20 Delivery of the Program

Dr. Anwara Hashmi

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Course Outline

  1. Introduction
  2. Objectives
  3. Concept of program delivery
  4. Implementation frameworks
  5. Approaches for program delivery
  6. Stages for program implementation

 

Introduction

 

Delivery of program is a process by which a specified set of activities are designed to put into practice an activity or program of known dimensions. These activities occur over time in stages that overlap and that are revisited over time. The program delivery is thus purposeful and is described in sufficient detail such that independent observers can detect the presence and strength of the “specific set of activities” related to implementation/ program delivery.

 

Objectives

 

By the end of this module the students shall:

  1. Understand the concept of program delivery
  2. Shall come to know about the implementation Frameworks
  3. Shall come to know about the approaches for program delivery
  4. Get acquainted with the steps of program implementation

Concept of program delivery

 

Delivery of the program is the application phase of the planning process. Once objectives are formulated while designing the program, it is necessary to carefully consider how to achieve these objectives. Implementation method should carefully be chalked out – how the plan will be executed and by whom? No matter how well program is thought of, it is of no value/use unless carried out properly.

 

The Active Implementation Frameworks help define WHAT needs to be done, HOW to establish what needs to be done in practice and WHO will do the work to accomplish positive outcomes in typical human service settings (effective implementation), and WHERE effective implementation will thrive (enabling contexts).

 

The identification of Implementation Teams answers the question of WHO does the work of implementation. The research and evaluation literature has identified practitioner readiness, organization readiness and support, and system variables that facilitate or impede the use of evidence-based programs in practice. This is important information and begs the question of WHO will assure practitioners and organizations are ready, WHO will help organizations to be supportive, and WHO will help change systems to facilitate hospitable environment WHERE the new ways of work embodied in any innovation can be used fully and effectively.

 

The Active Implementation Frameworks used by skilled Implementation Teams provide ways to increase the likelihood that the good outcomes achieved in well-controlled studies can be reproduced in the complex conditions that exist in human services and society. Implementation Teams don’t have to wait for readiness; they can help create readiness by using Implementation Stages and Implementation Drivers. Implementation Teams don’t have to wait for a champion to appear; they can help organizations and systems change to provide more hospitable environments for effective innovations and for the necessary implementation supports. Active Implementation “recreates a complex, causally ambiguous set of routines in new settings and keeps it functioning.

 

Approaches for Program delivery

 

There are two approaches that could be used for delivery of program, namely top-down approach and bottom-up/participatory approach. The bottom-up approach is a two-way information flow system that considers prior consultation with target beneficiaries about their needs/problems and aspirations for effective planning. On the contrary, the top-down approach is simply a one-way information delivery system that reinforces the hierarchical relationship between the extension agent and the client.

 

Bottom-up/participatory approach should be adopted in delivery of program to ensure active people’s participation in project selection, design and implementation. This also makes delivery of program efficient, timely and cost-effective.

 

STAGES FOR PROGRAM IMPLEMENTATION

 

According to Fixsen et al., 2010, the Stages of Implementation are;

  1. The Exploration stage
  2. The installation stage
  3. Initial implementation stage
  4. Full implementation stage

Stage 1: The Exploration stage identifies the need for program, determine what innovation or set of practices are likely to meet that need, and to decide whether or not to move ahead with the implementation process. If the decision is to proceed with the implementation, then building public awareness and widespread support for the change is crucial.

 

Step 1. Establish a team to guide exploration

  • a) Include representatives from each of the key agencies/ programs with the authority to make decisions and expend resources (or an individual with easy access to that decision-maker)
  • b) Select staff whose responsibilities will allow them to undertake this initiative over several years and
  • c) Select staff with expertise about the implementation process as well as potential innovations or practices that fit identified needs.
  • d) Team defines their roles and responsibilities.

 

Step 2: The team convenes a stakeholder group for needs assessment and program analysis

 

  • a) Determine appropriate stakeholders including state agency personnel (if involved or needed), Technical assistance personnel and pre-service personnel, regional and/or program administrators.
  • b) Clarify stakeholder group’s purpose, responsibilities and projected timeline for involvement.
  • c) Articulate the purpose and rationale for change, including any supporting data.
  • d) Review infrastructure and current practices, including issues, concerns, and strengths from the perspectives of all stakeholders.
  • e) Identify the concerns and problems at all levels of the program delivery.
  • f) Identify desired outcomes and changes for each level of the program.
  • g) Review or realign the program’s mission and values to fit with desired outcomes and new vision for a change in practices.

