strategies from implementation science applied to the ... · society for prevention research annual...

Society for Prevention Research Annual Meeting

May 31st, 2018

William A. Aldridge II1,2, Rebecca H. Roppolo1, LaTanya R. Moore1, Robin H. Jenkins1, 2, & Renée I. Boothroyd1

1The Impact Center at FPG Child Development Institute, UNC–Chapel Hill2National Prevention Science Coalition to Improve Lives

Strategies from Implementation Science Applied to the Triple P System

Triple PPositive Parenting Program System of Interventions

Public hea

lth app

roach to

parenting an

d family su

pport

Triple P in North Carolina

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To strengthen caregivers to become more positive catalysts of healthy child development acknowledging that every child deserves to grow‐up in safe and nurturing environments, with stable relationships that promote their emotional and behavioral health.

• Substantiated child abuse and neglect• Out‐of‐home placements• Emergency room visits indicating child maltreatment

Mission Statement:

Service Agency Capacity & Practitioner Fidelity

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These relationships are not only significant, but characterized by moderate to large effect sizes!

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

Implementation Capacity for Triple P Project –North Carolina

To provide to NC lead agencies and statewide stakeholders interested in or currently scaling‐up Triple P information, learning, and enhanced

implementation support based on TPIE, TPIE‐Qualitative, and continually emerging evidence and models from implementation

science and practice.

State, regional, and local Triple P coordinators; community and local service agency leaders; funders; policymakers;

and technical assistance providers

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• Implementation Site

• Program Purveyor

• Funder

Child & FamilyOutcomes

Co‐Creation Partner Support

Triple P SystemOptimization

Population‐levelOutcomes

(Aldridge, Boothroyd, Veazey, Powell, Murray, & Prinz, 2016)

Integrated Theory of Change for the supporting the implementation and scale‐up of evidence‐based prevention and wellbeing strategies

External Implementation

Support

Proposed Core Components of External Implementation Support (Aldridge, Brown, Bumbarger, Boothroyd, & Roppolo, under review)

1.

2.

3.

4.

5.

6.

8.

7.

9.

10.

Two Demonstration Sites for Support

1. Can we deliver support that increases local implementation capacity?• Lead Implementing Agencies (LIAs)• Local Triple P Service Agencies – cross‐sector community organizations

2. Can we achieve favorable implementation outcomes of the support process?

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Wake(Nov 2016)

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GASTON

Madison

Mecklenburg

App District Durham Halifax

New LIA?

Albemarle

PittCurrent Lead Implementing Agencies (LIAs)

Proposed new LIA in Sandhill/SE NC

Cabarrus

Implementation Capacity: Core Area PRIORITY GOALS (illustrative) STRATEGIES (examples)

Co‐Creation Partners

Greater agencies’ ownership of collaborative process

Redesign coalition & committee structure to ensure community ownership

Leadership & ImplementationTeams

Formalize a Community/Coalition Implementation Team with dedicated time, effort, resources AND Re‐establish a set of engaged and effective community service agencies with identified leadership and implementation team structures

Move to a formal Community Coalition structure that integrates implementation best practices and collective impact ANDMove to quarterly coalition meetings with the new design and leadership team structure

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EXAMPLE Goals, Strategies, & Early Wins: Wake County Triple P Coalition

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Progress within Community Triple P Service Agencies

Challenges of the Lead Implementing Agency Capacity

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GASTON

Current Lead Implementing Agencies (LIAs)

Proposed new LIA in Sandhill/SE NC

Madison/Buncombe(Feb 2017)

Mecklenburg

App District Durham Halifax

New LIA?

Albemarle

Pitt

Cabarrus

Wake

Implementation Capacity: Core Area PRIORITY GOALS (illustrative) STRATEGIES (examples)

Workforce Development Infrastructure

Improve the number of practitioners actively using Triple P

AND

Retention of agencies and practitioners

Ensure that those trained in Triple P continue to use Triple P (PASS Model Peer Support)

Develop clear, shared, and applied recruitment and selection practices for agencies and practitioners to deliver Triple P

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EXAMPLE Goals, Strategies, & Early Wins: Madison & Buncombe Triple P Cluster

Progress within Lead Implementing Agency Capacity

Unable to assess capacity in

community Triple P service

agencies the last two timepoints

Implementation Support for LIAs: Implementation Outcomes

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Additional LIA Support Outcomes: Confidence & Competence with Local Implementation Processes

Convergence of scores between ICTP support teams and LIA implementation teams

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Practitioners' Responsive & Effective Delivery of

Triple P

NC Triple P State Learning Collaborative

Parent and Family Wellbeing &

Self‐Regulation

Supp

ort

Feedback

Feedback

FeedbackSu

pport

Supp

ort

Cross‐Agency State

Leadership Team

Ideal Support Model for the Triple P System in

North Carolina

Triple P America

Prevent Child Abuse North Carolina

The Impact Center at FPG, UNC‐CH

Workforce Development

Proactive & Responsive Implementa‐tion Support

Partnership Engagement & Communication

Policy & Finance Support

Research, Evaluation, & Data‐Linking Capacity

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An intermediary organization is defined as a statewide center or partnership that supports

state and local child‐ and family‐serving agencies in designing, implementing, and sustaining evidence‐based programs like

Triple P (Mettrick et al., 2015).

