dean l. fixsen, ph.d. karen a. blase, ph.d. national implementation research network louis de la...
TRANSCRIPT
Dean L. Fixsen, Ph.D.Karen A. Blase, Ph.D.
National Implementation Research NetworkLouis de la Parte Florida Mental Health Institute
Implementing Innovations with Benefits to Consumers & Stakeholders
SIG/SPDG Directors and Evaluators
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
A Little Known Fact
An evidence-based program is one thing
Implementation of an evidence-based program is a very different thing
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
– Lisbeth Schorr, 1993
Implementation
Successful programs do not contain the seeds of their own replication.
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Effective ProgramsEvidence-based programs are
effective when they are implemented with fidelity
Fidelity = the practitioners use all the core intervention components skillfully
68
92 9789
363447
59
0
20
4060
80
100
2000-01 2001-02 2002-03 2003-04
Years
Mea
n %
of S
choo
lwid
e Fe
atur
es Im
plem
ente
d
SET
ODR/100
ODR = Office Discipline Referrals ; SET = Fidelity Measure (80% Score for Criterion)
Data provided by Sugai, Horner, Eber, Dunlap: OSEP TA Center on SWPBS
PBS: Fidelity and Outcome
0102030405060708090
100
4 months 8 months 12 months Tx yeartotal
Adherent
Non-adherent
Pro
po
rtio
n o
f n
egat
ive
UA
sPROPORTION OF NEGATIVE URINALYSES BY ADHERENT AND NON-ADHERENT
DBT THERAPISTS
86.0
39.0
75.4
37.1
81.1
10.5
80.8
28.9
Linehan, Dimeff et al., 2002
FFT: Therapist Competency Ratings
29%
25%
14%
17%
22%
0%
5%
10%
15%
20%
25%
30%
35%
Not Competent Marginal Competent HighlyCompetent
Control GroupRecidivism Rate
12 M
onth
Fel
ony
Rec
idiv
ism
Source: “Implementing and Evaluating Evidence-based Intervention Programs for At-RiskYouth”, Thomas L. Sexton, Indiana University, School of Education. Available at:http://www.indiana.edu/~cafs/presentations/SchoolEDRES.ppt
0.60
0.72
0.83
0.95
1.07N
um
be
r o
f C
ha
rge
s p
er
Ye
ar
Po
st-
Tx
-0.64 -0.36 -0.09 0.19
Deviation from Mean TAM Score (TAM - .64)0 .28 .55 .83 1
MST Therapist Adherence Measure (TAM)
Schoenwald, Sheidow, & Chapman, 2006
Multisystemic Therapy (MST)
38% Improvement
Lower Higher
Therapist Adherence Predicts 2-Year Post Treatment Youth Criminal Activity* (N = 1,979 Families)
Information provided by Keller Strother and Sonja Schoenwald, MST Services.
Teaching-Family Model
0%
10%
20%
30%
40%
50%
Homes
1.0
1.2
1.5
1.7
1.9
2.0
1.1
1.4
1.6
1.8
1.3
Delinquency
(Outcomes)
Teaching
(Fidelity)
rs = – .94
Pe
rce
nt
Pa
ren
tal-
Tea
ch
ing
Wit
h Y
ou
ths
Me
an
Se
lf Rep
orte
dD
elin
qu
en
cy
Ratin
gs
1 2 3 4 5 6
Bedlington, et al., 1982
Fidelity is Essential (Reduction in Recidivism from .50 Control Group Rate)
Source: Adapted from Lipsey, 1997, 2005
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Summary
Across many evidence-based programs, fidelity matters
The best outcomes are associated with high fidelity practitioners
High fidelity results from careful attention to implementation of evidence-based programs
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Evidence-based programs
The usability of a program has little to do with the quality or weight of the evidence regarding that program
Evidence about intervention effectiveness for specific populations helps us choose what to implement
Evidence about the effectiveness of the intervention does not help implement the program or practice successfully
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Evidence-based programs
Key aspects of core components
Clearly described (what/how)
Practical measure of fidelity
Fully operationalized (do/say)
Field tested (iterative revision)
Contextualized (school/systems fit)
Good outcomes (worth replicating)
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Teachers, Staff, Schools
Teachers impact students
It is the job of superintendents, principals, and funders to align policies and structures to facilitate effective teacher practices
There is no such thing as an “administrative decision” – they are all education decisions
“Climate for Implementation”* & Success
IMPLEMENTATION EFFECTIVENESS
(e.g. fidelity)
Measures • Top mgmt support
• Goal Clarity
• Dedicated resources
• Access to training & TA
• Performance monitoring
• Reinforcement/rewards
• Removal of obstacles
• Freedom to express
doubts
INNOVATION EFFECTIVENESS
(e.g., outcomes)
+++
+++
NS
* (Practice- specific e.g., Klein & Sorra, 1996, 2001; Panzano, Roth, Crane-Ross et al, 2004, Vaidyanathan, 2004)
INTEGRATED & COMPENSATORY
CONSULTATION & COACHING
CONSULTATION & COACHING
STAFF PERFORMANCE EVALUATION
STAFF PERFORMANCE EVALUATION
FACILITATIVE ADMINISTRATIVE
SUPPORTS
FACILITATIVE ADMINISTRATIVE
SUPPORTS
RECRUITMENT AND SELECTION
RECRUITMENT AND SELECTION
PRESERVICE TRAINING
PRESERVICE TRAINING
SYSTEMSINTERVENTIONS
SYSTEMSINTERVENTIONS
Implementation Drivers
DECISION SUPPORT DATA SYSTEMS
DECISION SUPPORT DATA SYSTEMS
OUTCOMES(% of Participants who Demonstrate Knowledge, Demonstrate
new Skills in a Training Setting, and Use new Skills in the Classroom)
TRAININGCOMPONENTS
KnowledgeSkill
DemonstrationUse in the Classroom
Theory and Discussion
10%
5% 0%
..+Demonstration in Training
30%20%
0%
…+ Practice & Feedback in Training
60% 60% 5%
…+ Coaching in Classroom
95% 95% 95%
Joyce and Showers, 2002
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Stages of Implementation
Exploration
Installation
Initial Implementation
Full Implementation
Innovation
Sustainability
Implementation occurs in stages:
Fixsen, Naoom, Blase, Friedman, & Wallace, 2005
0% 100%
Implementation Outcomes
Intervention Outcomes
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Active Purveyor RoleChange the behavior of adult human service professionals
“Systems don’t change, people do” (J.W.)
Change organizational structures, cultures, and climates
Change the thinking of system directors and policy makers
Successful and sustainable implementation of evidence-based practices and programs always requires organizational change.
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Active Purveyor Role
Organization
Management (leadership, policy)
Administration (HR, structure)
Supervision (nature, content)
Practitioner
State, County and Local Context
System of care
Pu
rvey
or
Gro
up
Simultaneous, Multi-Level Interventions
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
Implementation EssentialsHelp faculty/staff acquire the knowledge, skills, and abilities to effectively provide innovations to students
Help schools/districts change to more effectively support the work of the faculty/staff
Transform education systems to effectively facilitate and sustain the use of innovations statewide
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
For More Information
Dean L. Fixsen
813-974-4446
Karen A. Blase
813-974-4463
National Implementation Research Network
http://nirn.fmhi.usf.edu
Copyright © Dean L. Fixsen and Karen A. Blase, 2006
For More Information
Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).
Download all or part of the monograph at:
http://nirn.fmhi.usf.edu/resources/publications/Monograph/index.cfm