 

Step 3: Stakeholders explore the feasibility and “fit” of potential innovations and practices

 

  • a) Explore the core features, functions and benefits of potential innovation(s) or set of practices.
  • b) Review the research and evidence base for the innovation or practices.
  • c) Gather information from other states (if involved), programs and consultants, experienced with implementing the potential innovation(s) and practices.
  • d) Analyze requirements of the implementation process and potential impact of adoption on system resources.

 

Step 4: Decide on practices/innovation and whether or not to proceed

  • a) Review all perspectives and information gathered.
  • b) Establish criteria for selecting the innovation or practices to adopt.
  • c) Consider which innovation can best address the identified needs, has evidence of producing desired outcomes, and aligns with the service system’s mission, values and resources.
  • d) Decide and recommend to final decision makers, which innovation or set of practices are most promising and whether or not to proceed with implementation.

 

Step 5: Secure agency and cross-agency leadership support

  • a) Identify administrators and decision makers whose buy-in will be needed to assure necessary support and resources for implementation and sustainability.
  • b) Use multiple strategies to help key individuals become champions who will promote the new practices or innovation.
  • c) Develop a plan for the involvement and continued support of these individuals.

Outcomes of Exploration

  1. A Team has been established to oversee the initiative.
  2. A stakeholder group has explored the need for change and the fit of potential new practices or innovation.
  3. An innovation or set of practices was selected which addresses the need and is likely to result in desired outcomes.
  4. The service system and current practices were analyzed to determine necessary changes in infrastructure, and training, technical assistance and coaching.
  5. The decision was made to proceed with the implementation initiative and move into installation.
  6. Necessary agency or cross agency leadership has committed to supporting the implementation of selected practices over multiple years.

Stage 2: The installation stage is to acquire or repurpose the resources needed to do the work ahead. Selecting staff, identifying sources for training and coaching, providing initial training for staff, finding or establishing performance assessment (fidelity) tools, locating office space, assuring access to materials and equipment, and so on are among the resources that need to be in place before the work can be done effectively (Fixsen et al. 2005; Saldana et al., 2012). During the Exploration Stage Implementation Teams help organizations recognize the need for these resources and during the Installation Stage Implementation Teams help organizations secure the needed resources to do the work ahead and prepare staff for the new practices.

 

Step 1: The Team finalizes membership and responsibilities

  • a) Ensure that the Team has the capacity, resources and commitment to oversee the implementation process for two – five years.
  • b) Establish an orientation for all members that include vision, mission, roles and responsibilities, ground rules and structures for voting and communication.
  • c) Determine the structures and mechanisms for ongoing stakeholder input.

Step 2: Develops a communication plan

  • a) Identify audiences (e.g., professional groups, families, referral sources, collaborating agencies, funders, legislators, practitioners) who need to understand and support the new practices.
  • b) Determine the “messages”, materials, and formats appropriate for each audience.
  • c) Describe core features and components of the new practice(s), the evidence base and expected outcomes.
  • d) Identify potential opposition, reasons for opposition and the team response.
  • e) Use multiple communication strategies and feedback loops to evaluate the impact of the messages.
  • f) Include ways to use your stakeholders and champions to promote the new practice(s).

Step 3:  Establishes Implementation Sites and Teams

  • a) Consider the characteristics of personnel and organizational structures most likely to support successful implementation.
  • b) Use selection criteria to choose initial Implementation Sites.
  • c) Sign written agreements.
  • d) Form an Implementation Team at each site to develop their plan, oversee all activities and timelines.
  • e) Include representation on the Implementation Team of administrators and direct service staff, and others who are or will become experts on both the implementation process and the new practice(s)
  • f) Clarify the roles and responsibilities of team members and their long term commitment to implementation and sustainability.
  • g) Ensure the Implementation Team has the resources, information and skills necessary to lead the change effort.

Step 4: Develops system supports and infrastructure changes

  • a) Make necessary changes to administrative structures (organizational drivers) such as contracts, interagency agreements, general supervision, oversight, policies, procedures, guidance and forms to support new practices.
  • b) Determine and make changes needed in staffing and staff responsibilities.
  • c) Find and align the fiscal resources to cover start-up costs, administrative structure costs, professional development mechanisms, training materials and any new service delivery costs.

