Implementing the Incredible Years Programmes

Implementing the Incredible Years Programmes

Introduction

"Choosing an evidence-based intervention is the foundation, but there are additional necessary tools that adept agencies/organizations must wield, to successfully construct an intervention program. Select carefully trained clinicians and ensure they receive co-ordinated and accredited training, coaching, and supervision. Construct adequate scaffolding for the program by providing a supportive infrastructure, adequate resources and managerial support. Conduct regular process and outcome evaluations, assuring fidelity of program delivery. Building this stable scaffolding for your program will result in higher levels of clinician fidelity and longer term sustainability." Carolyn Webster-Stratton

The Incredible Years have identified five key elements to effective program implementation:

1)standardized treatment delivery (using comprehensive clinician manuals, well-articulated protocols, videotapes and materials for parents and children);

2)standardized quality training for group leaders delivering the intervention;

3)Effective supervision of group leaders;

4)on-going fidelity monitoring and certification; and

5)Agency or administrative support

Please see CWS paper:Quality Training, Supervision, On-going Monitoring, and Agency Support: Key Ingredients to Implementing The Incredible Years Programs withFidelity Carolyn Webster-Stratton, Ph.D. University of Washington access online

The summary of her paper states: implementing a new evidence based intervention in an agency is not unlike undertaking a house re-model. The architect for the house (program developer or trainer) must work closely with the contractors (clinicians and administrators) to explain the blueprints and house design features, while the contractor assures that the optimal building codes are adhered to, that foundations are in place, and that subcontractors are provided with the needed expertise to handle the job. Both the architect and contractor must be aware of what the family’s needs and desires are for a house as well as their timeline and budget constraints.

As the building continues, there will undoubtedly be change orders as the family realizes different needs or as new discoveries are made in the existing structure (e.g., asbestos) when it is uncovered. This process will necessitate a collaborative and flexible approach where each member of the team works together with open communication and a spirit of problem solving to arrive at satisfactory solutions. In a similar fashion, the clinicians must first be carefully selected and well trained and then be provided with supervision and consultation from trainers and mentors in order to assure a supportive infrastructure and quality control of the program delivery. Regular feedback from the clients (parents, teachers, and children) in the process of collaborative discussion and session evaluations will assure that the clinician is implementing the program with sensitivity and relevance according to the individual family needs, cultural background, and nature of the children’s problems.

In the paper “Impact of Therapists’ Skill on Effectiveness of Parenting Groups for Child Antisocial Behaviour, (January 15 2008) by Stephen Scott, Anne Carby, and Alison Rendu; they stated that the association between the level of the therapists’ skill in running the groups and the child behaviour outcome was strong. Their findings appear to uphold the notion that skill is an important contributor to therapy outcomes, thus adding to the literature on what makes interventions effective. These results are consistent with the findings of Forgatch et al (2004), who found that skill was significantly associated with change in parenting, rather than child antisocial behaviour.

These confirm the outcomes from the paper “Fostering the Adoption of Evidence-Based Practices in Out-Of-School Time Programs” Allison J. R. Metz, Ph.D., Karen Blase, Ph.D., and Lillian Bowie, M.A. (2008) (full paper below ) which state six DRIVERS OF SUCCESSFUL IMPLEMENTATION;

1)Staff Selection: Staff recruitment and selection are key components of implementation atpractitioner and organizational levels.

2)Staff Training: Staff members at all levels require training when a new practice isimplemented. Effective training involves theory and discussion;demonstration of skills; andopportunities for practice and feedback.

3)Coaching, Mentoring, and Supervision: Whereas skills needed by successful practitionerscan be introduced in training, many skills can only really be learned on the job with the helpof a consultant or coach.

4)Internal Management Support: Internal management support provides leadership tosupport implementation, makes use of a range of information to shape decision making, andprovides structures and processes for implementing new practices and keeping staff focusedon desired outcomes.