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8 7

38

31

42

25

44

15

0

46

38 38

27

39

0

10

20

30

40

50

60

70

80

90

100

Proactive & ResponsiveImplementation Support

Research, Evaluation, &Data Linking

Partnership Engagement& Communication

Workforce Development Policy & Finance Support Functional CapacitySummary Index

Organizational Leadership& Alignment

Percen

tage of P

oints P

ossib

le

Index

Intermediary Organization Capacity Assessment for the Triple P System of Interventions

July‐17 Dec‐17

Baseline Scores

Early Support Process Data – Frequency of Contact

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Wake County Triple P

Madi/Bunc

Triple P

PCANC

Madi/Bunc

Triple PEarly Support Process Data – Dosage of Core Components

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Wake County Triple P

PCANC

RE = Readiness & ExplorationCD = Capacity DevelopmentSP = Supported PerformanceLR = Local Regulation

Early Support Process Data – Working Alliance

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Site A

Site B Site C

• Measuring implementation support processes and outcomes

• Engaging in continuous quality improvement of the support process

• Future efforts will examine more formally the degree to which external implementation support contributes to the optimization of EBP scale‐up

Policy & Practice

• It takes time to optimize EBPs in complex, multi‐level system environments

• Identifying core components of external implementation support

• Need for strong relationships and tailored implementation support around collaboratively set goals

• Implementation support may be helpful even if it is added later

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Research, Evaluation, & Quality Improvement

Key Takeaways

Current & Future Directions• North Carolina

• Moving from demonstration to statewide support system• Support system partnerships: PCANC and Triple P America• Working with an expanded cross‐agency state leadership team

• South Carolina• Beginning an initiative to scale Triple P statewide July 2018• ICTP will be there! We’re already adapting to new context and partners

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Will AldridgeLaTanya MooreRebecca RoppoloWendy Morgan

Renée BoothroydRobin JenkinsJessica ReedSimon PipkinJulie Austen

Jenna BarnesKimberly RuckJulie Chin

Ximena Franco

Thank You

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Will Aldridge 919‐966‐4713

[email protected]

Aldridge, Roppolo, Moore, Jenkins, & Boothroyd (2018, May) 1

What strategy are they using to achieve this vision?


Where are they currently using this strategy?


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.


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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• ICTP support team has been working in the Workforce Development area


After spending 30% of external implementation support time focused on Work Force Development the most recent Community Capacity Assessment scores have increased in the three areas measured. Recruitment and Selection increased from 50% at our first data collection point to 67% at our most recent data collection point. Training increased from 82% to 95% at our most recent data collection point, and Coaching scores increased from 25% to 50% of points possible on the CCA at our most recent data collection point.

LIA Coordinators, created MOA’s to use with agencies and selected 5 agencies to schedule MOA visits with based on data collected showing each agency’s use of Triple P. The ICTP Support Team working with LIA Coordinators created an MOA checklist tool for coordinators to use on site and role played the use of this tool in a recent site visit to build capacity for its use.

LIA Coordinators plan to use the agency MOA visits to identify interested agency leaders who can contribute to the implementation of Triple P by joining a coalition leadership team as well as scheduling follow‐up visits with the agencies to complete sections of the IDA relevant to the communities current needs as assessed at the MOA visits.


Intermediaries leverage and support scaling of EBPs across multiple system layers. They can help accelerate the adoption and implementation of an EBP by providing expertise in various functional practices or services. Mettrick et al. in partnership with Annie E. Casey Foundation completed one of the most thorough studies of organizations providing intermediary supports through a range of Centers of Excellence. As written, Centers of Excellence are functionally comparable to intermediary organizations in the work that they do, and have been documented to deliver 5 core sets of activities captured in the research. COE’s (IO) main goal is to design and deliver a full range of ongoing implementation and collaborative learning activities in service to multiple system layers interacting with an implementing agency or agencies.

Aldridge, Roppolo, Moore, Jenkins, & Boothroyd (2018, May)

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Contextual Notes for interpretation of PCANC Time 2 Results• Both sets of scores should be considered baseline scores, prior to the beginning of

systematic and intentional capacity development activities between NCIC‐TP and PCANC.

• Differences between index scores from July to December 2017 represent only a 1‐2 point change on the index; these are NOT likely to be meaningful at this point. These small variations might best be understood within the context of participants’ better understanding of assessment terms and processes.

• The December 2017 Proactive & Responsive Implementation Support Index rose slight in part because PCANC and NCIC‐TP/FPG are entering into a partnership whereby NCIC‐TP/FPG will provide active implementation support statewide for Triple P communities. The early development of this partnership increases PCANC’s capacity to support this area of intermediary support.

• The initial score for Research, Evaluation, and Data‐Linking incorporates some general capacity PCANC has for its other EBPs. Scoring such general capacity was not allowed in the second administration.

• An additional item was added to the Organizational Leadership & Alignment Index for the second administration. This additional item is the only reason for the slight downturn in OLAI score from the first administration to the second administration.


PCANC’s last reports: 23, 30, 25 hours. Wakes: 23, 18, 18. MadiB: 20, 20, 22).

Here are the cumulative support hours since last quarter’s report:

Raleigh = 8855 minutes, ~148 hours (Nov 2016 – Feb 2018) [148/15 = 10 hours per month]

PCANC = 6457 minutes, ~108 hours (June 2017 – Feb 2018) [108/8 = 13.5 hours per month]

Madison/Buncombe = 6460 minutes, ~108 hours (February 2017 – February 2018) [108/12 = 9 hours per month]


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