Step 5: Improves data systems, evaluation and monitoring

  • a) Determine the data needed to monitor and evaluate key aspects of the implementation process, such as communication and feedback loops and professional development activities.
  • b) Determine data needed to evaluate intervention effectiveness including performance assessment, fidelity and the emergence of desired outcomes.
  • c) Determine the data needed by teams, trainers, coaches, practitioners and any other individuals for decision-making.
  • d) Determine the capacity of the current data system and make additions and improvements.

 

Step 6:  Builds Training and Technical Assistance (T&TA) capacity; begins training

 

a) Determine and develop T&TA procedures, activities, and materials.

b) Assure availability of the human resources needed to develop and conduct T&TA at initial sites.

c) Determine, develop or adapt measures of fidelity.

d) Develop an evaluation plan to understand the effectiveness and outcomes of T&TA activities.

e) Conduct orientation and informational training(s) for all potential early implementers.

f) Conduct “train the trainer” and “train the coach” activities.

 

Step 7:  Finalizes a written plan

 

a) Develop a written Implementation Plan that addresses:

  • communication and dissemination,
  • training and technical assistance,
  • planned improvements in organizational structures, data and system supports
  • all evaluation activities; and
  • activities that address expansion (scale-up) and sustainability.

  b) Identify and engage external expertise and additional resources as needed to support the implementation plan.

 

c) Develop a progress monitoring and evaluation schedule that ensures the Implementation, Plan is regularly reviewed, updated and improved.

 

d) Determined mechanisms for keeping stakeholders and the field apprised of progress.

 

Outcomes of Installation:

  • An implementation team has committed to guide the implementation process.
  • With stakeholders input, concise descriptive materials were made available to assure regular communication, and support for the new initiative.
  • System capacity, including communication structures, T&TA, data systems, and infrastructure changes, has been strengthened to support implementation and scale up.
  • The written Implementation Plan is “in use” by the team and shared with stakeholders.

Stage 3: Initial implementation stage includes providing intensive technical assistance and coaching and addressing challenges as they emerge. Training and coaching is provided to the site Implementation Teams, who in turn support practitioners. Practitioners in the sites are trained and begin to use the practices or innovation. Coaching is provided to enhance the fidelity of use of the practices. The Implementation Sites set up mechanisms to collect evaluation data. Data is used to assess the quality of implementation and to quickly identify problems and make decisions for improvement. Team guides the implementation process, review data, make decisions and provide feedback. Feedback is used to revise the written plans when necessary. During Initial Implementation the new practices are at least partially in place in the initial Implementation Sites. As outlined in the communication plan, leaders, stakeholders and the field are kept apprised of progress and important changes.

 

Step 1: Technical Assistance providers train and coach Implementation Site personnel

 

a) The Implementation Team at each site appoints a leader and schedules regular meetings.

b) Technical Assistance (TA) providers build confidence and competence of site Implementation teams through on-going training, coaching and guidance.

c) The Implementation Teams, with assistance from TA providers, train, and support practitioners.d) The Implementation teams evaluate activities and use data for making decisions and incorporating changes in on-going training and support.

 

Step 2: Implementation teams support practitioners and monitor the use of new practices

 

a) Practitioners begin to use the practices.

b) The Implementation Teams provide on-going coaching to assure practice fidelity.

c) The Implementation Teams measure implementation fidelity by regularly conducting performance assessments, using observations and fidelity tools.

d) Implementation Teams regularly review information about the implementation process, practice fidelity, participant satisfaction, costs, and emerging outcomes.

 

Step 3: The Implementation Teams use feedback loops and improvement cycles to adjust organizational supports

 

a) Use feedback loops and improvement cycles to quickly resolve barriers and identify additional supports needed.

b) Revise policies, procedures, guidance and forms to support the new practices.

c) Adapt fiscal policies and fiscal procedures to support and sustain the new practices.

d) Adjust administrative structures and personnel as necessary.

 

Step 4:  The Implementation Teams evaluate fidelity, and emerging outcomes

 

a) Use data from the fidelity measures to make adaptations in training and support.

b) Provide continuous feedback to practitioners related to the fidelity of their practice.

c) Evaluate activities according to the evaluation plan, with particular attention to the implementation process, practice fidelity, participant satisfaction, costs, emerging benefits and outcomes.

d) Review and   adapt          written   Implementation    Plans   to   prepare   for    full implementation.

 

Outcomes of Initial Implementation

  1. Implementation Team, supported by Technical Assistance providers, provided oversight to activities at all sites.
  2. Practices were implemented, and training and coaching assured increasing levels of fidelity.
  3. Data were used to inform all aspects of implementation.
  4. Systemic changes and organizational supports were added to support the practices.
  5. Training and coaching were adapted and strengthened according to evaluation results.
  6. Implementation of new practices began to show expected results.
  7. Evaluation of sites provided information to assist in expansion and scaling up to full implementation.

 

Stage 4: Full implementation stage assures program delivery with high fidelity, achieving expected outcomes.With a focus on both fidelity and sustainability, all professional development and organizational structures are fully functioning and work together to support practitioners. Orientation activities provide necessary training and support to newly hired practitioners and leaders so they can use and sustain the new practices. Evaluation activities continue to monitor fidelity and outcomes of practice, so that “drift” (movement away from fidelity) in practices is quickly identified and addressed.

 

In addition to sustaining high fidelity practices in the initial Implementation Sites, the implementation team focuses on beginning scale up and sustainability activities outlined in the Implementation Plan.

 

Step 1: Site Implementation Teams maintain Training &Technical Assistance(T&TA) supports

 

a) Recruitment and selection policies are used to hire staff with competencies to match desired practices.

b) All new staff, including administration, practitioners and Implementation Team members are oriented to their roles and trained in new practices.

c) On-going training of new staff and “booster” training occurs as needed.

d) Regular supervision and performance assessment occurs for practice fidelity.

e) Coaching occurs regularly for new staff and experienced staff to sustain practice fidelity.

 

Step 2: The Implementation Teams ensure that data systems, policies, procedures and funding are integrated and functioning

 

a) Monitoring, support systems and reporting processes are in place and used regularly.

b) Feedback Loops and Improvement Cycles are used for continuous improvement and sustainability of practice.

c) Reliable data systems are in place and provide information about the specific processes, practices and outcomes.

d) Data and other information are frequently used by practitioners, coaches and supervisors to improve performance.

e) Policies, procedures and budgets at relevant state, regional and local levels are adjusted as needed to support practice.

 

Step 3: Implementation Teams regularly use performance assessment

 

a) Staff conducting performance assessments are well trained and receive supportive supervision as well.

b) Staff performance is evaluated for fidelity of the practices.

c) Multiple sources of information (self-assessment, observation, supervision, peer reports, video clips, team meetings, etc.) are used.

d) Staff understand that the performance assessment process and fidelity measures are the basis of feedback and improvement.

e) Feedback is provided in a helpful and timely manner.

 

Step 4: The Implementation Teams use feedback and data to sustain fidelity

 

a) Data are reviewed to make administrative changes as needed.

b) Implementation Teams frequently use communication strategies and feedback loops to receive and provide information.

c) State, regional and local administrators are actively engaged in reducing any administrative barriers that arise.

d) Improvement cycles are used with a focus on sustainability.

 

Step 5: The Implementation Teams ensure on-going sustainability of structures and practices

 

a) Continue to provide administrative, organizational and fiscal support.

b) Continue to provide technical assistance and coaching for maintaining fidelity.

c) Maintain relationships and provide materials to higher education and professional organizations to impact pre-service education and licensing requirements.

d) Continue to promote buy-in and to expand support base.

 

Outcomes of Full Implementation

The practices have been successfully implemented at all initial sites with fidelity.

The outcomes were measured and showed intended results.

Training, TA and coaching are effective in helping all staff implement practices with fidelity.

Systemic issues were resolved and the system has the capacity to support the practices.

 

Summary

 

Delivery of program is a process by which a specified set of activities are designed to defining WHAT needs to be done, HOW to establish what needs to be done in practice and WHO will do the work (effective implementation), and WHERE effective implementation will thrive (enabling contexts). The delivery of program can be either through top-down approach or bottom-up/participatory approach involving activities that occur over time in stages that overlap and that are revisited over time. The program delivery is thus purposeful and is described in sufficient detail such that independent observers can detect the presence and strength of the “specific set of activities” related to implementation/ program delivery.

 

you can view video on Delivery of the Program