5)Systems-Level Partnerships: Systems-level partnerships involve working with externalpartners to support program implementation and the frontline work of practitioners.

6)Staff and Program Evaluation: Evaluation entails using measures of practitionerperformance and adherence to the program model, along with program outcome measures, toassess overall program performance and develop quality improvement plans.

Implementing the Incredible years

Pre group Planning

1)Set up weekly self-study meetings with co-leader and other staff who will be involved in delivering the IY parent program.

2)Review the leader manual introductory materials and start planning for some of the logistics for how you will advertise your parent program, recruit families, arrange day care, and select a comfortable room for your groups. (see checklist in parent leader’s manual)

3)Read overview chapters; Parent Group Leaders read chapter 4 in Troubled Families: Problem Children book (book available from IY) Chapter titled - Working with Parents of Children who Have Conduct Disorders: A Collaborative Process. Also read article on web site: C., & Hancock, L. (1998). Parent training: Content, methods and processes. In E. Schaefer (Ed.), Handbook of parent training, second edition (pp. 98-152). New York: Wiley and Sons.

4)View the sample videotape of actual parent group sessions in your self-study meeting (Limit Setting). This will give you an idea of how the group operates, the leader’s role and how the videotapes are used to stimulate discussion.

5)Start with the first program in the series Play Part 1 and follow the manual with the accompanying videotapes. If you are doing this in a group, take turns leading the group (others pretend to be parents), showing the videotapes and asking questions.

6)At each meeting select the next program or part to study.

7)Choosing a different person to be prepared to lead and present specified vignettes each week can be helpful.

8)To prepare for each meeting, read the accompanying chapter in the Incredible Years parent book. E.g., before reviewing Play part 1, read the chapter on Play in the Incredible Years parent book (or listen to it on CD or audiotape).

9)At your self-study meetings practice being leader with others taking the role of parents to try out vignettes, questions and role plays. This will give you experience and more comfort with the materials.

Start a Group

1)Begin a parent group.

2)Continue to meet in your peer review group to consult with each other about progress and to get feedback on your group.

3)Videotape your parent group session for self-study. Use the Collaborative Group Process Checklist when you view your tape.

4)Choose segment of your videotape of your group for peer review.

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Obtain Consultation and Supervision

Once you have started doing groups and have done some self-evaluations of your group tapes using the Collaborative Group Process Checklist you may request consultation from an IY mentor or trainer on one of your tapes of your group and to implement supervision sessions and workshops.

Become Certified/Accredited See certification information on web site.

IMPLEMENTING EVIDENCE-BASED PRACTICES:

SIX “DRIVERS” OF SUCCESS; Aspects taken from ; Part 3 in a Series on Fostering the Adoption of Evidence-Based Practices in Out-Of-School Time Programs, Allison J. R. Metz, Ph.D., Karen Blase, Ph.D., and Lillian Bowie, M.A. (2008)

BACKGROUND

One of the biggest challenges for practitioners is implementing a new program or a new practice.This challenge is due, in large part, to a lack of information on strategies that promote effectiveand efficient program implementation. In most cases, implementation strategies have beenlimited to paper-based manuals that focus on describing interventions without providingcomplementary information on necessary implementation resources and activities. Because ofthis, they do not facilitate the real-world application of innovative, research-based practice.Recently, researchers have begun to study implementation in an effort to understand the keyingredients for successful program implementation. This brief will define implementation,highlight why the effective implementation of evidence-based practices is critical to achievingoutcomes, and outline six core components that drive successful program implementation,referred to as “drivers.”

1)WHAT IS IMPLEMENTATION?

Implementation is a “specified set of activities designed to put into practice an activity orprogram of known dimensions.” A synthesis of the research in the field describesimplementation as “a mission-oriented process involving multiple decisions, actions, andcorrections.”Implementation involves six stages that typically take place over two to four years:

Stage 1: Exploration Stage – Programs begin to consider the idea of adopting orreplicating an evidence-based program or practice, searching various options, examiningthe “fit” of various programs and practices with their target population, assessing thefeasibility of implementing a new program or practice, and investigating whethertechnical assistance is available from program developers or other sources.

