure: Will Aldridge’s costs to participate in the Helping Families Change Conference were supported, in part, by the University of Queensland. This support has been disclosed to UNC‐Chapel Hill.
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Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging Research and Practice Models for Dissemination and Implementation Research. American Journal of Preventive Medicine, 43(3), 337‐350. doi: 10.1016/j.amepre.2012.05.024
Waltz, T. J., Powell, B. J., Matthieu, M. M., Damschroder, L. J., Chinman, M. J., Smith, J. L., . . . Kirchner, J. E. (2015). Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implementation Science, 10(1), 109. doi: 10.1186/s13012‐015‐0295‐0
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Prochaska, J., Prochaska, J., & Levesque, D. (2001). A transtheoretical approach to changing organizations. Administration and Policy in Mental Health and Mental Health Services Research, 28(4), 247‐261. doi: 10.1023/A:1011155212811
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Heifetz, Grashow, & Linsky (2009) The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Boston, MA: Harvard Business Press.
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Aldridge, W. A., II, Boothroyd, R. I., Veazey, C. A., Powell, B. J., Murray, D. W., & Prinz, R. J. (2016, December). Ensuring Active Implementation Support for North Carolina Counties Scaling the Triple P System of Interventions. Chapel Hill, NC: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.
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Aldridge, W. A., II, Boothroyd, R. I., Fleming, W. O., Lofts Jarboe, K., Morrow, J., Ritchie, G. F., & Sebian, J. (2016). Transforming community prevention systems for sustained impact: Embedding active implementation and scaling functions. Translational Behavioral Medicine, 6, 135‐144. doi:10.1007/s13142‐015‐0351‐y
Aldridge, W.A., II, Brown, J., & Bumbarger, B. K. The role of external change agents in developing hospitable service systems for scaling effective prevention strategies. Manuscript in preparation.
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Aldridge, W. A., II, Boothroyd, R. I., Veazey, C. A., Powell, B. J., Murray, D. W., & Prinz, R. J. (2016, December). Ensuring Active Implementation Support for North Carolina Counties Scaling the Triple P System of Interventions. Chapel Hill, NC: Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.
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Aldridge, W. A., II, Brown, J., Bumbarger, B. K., & Boothroyd, R. (2017). The role of external implementation agents in contributing to nurturing systems environments for scaling effective prevention strategies. Invited manuscript submitted for publication.
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Among this collaboration of stakeholders and support systems, there is a need for partnering, active listening, identification and acceptance of adaptive issues, and commitment to move the initiative forward.
Metz & Albers (2014) What does it take? How federal initiatives can support the implementation of evidence‐based programs to improve outcomes for adolescents. Journal of Adolescent Health, 54, 592‐596.
Metz, A. (2015). Implementation brief: The potential of co‐creation in implementation science: Chapel Hill, NC: National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.
Boothroyd, R. I., Flint, A. Y., Lapiz, A. M., Lyons, S., Jarboe, K. L., & Aldridge, W. A., 2nd. (2017). Active involved community partnerships: co‐creating implementation infrastructure for getting to and sustaining social impact. Transl Behav Med. doi:10.1007/s13142‐017‐0503‐3
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Heifetz RA, Grashow A, Linsky M. The practice of adaptive leadership: Tools and tactics for changing your organization and the world. Boston, MA: Harvard Business Press; 2009.
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