Local capacity for Triple P scale up and sustainability · The Impact Center at FPG Child...

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)

1.

2.

3.

4.

5.6.

9.

10.

7.

8.

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

[email protected]

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.

Aldridge (2018, March) 1

4Aldridge (2018, March)

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


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


Heifetz, Grashow, & Linsky (2009) The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Boston, MA: Harvard Business Press.


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, 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.


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.


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


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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