Stage 2: Preparation Stage – Once a decision to adopt a certain program or practice ismade, preparation for implementation begins. This includes securing funding; hiringstaff; arranging space, equipment, and organizational supports; and creating newoperating policies and procedures.

Stage 3: Early Implementation Stage – At this stage, staff members have been hired,participants recruited or referred for program services, and organizational supports put in information for practitionersseeking to use evidence-basedpractices to enhance programoutcomes. This stage of implementation is often characterized by frequent problem-solving atpractice and program levels.

Stage 4: Full Implementation Stage – A program or practice is considered fullyimplemented when new staff members have become skilful in their service delivery, newprocesses and procedures have become routine, and the new program or practice is fullyintegrated into the agency or organization.

Stage 5: Sustainability Stage – When a program is no longer new, the focus ofimplementation becomes sustaining the program through continuous training forpractitioners and other staff members and seeking new funding to support the program infuture years. However, sustainability should not be thought of only as a sequential stagethat only follows full implementation, but should be an active part of each stage above.For example, it is important to identify and maintain funding and other start-up resourcesduring the early stages of implementation as well.

Stage 6: Innovation Stage – Once a program has been implemented effectively andadheres to the original model, an organization may choose to test innovations orimprovements. This step often involves consultation with the original program developeror expert consultants to ensure that essential elements of the program or practice are notlost when changes are made.

2)WHY IS IMPLEMENTATION IMPORTANT?

Effective implementation is as important as components of the intervention itself. For example, itis possible to implement an ineffective program well, or an effective program poorly. Neither ofthese approaches would lead to good outcomes for children and youth. Desirable outcomes aremore likely to happen when effective interventions are implemented well.Effective intervention practices + Effective implementation practices =Increased likelihood for positive youth outcomes

3)WHAT ARE THE MAJOR OUTCOMES ASSOCIATED WITH SUCCESSFUL IMPLEMENTATION?

Successful implementation involves activities and outcomes at the practice level, organizationallevel, and systems level. Practice-level changes are important because, in out-of-school timeprograms, practitioners are the ones who actually carry out the intervention. Simply put, there isno such thing as an “administrative”; all decisions and changes need to affect frontline practiceswith children and youth participating in out-of-school time programs. The successful andsustainable implementation of evidence-based practices and programs always requiresorganizational and systems change to support practice changes on the front line. It is, therefore,critical to align the following implementation activities on these three levels to ensure thatprograms will be able to achieve intervention outcomes:

a)Change the behaviour of practitioners and other key staff members – In order to adopta new program or practice, practitioners and other key staff members, such as supervisorsand program managers, will need to increase their knowledge and learn new skills relatedto the new program or practice.

b)Change the organizational structures, cultures, and climates – Changes in bothformal and informal organizational structures and cultures (i.e., values, philosophies, policies, procedures, and decision-making) are needed to bring about and support thechanges in staff.

c)Change systems and policies, as well as relationships with external partners –Changes in policies, management, and relationships with external partners are needed tosupport the implementation of the new practice or program. System-level partners mayinclude organizations or agencies that can help support the actual delivery of services orcan provide financial or human resources to support a program.

When implementation activities are not aligned on these three levels, the result is failed orfragmented implementation.

4)HOW IS SUCCESSFUL IMPLEMENTATION DIFFERENT FROM “IMPLEMENTATION AS USUAL?”

Just as evidence-based programs are designed to change “service as usual,” attention to soundimplementation strategies are designed to change “implementation as usual.” Below is adescription of three different attempts at implementing an evidence-based practice or program.Implementation as usual” often is characterized by paper or fragmented implementation, while“implementation for impact” demonstrates how the application of high-quality implementationstrategies can ensure that a newly implemented program or practice has the intended benefits forprogram participants.

a) Paper implementation – A program develops new policies and procedures to supportthe implementation of an evidence-based practice. Unfortunately, research indicates thatthe vast majority of implementation attempts stop here. In other words, the program isimplemented “on paper,” but no meaningful changes take place at the practice level tosupport the adoption of the program and the delivery of new services to programparticipants.

b)Fragmented implementation – A program puts new operating structures in place (suchas staff training sessions, workshops, and supervision) to support the implementation of anew program or practice directly. However, most of these new operating structures do not support the implementation of the new practice. For example, staff members may beexpected to run a life-skills group for adolescents but the training involves lectures. Staffmembers do not get to practice new skills, and the supervision provided to staff isunrelated to and uninformed by the training staff receives. In this stage ofimplementation, programs hope that implementation will take place, but in reality little ornothing changes at the practice level.

c)Implementation for impact – A program puts new procedures and operating structuresin place in such a way that they directly support the adoption of the new practice andbenefit program participants. In this case, implementation strategies are aligned at alllevels (organizational and practice). For example, training on the new program or practiceis provided for all levels of staff, including frontline staff, supervisors, and programdirectors, and frontline staff members are provided with on-going coaching andconsultation to ensure that they are implementing their new skills in ways that directlybenefit the youth they serve.“Implementation for impact” is the goal for all programs - implementing an evidence-based practice.

5)“WHAT WORKS” IN PROGRAM IMPLEMENTATION?

Recent implementation research has begun to identify “what works” in implementation, as wellas what does not work. For example, studies show that successful implementation processesappear to be independent of the content of the practice or program being implemented.Therefore, even though great variation exists in out-of-school time programs, these programswill most likely experience similar implementation problems and similar implementationsolutions.

6)SIX DRIVERS OF SUCCESSFUL IMPLEMENTATION

Below we list six basic components of implementation—or implementation drivers—that can beused by a program to carry out an evidence-based practice successfully. These drivers are not“stages” of implementation, but simply represent six components demonstrated by research to becritical for successful implementation. Therefore, when implementing a new program or practice,program directors may want to pay particular attention to these six core components. Thesedrivers are based on a list of core implementation components developed by the National

Implementation Research Network, based at the Louis de la Parte Florida Mental Health Institute

at the University of South Florida.

Driver 1: Staff recruitment and selection – Staff recruitment and selection involve recruiting,interviewing, and hiring new staff or redeploying existing staff within the program. Staffselection is a key component of implementation at every level, including selecting practitionerswho will actually deliver the services, and selecting the organizational staff members (trainers,coaches, supervisors) who will carry out the organizational changes needed to supportpractitioners in delivering the evidence-based practices. Whether an organization is planning touse existing staff or hire new staff, similar questions should be asked, including:

• Who is qualified to carry out the evidence-based practice or program that a programwants to implement?
• What methods will be used for recruiting and selecting those practitioners?
• Beyond academic qualifications or experience factors, what practitioner characteristicsare essential for carrying out the evidence-based practice “on the ground?”
• Whatcharacteristics or abilities will not or cannot be addressed through training and coaching?
• Do organizational staff members have a comprehensive understanding of the practicesbeing implemented?
• Are organizational staff members prepared to support practitioners in carrying out theevidence-based practices that are slated to be implemented?

Driver 2: Pre-service or in-service training – Training includes activities related to providingspecialized information, instruction, or skill development in an organized way to practitionersand other key staff members within the program. It is important to remember that staff membersat all levels require training when a new practice is implemented. The content of training willvary across out-of-school time programs, depending upon their priorities and the evidence-basedpractices that they have selected to implement. However, effective methods of training are lessvariable. Regardless of the content area, some specific training methods seem to work better thando others. Research indicates that effective training involves: