Discovering what

works for families

Implementation in action
A guide to implementing evidence-informed
programs and practices

Jessica Hateley-Browne, Lauren Hodge,

Melinda Polimeni and Robyn Mildon
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on family functioning and wellbeing. Views expressed in its publications are those of individual authors and may not
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 Implementation in action 1

About the authors

The authors of this guide are from the Centre for Evidence and Implementation (CEI). CEI is a global team of
research, policy and practice experts working with policy makers, governments, practitioners, program providers,
organisation leaders and funders to:
l understand the evidence base
l develop methods and processes to put the evidence into practice
l trial, test and evaluate policies and programs to drive more effective decisions and deliver better outcomes.

Assoc. Prof. Robyn Mildon is founding Executive Director of CEI. She is an internationally recognised leader with
a long-standing career focused on implementation of evidence to achieve social impact for children, families and
communities.

Dr Melinda Polimeni is a Director at CEI, and a registered psychologist and researcher specialising in program
design and implementation.

Dr Jessica Hateley-Browne is a Senior Advisor at CEI and a researcher specialising in implementation and
evaluation of evidence-informed approaches in human service delivery settings.

Dr Lauren Hodge is an Advisor at CEI and a researcher with expertise in delivering, implementing and evaluating
programs for children and families in community settings.

Acknowledgements
This document has been produced as part of the Families and Children Expert Panel Project funded by the
Australian Government through the Department of Social Services.
2 Australian Institute of Family Studies

Contents
About the authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
List of abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1 What is the purpose of this guide? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2 Who is this guide for?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3 How should I use this guide?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2. What is implementation science? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1 Why is good implementation important?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.2 What are the key concepts of implementation science? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3. Overview of implementation stages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Stage 1: Engage and explore. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Stage 2: Plan and prepare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Stage 3: Initiate and refine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Stage 4: Sustain and scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4. Stage 1: Engage and explore. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
4.1 Define what needs to change and for whom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
4.2 Select and adopt an evidence-informed program or practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
4.3 Set up an implementation team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
4.4 Consider likely enablers and barriers, and assess readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5. Stage 2: Plan and prepare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
5.1 Choose implementation strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
5.2 Develop an implementation plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
5.3 Decide how to monitor implementation quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
5.4 Build readiness to use the program or practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
6. Stage 3: Initiate and refine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
6.1 Initiate the program or practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
6.2 Continuously monitor the implementation process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
6.3 Make improvements based on monitoring data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
6.4 Adapt the program or practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
7. Stage 4: Sustain and scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
7.1 Sustain the program or practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
7.2 Scale-up the program or practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
8. A note of encouragement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Appendix A: Implementation stages – Deciding where to start tool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Appendix B: Implementation progress checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Appendix C: Implementation considerations checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Appendix D: Readiness Thinking Tool®. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Appendix E: Implementation plan template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
 Implementation in action 3

List of abbreviations
AIFS Australian Institute of Family Studies

CEI Centre for Evidence and Implementation

CFIR Consolidated Framework for Implementation Research

R=MC2 Readiness = Motivation x General-Capacity x Specific-Capacity

Glossary
Term Description
Acceptability The perception that a program or practice is agreeable, palatable or satisfactory

Appropriateness The perceived fit, relevance or compatibility of a program or practice

Evidence-informed Programs and practices that integrate the best available research evidence with practice
programs and expertise, and the values and preferences of clients
practices
Feasibility How successfully a program can be implemented or used within your setting

Fidelity The degree to which a program or practice was delivered as intended

Implementation A process that uses active strategies to put evidence-informed approaches into practice. It
is the process of understanding and overcoming barriers to adopt, plan, initiate and sustain
evidence-informed programs and practices.
Implementation Implementation barriers make the implementation process more challenging.
barriers
Implementation Implementation enablers increase the likelihood a program or practice will be successfully
enablers implemented.
Implementation plan A document that specifies what implementation strategies are being used, how they will be
actioned, when, and by whom
Implementation The effect of using implementation strategies to implement new programs, practices and
outcome services. It is different to a client outcome.
Implementation The study of how to improve the uptake of research findings and other evidence-informed
science practices into ‘business as usual’. It aims to improve the quality and effectiveness of human
services.
Implementation A technique that enhances the adoption, planning, initiation and sustainability of a program
strategy or practice. It is the ‘how to’ component of implementing a new program or practice.
Program outcome A specific change expected in the target population as a result of taking part in a program

Randomised A research design that allocates participants at random. This design aims to reduce selection
controlled trial bias and produce high-quality evidence.
Reach How well a program or practice has been integrated into an agency or service provider,
including the target population
Sustainability The extent to which a program or practice has become incorporated into the mainstream way
of working, rather than being added on
4 Australian Institute of Family Studies

1. Introduction

1.1 What is the purpose of this guide?

Implementation is both a science and an art. It’s the active process of integrating evidence-informed programs
and practices in the real world (Rabin & Brownson, 2018). Implementation focuses on ‘how’ a program or practice
will fit into and improve a service (Burke, Morris, & McGarrigle, 2012).

We’ve written this guide to help you implement evidence-informed programs and practices in the child and
family service sector. We encourage you to use it in conjunction with the recommended tools and resources
highlighted throughout the guide.

We developed this guide using best-practice recommendations from implementation science. It uses a staged
implementation process to guide your implementation activities (Metz & Bartley, 2012; Metz et al., 2015). The
guide outlines all stages and steps briefly, and provides links to useful online resources.

Our guide aims to:

l increase awareness about implementation science
l explain how high-quality implementation works
l explain why implementation science is important
l equip agencies and service providers to use implementation strategies
l explain how to adapt program or practice implementation strategies for different contexts
l explain how to monitor and measure implementation outcomes
l share useful tools and resources.

It also helps you to:

l explore different types of evidence-informed programs and practices
l decide if you’re ready to implement a program or practice
l identify implementation enablers and barriers
l identify and use implementation strategies
l initiate and refine your implementation process
l sustain and scale-up programs and practices.

1.2 Who is this guide for?

We wrote this guide for child and family service agencies, and their staff. It is relevant for both large and small
implementation initiatives.

Our guide may help:

l agencies and service providers that are planning to implement a new program or practice
l agencies and service providers that would like to refine or sustain an existing program or practice
l staff with varying levels of experience, including frontline practitioners; their team leaders and managers; senior
leaders in the organisations; and those who design or develop programs in the child and family service setting.

1.3 How should I use this guide?

You can use this guide to help you adopt, plan, initiate and maintain an evidence-informed program or practice in
the child and family services sector.

The guide has different sections explaining the different stages of implementation. Depending on where you’re
at in your implementation process, it may not make sense for you to follow the process exactly as outlined in
this guide. You can ‘dip in’ to the different sections of the guide based on what information you need. However,
if your agency or service provider is new to implementation science – or has limited experience implementing
evidence-informed programs or practices – you’ll probably benefit from reading the whole guide.
 Implementation in action 5

2. What is implementation science?

Implementation science is the study of methods and strategies to promote the uptake of evidence-informed
practices into ‘business as usual’, with the aim of improving service quality (Eccles & Mittman, 2006).
Evidence‑informed programs and practices are incorporated into ‘business as usual’ at very different speeds and
there is often a gap between what we know works and what’s being done in practice. There are many reasons
for this. Sometimes the research is difficult to access and translate into a real-world environment; sometimes the
evidence-informed program or practice is not a good fit for the local context; sometimes the service provider
or staff are not interested in making changes to how they work; and sometimes there are barriers relating to the
broader operating context, such as funding models. The field of implementation science aims to close this gap
between research and practice.

2.1 Why is good implementation important?

When your program or practice implementation is high-quality, the children and families receiving your services
are more likely to benefit from your service.

Many agencies and service providers now try to select and deliver programs and practices using the best
available research evidence (i.e. those proven to be effective, based on well-designed evaluation studies) and
best practice. Having an effective program or practice is necessary for good client outcomes. However, it is not
sufficient. Using programs and practices with a strong evidence base is important, but two common pitfalls
contribute to their potential not being realised:
l only focusing on ‘what’ program or practice to use, and ignoring ‘how’ the program or practice will be
implemented
l failing to consider influencing factors (such as enablers and barriers) that impact your ability to initiate and
sustain the program or practice.

You need to consider all these factors – the ‘what’, the ‘how’ and the influencing factors – to achieve the best
outcomes for children and families, as illustrated in Figure 1.

Figure 1: Factors to consider when improving client outcomes

Barriers/enablers
Factors that
hinder or help
implementation

What? How? Positive outcomes

Evidence-informed + Active and effective Benefits for the
program or practice implementation people you serve
6 Australian Institute of Family Studies

2.2 What are the key concepts of implementation science?

This section explains some key concepts of implementation science. We’ll highlight key ideas, themes and
assumptions used throughout this guide.

Implementation frameworks
Implementation frameworks explain the different stages and activities you’ll use when implementing a program
or practice. They provide a map and shared language for the implementation process. Many are applicable
across a wide range of settings – though some are better for particular types of interventions, or focus on
different aspects of implementation. During the past 20 years, researchers have developed many implementation
frameworks (Albers, Mildon, Lyon, & Shlonsky, 2017; Moullin, Sabater-Hernández, Fernandez-Llimos, & Benrimoj,
2015; Tabak, Khoong, Chambers, & Brownson, 2012).

Our guide outlines an implementation framework that integrates relevant concepts that are common across
existing frameworks frequently used in the child and family service sector (see Chapter 3 for more information).

Implementation stages
Implementation happens in stages. It is a process that unfolds – it’s not a single event. Your implementation
model should guide you through the different steps in your implementation process. It should help you decide
when to focus on each implementation activity – though the exact order of activities should not be fixed. Ideally,
you should tailor your implementation process to your needs and context. And while implementation does
happen in stages, the stages don’t always end exactly as another begins. The process isn’t always linear. For
example, timeline and funding pressures may mean that you need to move fast and cause stages to overlap (with
activities from two different stages happening at the same time). You may also experience setbacks that mean
you need to revisit a previous stage before you can progress further. For example, staff turnover may mean you
no longer have enough practitioners trained in the program or practice, resulting in a ‘pause’ on service delivery
while you recruit and/or train additional staff.

This guide outlines four stages (see Chapter 3 for more information):
1. Engage and explore
2. Plan and prepare
3. Initiate and refine
4. Sustain and scale.

Implementation enablers and barriers

Implementation enablers increase the likelihood a program or practice will be successfully implemented. Enablers
can include support from an organisation’s leadership, and the program or practice being a good fit for target
children and families.

Implementation barriers make the implementation process more challenging. Barriers can include a lack of
resources to deliver a program or practice, and low confidence in the program or practice among the people
delivering it. However, you shouldn’t give up on your implementation simply because you face barriers. It’s normal
to experience barriers. Your implementation will be successful if you can identify and overcome barriers early in
the process. You should continually monitor the enablers and barriers, as different influencing factors will emerge
during different stages of implementation. The process of assessing and identifying enablers and barriers is
described in Chapter 4.

Implementation strategies
Implementation strategies are techniques that improve the adoption, planning, initiation and sustainability of a
program or practice (Powell et al., 2019). They are the ‘how to’ components of the implementation process and
are used to overcome barriers.

So how do you decide which implementation strategies to use? Sometimes there is existing evidence showing
which implementation strategies are likely to be useful for implementing your particular program or practice.
Or, if you’re implementing a manualised program (i.e. a program which has been developed with a structured,
detailed manual that you usually need to buy a license for), the program developers may require you to use
 Implementation in action 7

particular implementation strategies. If you don’t have any suggested implementation strategies, you can tailor
your strategies based on the barriers you’ve identified and experienced in your program or practice.

For example, in Stage 1 (engage and explore) a key barrier may be a lack of information about the needs of the
children and families who participate in your service. You can overcome this barrier by compiling agency or
service provider data, such as demographics; client goals at baseline; child and family feedback; and outcomes
for families when they exit your program. During Stage 2 (plan and prepare), when you’ve already decided what
to implement, a barrier might be that staff lack the right experience and skills to implement the new program
or practice. You can overcome this by providing staff with interactive, skills-based training and post-training
technical assistance, such as coaching.

Chapter 5 explains how to identify and choose implementation strategies.

Implementation pace and planning

We don’t provide a recommended timeline for a high-quality implementation process, as it always varies
depending on your circumstances and context. However, it often takes two to four years for a well-structured
program to be fully implemented. The timeline and duration of your implementation process will depend on
the complexity and adaptability of your program or practice; the context of your implementation; and other
influencing factors, such as policy and funding priorities.

It’s important for your agency or service provider to prioritise your implementation planning and preparation
activities. Common pitfalls include:
l not investing enough time or resources during the early stages of implementation
l attempting to implement too many new programs and practices at once
l not reprioritising resources from an ‘old’ to a ‘new’ initiative.

Investing adequate time and resources during the early stages of implementation will reduce your efforts later
down the track. This short-term pain will result in long-term gain.

Implementation leaders and champions

Implementation leadership is the level of support leaders provide to implementation efforts. Leadership can
come from people who have formal organisational authority and can mandate and create change (including
executive leaders, middle management and team leaders), as well as from champions of the specific program
or practice who have informal influence in the organisation (including practitioners or other staff). The benefits
of having implementation leaders and champions are undisputed and should not be underestimated (Aarons,
Ehrhart, & Farahnak, 2014; Aarons, Ehrhart, Farahnak, & Hurlburt, 2015; Aarons, Ehrhart, Farahnak, & Sklar,
2014; Aarons et al., 2016). Effective implementation requires support, involvement and communication from
leadership. Leaders define the vision for your implementation. They also set expectations for staff behaviours
and performance; allocate resources for your implementation efforts; and determine how the implementation
is perceived throughout your organisation.

Indicators of high-quality implementation

To see how well your implementation process is going, you need to monitor your ‘implementation outcomes’
(Proctor et al., 2011). Implementation outcomes are the effects of using your implementation strategies. They
are indicators of the quality of implementation. For example, you can monitor how acceptable your program or
practice is to staff who are delivering it; how feasible the program or practice is in your context; and the fidelity
of program delivery (i.e. whether the program has been implemented as intended. See Chapter 5.3 for more
detail). Figure 2 illustrates the relationships between the ‘what’ (the evidence-informed program or practice),
the ‘how’ (implementation strategies), and implementation and client outcomes.

In summary, using relevant implementation strategies will improve the quality of your implementation (as shown
by improved implementation outcomes). This, in turn, improves client outcomes. This shows just how important it
is to monitor implementation quality, as well as client outcomes.

Consider this scenario: You evaluate a new program by assessing the outcomes for children and families, and you
find no beneficial effects. Unless you also assess the implementation outcomes, it’s unclear if the program had
no effect because it was poorly implemented (e.g. lack of program buy-in or fit; or program components were
skipped or not delivered as intended), or because it’s a truly ineffective program.
8 Australian Institute of Family Studies

Figure 2: The relationships between implementation strategies, implementation outcomes and client outcomes

Barriers/enablers
• Policy environment
• Leadership support
• Complexity of
program or practice
• Practitioner
attitudes towards
program or practice
• Practitioner skill in
program or practice

What? How? Implementation Client outcomes

outcomes
Evidence-informed Implementation • Family functioning
program or practice strategies • Acceptability • Parenting
Examples: Examples: • Feasibility self-efficacy
• Motivational • Establish • Appropriateness • Child safety and
interviewing implementation • Fidelity wellbeing
• Client feedback team • Reach
• Positive parenting • Training and
Program (Triple P) coaching
• Leadership
engagement

Source: Adapted from Lewis (2017), Lyon and Bruns (2019), Proctor et al. (2011)
 Implementation in action 9

3. Overview of implementation stages

Implementation is a process and it unfolds over a series of stages (Figure 3). Different implementation activities
are relevant during each stage.

Depending on where you’re at in your implementation process, it may not make sense for you to follow every
step in every stage, as outlined here. Consider which activities you’ve already completed, what decisions have
already been made and what makes sense in your context. You may skip some steps or start at a later stage. Use
the Implementation Stages – Deciding Where to Start tool (Appendix A) to help you determine where you are
up to, and which stage and step should come next. You can also use the Implementation Progress Checklist to
monitor your progress through the stages (Appendix B).

Figure 3: Stages of implementation

Stage 1: Engage and explore Stage 2: Plan and prepare

• Define what needs to change • Choose implementation
and for whom strategies
• Select and adopt program • Develop an implementation plan
or practice • Decide how to monitor
• Set up an implementation implementation quality
team • Build readiness to use program
• Assess readiness; or practice
consider barriers and
enablers

Stage 4: Sustain and scale Stage 3: Initiate and refine

• Sustain the program or • Start using the program
practice, embedding as or practice
‘business as usual’ • Continuously monitor and
• Scale-up the program improve
or practice
10 Australian Institute of Family Studies

Stage 1: Engage and explore

Define what needs to change and for whom: Is there a need or gap in your service? Who is affected by this need
or gap? Identify what these gaps are, then decide what outcomes you’d like from a new program or practice.

Select and adopt a program or practice: Look for existing programs and practices that could fill your gap.
Ensure they can meet your needs, can create the desired outcomes, are a good fit for your context and are
supported by evidence.

Set up an implementation team: Consider establishing a team that’s responsible for moving the program or
practice through the stages of implementation.

Consider likely enablers and barriers, and assess readiness: Identify enablers and barriers to implementation
that will occur early in the process, (noting enablers and barriers will need to be continuously monitored
throughout the stages). Focus particularly on the ways in which your organisation is ready – and unready – to
implement the program or practice.

Stage 2: Plan and prepare

Choose implementation strategies: Decide which implementation strategies are best to drive the
implementation process at each stage.

Develop an implementation plan: Develop an implementation plan that identifies how to put your
implementation strategies into action. Carefully plan what needs to be done; when and where it needs to happen;
how it is to happen; and who is responsible.

Decide how to monitor implementation quality: Identify the best indicators of implementation quality. Plan how
you will measure and monitor these during the implementation process.

Build readiness to use the program or practice: Ensure your organisation will be ready to start using the
program or practice. Use implementation strategies such as training, acquiring resources and adapting existing
practices.

Stage 3: Initiate and refine

Start using the program or practice: The first practitioners start using the program or practice.

Continuously monitor and refine: Use continuous quality improvement cycles to monitor the quality of the
implementation. Use this information to guide improvements or adaptations to your implementation.

Stage 4: Sustain and scale

Sustain the program or practice: Improve and retain your staff’s competency levels. Ensure your program or
practice is embedded into ‘business as usual’.

Scale-up the program or practice: If the first implementation attempts are stable, introduce the program or
practice to new teams, sites or contexts. This begins a new implementation process.
 Implementation in action 11

4. Stage 1: Engage and explore

An implementation process begins with an exploration of your current practices and context, and a consideration
of what needs to change to improve outcomes for children and families. During this stage, you also identify
potential solutions to bring about your desired changes.

During this stage, your aim is to make an informed decision about which evidence-informed program or practice
to adopt. You also need to assess your organisation’s readiness to implement this program or practice. As you
move through this process, engage as many internal stakeholders as possible. Consider running workshops or
other collaborative activities to explore their insights and understand their preferences and experiences.

To make good decisions about what program or practice to implement, you need to consider:
l the needs of the target population participating in your service
l the outcomes you’d like to achieve with and for children and families
l your agency or service provider’s capacity to implement the new program or practice
l the evidence proving the effectiveness of the program or practice you plan to implement.

4.1 Define what needs to change and for whom

Before you select your new program or practice, identify your target population and assess their needs. Focus
on the needs that are not being met by existing services. To avoid duplicating services within a region, identify
the needs not currently being met by any service – not just your own. A service-mapping exercise can aid in this
process. This exercise requires you to systematically review the service providers in your area and describe what
they offer your target population.

To assess the needs of the target population, use data that indicate the intensity of the problem. Involve all
relevant stakeholders who can help find solutions, including people from other service providers in your region.
This exercise helps to identify and define the problem you’re trying to solve with your new initiative.

Next, identify the outcomes you’d like the new initiative to bring about for children and families. These should be
measurable changes or benefits that are experienced as a result of your new program or practice. The outcomes
should relate to the problem you defined at the start of this step. For example, if the problem was defined as
children living in an unsafe home environment, relevant outcomes might include a decrease in child injuries and
adequate stimulation for children in the home environment. This process helps you to narrow down the possible
programs or practices under consideration. Using a program logic can help, as it draws out the relationships
between program or practice inputs (e.g. resources), outputs (e.g. key activities) and outcomes (e.g. benefits for
children and families). Refer to the Child Family Community Australia guidance for developing a program logic
for more information.1

Box 1 provides example questions that you can use when defining your target population, their needs and the
desired outcomes.

1 aifs.gov.au/cfca/expert-panel-project/program-planning-evaluation-guide/plan-your-program-or-service/how-develop-program-logic-
planning-and-evaluation
12 Australian Institute of Family Studies

Table 1: Questions to help define what needs to change and for whom

Define the target population

Will you work with children, youth, parents, carers or the family unit?
What are their key characteristics (e.g. age, geography, culture, ethnicity and family structure)?
What are their strengths?
What problems do they face?
What are the main factors contributing to these problems?
Define the needs
What are you (and others in your region) currently doing to address the problems defined above?
Which problems are not being effectively addressed? What are the gaps in service provision?
Do you have data that can help you see whether existing services (yours and others) are effectively addressing these
problems or not?
Considering the above answers, what emerges as the key problem or challenge?
What setting is best suited to addressing this problem (e.g. intervention in the home, school or community)?
Define the desired outcome
What benefits do you hope your clients experience as a result of a new initiative?
What changes do you hope to see for your clients as a result of the new initiative?

Using an outcomes framework can help you identify and describe which outcomes you’d like to create.
Examples include the NSW Government Human Services Outcomes Framework and the Victorian Public
Health and Wellbeing Outcomes Framework.

4.2 Select and adopt an evidence-informed program

or practice
Your next step is to identify existing programs or practices that have been proven to effectively address your
problem and bring about the desired outcome. Consider where you might find these programs or practices.
There are several menus and repositories of evidence-informed programs and practices,2 and these can help you
identify available interventions. The program or practice also needs to be:
l a good fit for your context. Ideally, it has been shown to work for your target population, in a similar setting.
l feasible. Your agency or service provider is able to obtain the necessary resources (e.g. funding, staff, meeting
rooms, vehicles) and capacity (e.g. relevant expertise, referral sources) to implement the program or practice.

You can use the Implementation Considerations Checklist tool (Appendix C) to guide decision makers through
the selection and adoption process.

The Implementation Considerations Checklist tool (Appendix C) can help you select a program that’s
appropriate and feasible for your context.

4.3 Set up an implementation team

Your implementation team will champion and drive your implementation process. It’s an internal team and its
purpose is to move the new program or practice through the implementation stages. It also solves problems
that arise due to implementation barriers. Establishing well-informed and collaborative implementation teams
(sometimes referred to as ‘coalitions’) can help your organisation to commit to high-quality implementation of
programs and practices (Brown, Feinberg, & Greenberg, 2010).

2 Several such menus exist; for example, Communities for Children Facilitating Partners Evidence-based Programme Profiles (apps.aifs.
gov.au/cfca/guidebook/), the Early Intervention Foundation Guidebook (guidebook.eif.org.uk/), and the California Evidence-Based
Clearinghouse for Child Welfare (www.cebc4cw.org/)
 Implementation in action 13

Should I establish an implementation team?

It isn’t always feasible or desirable to establish an implementation team. This may be due to staffing limitations, time
restrictions, and external or executive decisions. However, implementation teams may be useful in these circumstances:
l Where the new program or practice is complex or is a significant shift away from current practice.
l Where the implementation of the program or practice impacts staff from different parts of the organisation
(or across multiple sites).
l Where it’s unclear who’s responsible for implementing the program or practice.

Table 2 presents an overview of the implementation team’s purpose, composition and core capabilities.

Table 2: Implementation team’s purpose, composition and capabilities

Purpose Composition and capabilities

l Prepare the agency or service provider for Composition
implementation Representatives from various levels of staff within the
l Action the implementation strategies organisation, including:
l Monitor the implementation outcomes l team leaders
(e.g. acceptability, feasibility, appropriateness, l supervisors
fidelity and reach) l program managers
l Gather, review and describe any barriers to l practitioners.
implementation
l Develop and implement targeted solutions for Core capabilities
removing these barriers l Detailed knowledge of the selected program or practice
l Detailed knowledge of the implementing environment
(i.e. the agency, service provider, region, community,
families)
l Commitment to and expertise in implementation

Over time, the work of the team will be refined. The tasks and composition of the team can change as the
implementation stages progress. Be prepared to change the membership of the implementation team over time,
as needed. Consider:
l What core competencies are needed to drive the implementation at each implementation stage?
l Who has the skills, knowledge and decision-making authority to effectively facilitate the necessary
implementation activities?
l Which internal stakeholders need to be included?
l What organisational systems and policies are needed to support implementation?

Other considerations
When you’re establishing your implementation team, it’s essential to invest time in the initial implementation
team planning. You’ll need to:
l select team members
l ensure the team has the appropriate authority to implement changes and make decisions ‘in the room’ to
improve implementation
l develop accountability mechanisms, including tracking actions and scheduling regular meetings.

4.4 Consider likely enablers and barriers, and

assess readiness

Explore possible enablers and barriers

Early in the process, it’s helpful to consider likely enablers and barriers to implementation. You can start doing
this when you’re familiar with the program or practice you want to implement.

You should continue to monitor enablers and barriers throughout the implementation process, as different
opportunities and challenges are likely to emerge as the process unfolds. However, starting now will help you
14 Australian Institute of Family Studies

identify and address early barriers that could slow down the process and reduce momentum. It will also help you
to nurture the enablers which will help the new program or practice to flourish.

Some enablers and barriers will be obvious. For example, you may have a clear mandate from senior leadership
to use whatever resources it takes to initiate your new program. Or, conversely, you might not have enough
funding to support the program you’ve selected. Or, practitioners may need to be upskilled in the new practice
you are seeking to implement. Other enablers and barriers will be less obvious, though no less important.

You may find it helpful to take a structured approach when assessing enablers and barriers. This approach
can guide your thinking and help you to clearly see the obstacles to overcome and the existing enablers to
be maintained. One common approach for exploring enablers and barriers is the Consolidated Framework for
Implementation Research (CFIR) (Damschroder et al., 2009).

The CFIR identifies five domains that will influence your implementation process:
l characteristics of the program or practice itself (e.g. adaptability and cost)
l individuals involved in implementation (e.g. knowledge and beliefs about the program or practice)
l the inner context or setting (e.g. organisational culture and leadership engagement)
l the outer context or setting (e.g. client needs, and policy and funding priorities)
l the implementation process (e.g. planning, reflecting and evaluating).

The CFIR website3 describes the factors that influence implementation within each domain. It also contains tools
for identifying the specific enablers and barriers in each domain.

You can use the CFIR Interview Guide Tool4 to build a set of questions to guide your discussions. These
can also help you to assess the enablers and barriers that are most important in your setting. The
questions can be used for interviews with staff and they can guide the implementation team’s discussions,
as well as discussions with other decision makers during the implementation process.

Assess organisational readiness

Organisational readiness is an important aspect of your implementation. It is a key potential barrier (or enabler) to
consider at this early stage of implementation. It will help you know where to focus your efforts in the next stage.

Organisational readiness refers to the extent to which your organisation is willing and able to implement the
selected program or practice (Scaccia et al., 2015). Low organisational readiness is a common barrier at this
stage of implementation. However, it’s important to understand that ‘readiness’ is not a static condition. Your
organisation does not have to be 100% ‘ready’ at the very beginning of the implementation process. Some
aspects of readiness may not be present at first, but you can use implementation strategies to build them later.
Readiness may also decrease over time; for example, if key staff leave your organisation. You can reassess
your level of readiness at particular points during the implementation process and this can further inform your
decisions on what support or change is needed. For example, the very end of Stage 2 is a good time to reassess
readiness to check if the organisation is ready to initiate the practice.

A framework or tool can be useful to help to guide your assessment of organisational readiness. The Readiness =
Motivation x Capacity (General) x Capacity (Specific) framework (or R=MC2; Scaccia et al., 2015) describes three
factors that influence organisational readiness for implementation:
l the motivation of agency or service provider staff to implement the program or practice
l the general capacities of an agency or service provider
l the program- and practice-specific capacities needed to implement the intervention.

You can assess these three components using the Wandersman Center’s Readiness Thinking Tool® (see
Appendix D). This tool helps you to consider whether the different components are strengths or challenges for
your organisation. The tool also provides suggested discussion questions to help you respond to your readiness
assessment findings. The goal of this process is to identify how you can improve organisational readiness and
enhance the likelihood of implementation success.

3 cfirguide.org/constructs/
4 cfirwiki.net/guide/app/index.html#/
 Implementation in action 15

5. Stage 2: Plan and prepare

During Stage 2, the implementation team (or other decision makers) will plan and prepare for implementation.
During this stage, you’ll need to:
l choose implementation strategies
l develop and start using your implementation plan
l identify your implementation outcomes
l decide how to monitor the implementation process.

5.1 Choose implementation strategies

Implementation strategies are the ‘how to’ of implementation. You’ll use these strategies to overcome barriers, build
readiness and drive the implementation process. Choose the best strategies for your context, and the program or
practice you’re implementing. Some interventions, such as manualised programs, come packaged with specific
implementation strategies; for example, training requirements and quality monitoring. However, even these usually
have scope to add other implementation strategies at the local level if you need them. Other programs or
practices will not suggest which implementation strategies to use, so you’ll need to choose them yourself.

If you’re able to choose your own implementation strategies, one useful technique is to match the strategies to
the implementation barriers you’ve identified or experienced. The Expert Recommendations for Implementing
Change (ERIC) project identified more than 70 commonly used implementation support strategies that can be
used to drive the implementation process (Powell et al., 2015; Waltz et al., 2015). See Table 3 for some examples.
These strategies have been matched with common implementation barriers (defined using the CFIR) to create a
decision aid – the CFIR-ERIC Matching Tool.

Table 3: Example implementation strategies, adapted from the ERIC project

Implementation strategy Explanation

Access new funding Access new or existing money to help implement the program or practice.
Alter incentive structures Develop and use incentives to support, adopt and implement the program or
practice.
Audit and provide feedback Collect and summarise performance data over a specified time period. Give
the data to practitioners and administrators to monitor, evaluate and modify
behaviour.
Change physical structure and Adapt physical structures and/or equipment (e.g. changing the layout of a room or
equipment adding equipment) to best accommodate the program or practice.
Conduct educational meetings Hold meetings with different stakeholder groups (e.g. providers; administrators;
other organisational stakeholders; and community, client, and family stakeholders)
to build awareness, inform them and educate them about the innovation.
Conduct local consensus Talk with local providers and other relevant stakeholders to determine if the
discussions chosen problem is important to them and whether they think the new program or
practice is appropriate.
Conduct ongoing training Plan for and conduct ongoing training in the program or practice.
Develop and use tools Develop tools and processes to monitor implementation quality (as assessed
and processes to monitor against your implementation outcomes). Use them to create your continuous
implementation quality quality improvement cycle.
Develop and distribute Develop and distribute manuals, toolkits and other supporting materials that help
educational materials stakeholders to learn about the program or practice, and that teach practitioners
how to deliver the program or practice.
Identify and prepare champions Identify and prepare people who’ll dedicate themselves to driving an
implementation. They will help to support, market and overcome indifference or
resistance within the organisation.
Increase demand Attempt to influence the market for your new program or practice. Increase
competition intensity and increase the maturity of the market for your new
program or practice.
Inform local opinion leaders Identify local opinion leaders or other influential people and inform them about the
program or practice in the hope they will encourage others to adopt it.
16 Australian Institute of Family Studies

Implementation strategy Explanation

Make training dynamic Vary your training methods to cater for different learning styles and work contexts.
Ensure your training is interactive.
Mandate change Ask your leadership team to publicly declare that the new program or practice is a
priority and they’re determined to implement it.
Model and simulate change Model or simulate the changes that the implementation will require.
Provide follow-on technical Provide practitioners with ongoing coaching or clinical supervision. Use modelling,
support feedback and support to help them apply new skills and knowledge in practice.
Promote adaptability Identify how a program or practice can be tailored to meet local needs. Clarify
which elements to maintain to preserve fidelity.
Recruit, designate and train for Recruit, designate and train for the implementation effort.
implementation
Remind practitioners Develop reminder systems that help practitioners to remember important
information. This system can also prompt them to use the program or practice,
or to do other important implementation activities. Reminders could be client- or
encounter-specific, and they can be provided verbally, on paper or electronically.
Revise roles Shift and revise staff roles. Consider redesigning job characteristics. When you
revise roles, consider if they need to expand to cover both implementation and
provision of the program or practice. Also consider how to eliminate service
barriers to care, and include personnel policies.
Use an implementation advisor Seek guidance and support from an implementation expert.
Train-the-trainer Train designated team leaders, practice leads and partner organisations on how to
train others in the program or practice.

Source: Powell et al., 2015

You can use the CFIR-ERIC Matching Tool5 to help you decide which implementation strategies to
use. Input the implementation barriers you’ve identified into the tool and it will generate a list of
implementation strategies that experts think will best address these barriers.

Sometimes the CFIR-ERIC Matching Tool will generate a long list of potential strategies for addressing the
inputted barriers, and these won’t all be feasible in your context. While helpful, the Matching Tool can’t replace
careful thought and decision making based on your specific context. We’ve identified some guiding principles to
help you select the best implementation strategies for your context:
l Select implementation strategies that best describe the change in behaviour you require to overcome the
barriers you identified in Stage 1.
l Engage stakeholders (practitioners, leadership, clients, referrers and the community) to help you select the
best implementation strategies and develop actions for these strategies. Consider asking stakeholders to rate
the importance and feasibility for proposed implementation strategies to help you make the decision.
l Remember that implementation strategies can be one discrete action, or a collection of actions that are
interwoven, packaged up and aimed at addressing multiple barriers (Powell et al., 2012).

Once you’ve chosen your implementation strategies, develop specific actions to bring them to life. Table 4
provides examples of common barriers to implementation, and relevant strategies and actions that can be used
in the child and family services context to overcome each of the barriers.

5 cfirguide.org/choosing-strategies/
Table 4: Implementation barriers, implementation strategies and actions that are relevant to the child and family services sector

Relevant implementation
Barrier Implementation strategy Definition stage(s) Example actions
Low adaptability Promote adaptability Identify how to tailor the program Stage 1: Engage and assess l Ask stakeholders which adaptations
A program or practice or practice to meet local needs. Stage 4: Sustain and scale would make the program or practice more
seems promising but Clarify which elements of the appropriate for their context.
has been developed for program or practice must be l Clarify which components of the
a different context and maintained to preserve fidelity. program or practice must be maintained
target population. It’s not to preserve fidelity. Determine which
appropriate in its current program elements can be tailored to your
form due to cultural, linguistic local context (if any). You can do this by
and other reasons. checking information in program menus
or repositories, program manuals or
guidelines, or by speaking directly with the
developer of the program or practice.
l If permitted, introduce the adaptations
once they’ve been approved and fidelity
to the core components of the program
or practice is reached (usually during
Stage 4). Monitor their impact to see if the
adapted version of the program or practice
is more acceptable, a better fit and can be
delivered with fidelity.
Resistance to change 1. Conduct local 1. Talk with stakeholders about (1) Stage 1: Engage and 1. (a) Conduct workshops with practitioners
Practitioners aren’t consensus discussions whether the chosen problem assess and ask for their thoughts on how to
committed to the change 2. Conduct educational is important to them and (2) & (3) Stage 2: Plan and define the target population, their unmet
because they don’t believe a meetings what program or practice is prepare needs, and how to explore new programs
new program or practice is appropriate to address it. or practices that might meet their needs.
needed. 3. Identify and prepare
champions 2. Meet with stakeholder groups (b) Conduct group discussions with
and tell them about the program practitioners and leadership staff using
or practice. the questions in the Implementation
3. Identify and prepare people who Considerations Checklist (see Appendix C).
can motivate colleagues, model 2. Run group or one-on-one information
effective implementation and sessions with staff and practitioners.
overcome resistance to change. Explain the program or practice, including
potential benefits and the resources and
commitment required. Give your staff the
opportunity to ask questions and explore
their concerns.
3. During consultations, identify possible
implementation champions. Approach
them afterwards and chat with them
Implementation in action

about the positive behaviours you

observed. Try to enlist their support in the
implementation process.
17
 18
Relevant implementation
Barrier Implementation strategy Definition stage(s) Example actions
Low engagement Recruit, designate and Recruit, designate and/or train Throughout the whole Implementation leaders need to continuously
from leadership train for leadership leaders to drive the implementation implementation process communicate the vision, purpose and
Key managers are process expectations for program implementation. Their
not committed to, or aim is to inspire and encourage staff to adopt
actively involved in, the the new way of working. You may need to:
implementation process. l Clearly designate who will lead the
implementation process.
l Recruit staff who will help drive the
implementation. Don’t assume current
personnel can implement the change.
Australian Institute of Family Studies

l Make clear professional development plans for

existing leaders. Help to build their capacity
ahead of major implementation efforts.
Limited evaluation of the 1. Develop and use 1. Develop tools and processes for (1) Develop in Stage 2: Plan (1 & 2) Plan how to collect and monitor
implementation process tools and processes monitoring the quality of the and prepare data that can inform your decisions about
for monitoring implementation, according to (1) Use in Stage 3: Initiate and how to improve practice or implementation
implementation the implementation outcomes. refine processes. The data should show if the
quality Use these to inform your (2) Stage 3: Initiate and refine program or practice is being used, how
2. Audit and provide continuous quality improvement well it’s being used, if it’s being used with
feedback cycle. fidelity; that is, as intended, the quality of
2. Collect and summarise the implementation process, and the impact
performance data over a of the program or practice on clients. You
specified time period. Give it to should decide and put into practice:
practitioners and administrators l the specific data points to collect
to monitor, evaluate and modify l how to best collect, store, manage and
behaviour. interpret the data
l how to communicate the data so it informs
decision making
l who is responsible for collecting, analysing
and reporting back on the data.
(1 & 2) Consider how you can use the
data you already have or routinely collect
(e.g. intake data and client feedback) and
systems and processes that already exist
(e.g. client database and case-noting)
to monitor implementation quality and
auditing performance.
 Relevant implementation
Barrier Implementation strategy Definition stage(s) Example actions
Low self-efficacy 1. Conduct ongoing 1. Plan for and conduct ongoing 1. Stage 2: Plan and prepare 1. Ensure all practitioners, team leaders,
Practitioners are not training training in the program or & Stage 3: Initiate and supervisors and managers can access
confident in their own ability 2. Make training practice. refine training in an ongoing way. Consider
to implement and deliver the dynamic 2. Vary your training methods to 2. Stage 2: Plan and prepare incentivising participation.
program or practice to a high cater to different learning styles 2. Use adult learning principles to design
standard. 3. Provide follow-on 3. Stage 3: Initiate and refine
coaching and work contexts. Ensure your training in the new program or practice.
training is interactive, with a Consider using web-based technology to
focus on skill-building. reach a broader audience and make the
3. Use skilled coaches to provide delivery more flexible.
ongoing modelling, feedback 3. Training alone is usually not sufficient to
and support for staff. These create a change in practice. Supplement
coaches help staff apply their training with follow-on coaching by
new skills and knowledge in experts in the program or practice. This
practice. They can be either will help practitioners to turn their new
internal or external to your knowledge into practice. Training takes
organisation. place at the end of Stage 2 and coaching
can start at Stage 3.
Consider a coach-the-coach model. In this
model, an expert gives intensive coaching
to an existing team leader or supervisor,
who in turn coaches the practitioners in
their team.
Implementation in action
19
20 Australian Institute of Family Studies

5.2 Develop an implementation plan

It’s important to plan your implementation carefully. Planning will help you identify and address many of the
common barriers before they start to cause issues. It will also help you to establish the right implementation
strategies to overcome or minimise the barriers. The implementation plan is best developed collaboratively by
those on your implementation team (or other key decision makers if you have not set up a team). You can amend
and adapt the plan over time. You may need to reconsider your priorities as conditions change and new barriers
emerge. The implementation plan can also be used to record implementation enablers, ensuring there is a plan in
place for maintaining them throughout implementation.

Your implementation plan should include:

1. the implementation barriers (identified in Stage 1)
2. the implementation strategies and specific actions you will take to overcome each of the barriers (chosen in
Stage 2)
3. who will deliver on each action
4. timeframes, milestones and due dates for each action.

Depending on your needs, your implementation plan may also include:

l a record of implementation enablers, and strategies and actions for how to maintain them
l a register of all the risks you’ve identified during implementation
l an implementation quality monitoring plan (described in Chapter 5.3)
l an activity tracker (to track the progress of your implementation strategies and actions)
l any other information that can help guide your process.

You can use the Implementation Plan Template (Appendix E) to help the implementation team or other
decision makers to map out their plan. For another example, see this template developed by the National
Clinical Effectiveness Committee.6

5.3 Decide how to monitor implementation quality

The only way to know if your implementation is going well is to monitor its progress. This needn’t be an onerous
task. Firstly, you’ll need to decide which data will be most useful. Choose data that will show when you need to
adjust and improve the implementation process, or your new program or practice. You’ll also need to ensure you
collect and review data regularly. The best implementation monitoring plans use continuous quality improvement
cycles during Stage 3 – once you’ve started the new practice or program (see Chapter 6.3). Ideally, they should
also help you identify any unintended consequences (both positive and negative), which can inform future
implementation efforts, such as scaling-up to other teams or sites (see Chapter 7.2).

Your implementation monitoring plan should track your key implementation outcomes (i.e. is the program being
implemented and how well?). These are different to your program outcomes, which describe the desired changes
for children, parents, carers, families and caregivers (i.e. is the program making a difference for people using the
service?). Implementation outcomes indicate the quality of your implementation. An evidence-informed program
or practice that’s implemented well (i.e. has good implementation outcomes) has the best chance of delivering
benefits for children and families (see Figure 2 in Chapter 2).

Your implementation team or other decision makers should select which outcomes to monitor, ideally before the
new program or practice has started. However, if the program or practice has already started, it’s not too late to
put monitoring measures in place. You can do this any time.

Table 5 includes some key implementation outcomes, alongside some simple, good-quality measurement
methods and tools. We also encourage you to consider additional outcomes and measures that are appropriate
for your context.

6 health.gov.ie/wp-content/uploads/2018/09/Tool-4-Implementation-Plan.pdf
 Implementation in action 21

It’s important to consider the quality of your measurement tools. This includes psychometric
considerations such as reliability, validity and sensitivity, as well as practical considerations such as length,
language and ease of use.

Table 5: Implementation outcomes and suggestions for measurement

Implementation outcome Definition How to measure

Acceptability The perception among l Qualitative interviews with people who deliver
stakeholders that a program or the program or practice (e.g. using CFIR
practice is agreeable, palatable or Interview Guide Individual Characteristics
satisfactory questions)
l Quantitative survey tool such as the
Acceptability of Intervention Measure (AIM)
Feasibility The extent to which the program l Qualitative interviews with people who deliver
or practice can be successfully the program or practice (e.g. using CFIR
used or carried out within your Interview Guide Intervention Characteristics
setting questions)
l Quantitative survey tool such as the Feasibility of
Intervention Measure (FIM)
Appropriateness The perceived fit, relevance or l Qualitative interviews with people who deliver
compatibility of a program or the program or practice (e.g. using CFIR
practice Interview Guide Intervention Characteristics Inner
Setting and Outer Setting questions)
l Quantitative survey tool such as the Intervention
Appropriateness Measure (IAM)
Fidelity The extent to which a program l Self-report practice checklists for practitioners
or practice is being delivered as l Client interviews or questionnaires regarding the
intended aspects of the program they’ve experienced
Reach The degree to which a program l Administrative data
or practice is integrated into an
agency or service provider setting,
including the degree it effectively
reached the target population.

Your fidelity measures should be tailored to the program or practice you’re implementing. The EPIS Centre
website (www.episcenter.psu.edu/fidelity) provides examples of existing fidelity measures for a range
of programs in the child and family service sector. The best fidelity measures or checklists allow for
assessment of how often the program or practice is used, and how extensive its reach is. They also track
the competence and quality of program or practice use.

The Society for Implementation Research Collaboration (SIRC) is currently developing a repository of
tools (see societyforimplementationresearchcollaboration.org/sirc-instrument-project/) that measure
implementation outcomes. The repository includes information on the psychometric properties (e.g.
reliability, validity) and pragmatic qualities of each tool. The repository is a work in progress and available
to paid members of SIRC.

Table 5 includes three short, simple and freely accessible implementation outcome measures with good
psychometric properties: AIM (to measure acceptability), FIM (to measure feasibility) and IAM (to measure
appropriateness). All three have been developed and validated by Weiner and colleagues (2017) and are
available as a free download.7

7 The Creative Commons license for the article is http://creativecommons.org/licenses/by/4.0/

22 Australian Institute of Family Studies

5.4 Build readiness to use the program or practice

Now it’s time to build your organisation’s readiness to implement the program or practice. Start using the
implementation strategies and activities in your implementation plan that are relevant at this early stage. Some
strategies, such as ongoing and skills-based training and identifying and preparing champions, will need to be
used during Stage 2 so you can start to build readiness before you start the program or practice. You may also
need to use other strategies in your implementation plan later in the implementation process (e.g. follow-on
coaching, which would only start after the program or practice has been initiated in Stage 3).
 Implementation in action 23

6. Stage 3: Initiate and refine

During Stage 3, you’ll start using the program or practice for the first time. By this point, staff will be trained in
the program or practice, and the necessary systems to support your implementation will be established (e.g. the
plan for data collection and monitoring; leadership engagement; and support). It’s very important to collect and
respond to the monitoring data in this stage. You’ll need to focus on continuously improving the implementation
of the program or practice and responding to the new implementation barriers that emerge as you begin using
the program or practice. Try to identify and respond to these barriers in a timely way.

6.1 Initiate the program or practice

Practice is initiated when the first practitioners have started using the new program or practice. You may choose
to initiate your program or practice with just one team or a small number of teams. In the early days, even your
highly experienced staff may feel challenged because the program or practice itself, or the implementation
activities, may be unfamiliar. They may perceive the new program or practice to be unhelpful, or even
burdensome.

If your implementation plan includes post-training implementation strategies, such as follow-on coaching, they
should be actioned now.

6.2 Continuously monitor the implementation process

Now it’s time to start monitoring implementation quality, according to the plan you made in Stage 2 (see
Chapter 5.3). You should also continue to look for new enablers and barriers to implementation (see Chapter 4.3
for some suggestions for how to do this). Use the information from your quality monitoring to help you
decide if you need to review your implementation strategies and how you might do that. Share summaries of
your monitoring data at your implementation team meetings (or meetings with other decision makers) and
identify and explore barriers regularly together. This will ensure the information you collect gets used to inform
decisions on how to improve the implementation process. It will also ensure any unintended consequences from
implementing the new program or practice are noticed, reviewed and responded to. This could include staff
burnout as a result of feeling over-stretched, and unexpected costs being incurred during implementation.

Be curious about the information and data you’re collecting. The purpose is not to judge whether the
implementation ‘succeeded’ or ‘failed’. Rather, the purpose is to bring some of the barriers to light so you can
respond to, minimise or overcome them.

6.3 Make improvements based on monitoring data

Regularly review your monitoring data. Your reviews may show that some implementation strategies or actions
in the implementation plan (see Chapter 5.2) don’t meet your needs and should be adjusted. This is a normal
part of the implementation process. For example, you may find that you need to provide top-up training or
more intensive coaching in the program or practice to help practitioners to build their skills and confidence. Or,
you may find that referral rates are slowing down and you need to undertake more promotion and educational
outreach activities to boost referral numbers.

When you identify barriers, draw on the resources of the implementation team or other decision makers to
decide how to respond to them and improve your implementation process. Use your data to inform your
decisions about how to make improvements. Once you’ve decided how to revise your implementation strategies,
update your implementation plan to record the new actions you’ve committed to. Remember to note who will be
responsible for each action and when each action is due to be completed.

It’s important to keep monitoring implementation quality, enablers and barriers after introducing potential
solutions. If nothing changes, you know the ‘solution’ you introduced is not working. You’ll need to try a new
implementation strategy or revisit your understanding of the barrier you’re trying to overcome. Figure 4
illustrates this continuous quality improvement cycle.
24 Australian Institute of Family Studies

Figure 4: Continuous quality improvement cycle

Monitor

Respond Review

Applying this cycle during implementation will help you to quickly determine whether you need to make changes
to the program or practice to improve the fit between your context, and the new program or practice. As you
become more familiar with the improvement cycle, data-informed decision making will become easier and more
natural. What may have felt challenging at the beginning of this phase will likely become routine.

Consider this example

A plan is developed to implement and monitor a new parenting program for families at risk of government
child protection services involvement. The program is implemented and administrative data are collected
to monitor whether the target population is being reached (monitor). After a few months of program
implementation, the administrative data show the parenting program is not reaching the intended target
population of families; however, enrolment targets are being met (review). The implementation team
investigates why this is the case; however, they need more information.

They can gather this information by reviewing the cases accepted at intake and discussing the issue
with relevant staff. Questions arise, like: Are the external referrals into the program inappropriate, but
being accepted at intake anyway? If so, they may need to ensure there’s clearer communication with
external stakeholders and undertake additional promotion of the program. Or perhaps practitioners are
self-selecting ‘easy’ children and families for the program, and putting those who reflect the true target
population on a wait list? This may suggest that practitioners aren’t confident with the new approach.
They may need additional encouragement (e.g. praising efforts) and support (e.g. reduced caseload or
administrative duties) from leadership, or more intensive coaching to build confidence in the program
elements (respond).

This example shows how implementation teams can make data-informed decisions to effectively address
barriers that can threaten high-quality implementation. Once you decide how to respond, you’ll need to
update and action your revised plan. Then the cycle starts again.
 Implementation in action 25

6.4 Adapt the program or practice

If you choose to adapt your program or practice at this stage, ensure you take a very considered approach. First,
get a clear sense of the ‘core components’ versus the ‘flexible components’ of the program or practice you’re
using. Core components directly reflect the underlying theory and mechanisms of change that the program was
built on, and cannot be changed. Flexible components are not directly related to the theory and mechanism of
change, and may offer scope for local adaptations. We suggest you seek advice from the program developer or
purveyor about which components are core and which are flexible before embarking on an adaptation process.

There is some evidence to suggest local adaptations may be beneficial to implementation, encouraging buy-in
and ownership, and enhancing the fit between an intervention and the local setting (Lendrum & Humphrey, 2012).
However, too much flexibility can take away from a program’s effectiveness, particularly when modifications are
made to the core components of the intervention. If you find lots of adaptations are needed to fit your context,
you may want to revisit your initial decision to adopt that particular program or practice.

Practitioners can feel frustrated when they’re delivering manualised programs with many fixed, core components.
These types of programs can be perceived as inflexible and you may find program fidelity (i.e. delivering the
program exactly as it was designed and intended) pitted against a practitioner’s sense of autonomy and ‘practice
wisdom’. However, it can be more helpful to view program fidelity as a guide to understanding where to be ‘tight’
and where to be ‘loose’. Practitioners should stick tight to the core components of an intervention until they fully
understand them, and can apply and use them in daily practice. Only then should you begin to introduce local
adaptations. A good fidelity measure will enable you to actively and accurately monitor the core components
and will show you when adaptations can be introduced.

Core components may include the content and mode of delivery of a program. Flexible components
may include the program packaging and promotional material, which can be adapted to use different
languages and images that best reflect the local context.
26 Australian Institute of Family Studies

7. Stage 4: Sustain and scale

During this stage, you’ll aim to achieve ‘full implementation’. This means your practitioners routinely apply the
program or practice, and it’s integrated into ‘business as usual’. There are no fixed rules defining exactly when
scale-up should take place, although we’ve outlined several considerations below.

7.1 Sustain the program or practice

Your program or practice can be considered sustainable when it becomes an integrated or mainstream way of
working. It’s sustainable when it’s embedded as ‘business as usual’ and is part of routine practice; when it’s no
longer a ‘new’ or ‘extra’ part of your service delivery. You know your program or practice is sustainable when
practitioners no longer revert to old ways of working or previous levels of performance, and don’t drop core
elements of the implementation process over a sustained period of time (e.g. two years). However, this doesn’t
mean your implementation efforts stop. During this stage, you should:
l continue to apply your continuous quality improvement processes, ensuring your data remain relevant and useful
l use relevant implementation strategies to ensure consistent quality of implementation (e.g. ongoing coaching)
l acknowledge and reward good implementation efforts.

Sustainment requires adequate and ongoing funding. It requires a good program or practice-context fit, and
sufficient capacity to train new and replacement staff. It also requires ongoing support and stable stakeholder
commitment. Constant change is a normal part of the child and family service sector, so it’s important to ensure
you’re always ready to adapt to change. This means you need to consider sustainment from the very beginning
of your implementation process.

7.2 Scale-up the program or practice

When you successfully implement a new program or practice, it can create great enthusiasm in organisations and
communities, and should be celebrated. As you will know by this stage, implementing a new program or practice
isn’t always easy! Success can spur decision makers into expanding the program or practice. They may choose
to implement it at a greater scale in identical, or slightly different, contexts. Both situations require cautious
decision-making, guided by questions like:
l Did we achieve the implementation and client outcomes we intended? Does our data support this?
l Have these outcomes been positive and stable over time?
l Do we expect major changes to the current implementation context within the foreseeable future (e.g. policy
or funding reform)?

If the answers to these questions indicate the initial implementation is stable, it may be natural to scale up or out.

Scaling is the process of implementing the same program or practice to other teams, sites, service providers
or agencies. You should try to use the lessons you learned from the initial implementation process to identify
potential enablers and barriers during expansion, as well as predict which implementation strategies you
require. It can help to revisit the implementation plan from your initial implementation to review the barriers you
identified, encountered and overcame at each stage, including any unintended consequences of implementation
that needed to be addressed along the way.

Scaling up or out can be like an entirely new implementation process. It will lead your organisation back to some
of the steps in earlier implementation stages, starting a new implementation process. For example, organisational
readiness should be assessed with each new team or site, as their context and resources may differ. You’ll
probably need a separate implementation plan for each new implementing team or site.

If you plan to scale up the program or practice across a service system, ensure it’s not mandatory for all sites and
isn’t tied to compliance requirements. Implementation of the program or practice will be most successful if the
potential implementation sites have agency over the decision, and if they believe the approach will be beneficial.

Implementation teams and other implementation champions will be important resources during this stage. They
can inform and guide the scaling process. Similarly, coaches who supported local implementation efforts and
helped practitioners to learn and acquire new skills can help to share their skills and knowledge on a broader scale.
 Implementation in action 27

8. A note of encouragement
Using good implementation practices can seem like a lot of work – and in many ways they are. They require
careful planning, thoughtfulness, resourcefulness and dedication. However, even though high-quality
implementation takes time and effort, this investment of resources pays dividends later – in the form of
more sustainable and effective service delivery for children and families. For further help, you can access
implementation support from a number of specialist organisations.

When you use the principles and processes outlined in this guide, you’ll become more familiar with what’s
required to achieve high-quality implementation. Actively using this guide will help you turn your knowledge of
the concepts into practical skills. Try applying the implementation framework outlined in this guide to your next
initiative. See what fits in your context, and what activities or approaches may need to be adapted or tailored. By
using this approach step by step, you’ll build your confidence and capacity to lead implementation efforts in your
context, for the ultimate aim of improving outcomes for the children and families using your service.
28 Australian Institute of Family Studies

References
Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The implementation leadership scale (ILS): Development of a brief measure
of unit level implementation leadership. Implementation Science, 9(45).
Aarons, G. A., Ehrhart, M. G., Farahnak, L. R., & Hurlburt, M. S. (2015). Leadership and organizational change for implementation
(LOCI): A randomized mixed-method pilot study of a leadership and organization development intervention for evidence-
based practice implementation. Implementation Science, 10(11).
Aarons, G. A., Ehrhart, M. G., Farahnak, L. R., & Sklar, M. (2014). Aligning leadership across systems and organizations to develop
a strategic climate for evidence-based practice implementation. Annual Review of Public Health, 35, 255–274.
Aarons, G. A., Green, A. E., Trott, E., Willging, C. E., Torres, E. M., Ehrhart, M. G. et al. (2016). The roles of system and organizational
leadership in system-wide evidence-based intervention sustainment: A mixed-method study. Administration and Policy in
Mental Health and Mental Health Services Research, 43(6), 991–1008.
Albers, B., Mildon, R., Lyon, A. R., & Shlonsky, A. (2017). Implementation frameworks in child, youth and family services – Results
from a scoping review. Children and Youth Services Review, 81, 101–116.
Brown, L. D., Feinberg, M. E., & Greenberg, M. T. (2010). Determinants of community coalition ability to support evidence-based
programs. Prevention Science, 11(3), 287–297.
Burke, K., Morris, K., & McGarrigle, L. (2012). An Introductory Guide to Implementation. Dublin: Centre for Effective Services.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation
of health services research findings into practice: A consolidated framework for advancing implementation science.
Implementation Science, 4(50).
Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation Science, 1(1).
Lendrum, A., & Humphrey, N. (2012). The importance of studying the implementation of interventions in school settings. Oxford
Review of Education, 38(5), 635–652.
Lewis, C. (2017). What are implementation mechanisms and why do they matter? Paper presented at the 2017 Society for
Implementation Research Collaboration (SIRC) Conference, Seattle, WA.
Lyon, A. R., & Bruns, E. J. (2019). From evidence to impact: Joining our best school mental health practices with our best
implementation strategies. School Mental Health, 11(1), 106–114.
Metz, A., & Bartley, L. (2012). Active implementation frameworks for program success. Zero to Three, 32(4), 11–18.
Metz, A., Bartley, L., Ball, H., Wilson, D., Naoom, S., & Redmond, P. (2015). Active implementation frameworks for successful
service delivery: Catawba County Child Wellbeing Project. Research on Social Work Practice, 25(4), 415–422.
Moullin, J. C., Sabater-Hernández, D., Fernandez-Llimos, F., & Benrimoj, S. I. (2015). A systematic review of implementation
frameworks of innovations in healthcare and resulting generic implementation framework. Health Research Policy and
Systems, 13(16).
Powell, B. J., Fernandez, M. E., Williams, N. J., Aarons, G. A., Beidas, R. S., Lewis, C. C. et al. (2019). Enhancing the impact of
implementation strategies in healthcare: A research agenda. [Perspective]. Frontiers in Public Health, 7(3).
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C. et al. (2012). A compilation of strategies for
implementing clinical innovations in health and mental health. Medical Care Research and Review, 69(2), 123–157.
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M. et al. (2015). A refined compilation
of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.
Implementation Science, 10(21).
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A. et al. (2011). Outcomes for implementation research:
Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and
Mental Health Services Research, 38(2), 65–76.
Rabin, B., & Brownson, R. (2018). Terminology for dissemination and implementation research. In R. C. Brownson, G. A. Colditz &
E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (Vol. 2, pp. 19–45).
New York: Oxford University Press.
Scaccia, J. P., Cook, B. S., Lamont, A., Wandersman, A., Castellow, J., Katz, J. et al. (2015). A practical implementation science
heuristic for organizational readiness: R=MC2. Journal of Community Psychology, 43(4), 484–501.
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.
Waltz, T. J., Powell, B. J., Matthieu, M. M., Damschroder, L. J., Chinman, M. J., Smith, J. L. et al. (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(109).
Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S. et al. (2017). Psychometric assessment of three newly
developed implementation outcome measures. Implementation Science, 12(108).
 Implementation in action 29

Appendix A: Implementation stages – Deciding

where to start tool
Implementation stages: Deciding where to start
This tool is designed to help you determine which stage you are currently at to allow you to start using the
implementation guide at the stage that is most appropriate for your initiative.

Do you have a program or practice

selected for implementation?

You are in Stage 1.

Start with ‘Define what
needs to change, for whom’.

Have you started to use the

program or practice?

Have you set up an

You are in Stage 3. implementation team?
Start with Stage 3, but check
that the relevant activities in
Stage 2 are complete.

You are in Stage 1.

Start with ‘Set up an
implementation team’
(if using).
Have you assessed
organisational readiness?

You are in Stage 1.

Start with ‘Consider likely
enablers and barriers, and
assess readiness’.
Have you developed an implementation plan with clear
strategies to improve readiness for implementation?

You are in Stage 2.

Start with ‘Choose implementations strategies’
and ‘Develop an implementation plan’.
Do you know how you
will monitor implementation?

You are in Stage 2.

Start with ‘Decide how to
monitor implementation quality’.

Are you ready to start using

the program or practice?

You are in Stage 3. You are in Stage 2.

Start with ‘Start using the Start with ‘Build readiness to
program or practice’. use the program or practice’.
30 Australian Institute of Family Studies

Appendix B: Implementation progress checklist

Use the following checklist to track your implementation progress. Further descriptions of each step are defined
in the Implementation Guide sections 4–7.

This checklist is intended to be used as a progress monitoring and planning tool to assist implementation teams
and other decision makers in keeping the implementation process on track.

When using this tool, remember that the implementation process is often non-linear, with overlapping stages and
activities. Depending on where you are already at in your implementation process, it may not make sense for you
to follow every step in every stage as outlined here. Depending on what activities have already been undertaken,
what decisions have already been made, and what makes sense in your context, you may decide to skip some
steps, or to start in a later stage or step. Given this, it may be useful to tailor the tool to reflect your context and
circumstances before using.

Status (please tick)

Not
Key implementation activities and requirements commenced Commenced Complete
STAGE 1: ENGAGE AND EXPLORE

Target population and the need or gap that needs to be filled

has been identified.

Desired outcomes of the program or practice have been

defined.

An existing program or practice that meets the defined need

and will bring about the desired outcome has been identified,
and is a good fit for your context.

Implementation team has been established (if using).

Early enablers and barriers have been assessed and identified,

including organisational readiness.

STAGE 2: PLAN AND PREPARE

Implementation strategies have been chosen.

An implementation plan has been developed.

Indicators of implementation quality have been decided on.

A plan for monitoring indicators of implementation quality has

been developed.

Readiness has been built by using implementation strategies

such as training and acquiring/adapting resources and
infrastructure.
 Implementation in action 31

Status (please tick)

Not
Key implementation activities and requirements commenced Commenced Complete
STAGE 3: INITIATE AND REFINE

The first practitioners have started using the program or

practice.

Implementation quality monitoring processes have commenced. n/a

Processes to review data and respond to monitoring data have

n/a
commenced.

STAGE 4: SUSTAIN AND SCALE

Staff competencies and skills have been further improved.

Continuous quality improvement processes are continuing to

n/a
be used.

Acknowledged and rewarded good implementation efforts. n/a

The first implementation has stabilised.

Opportunities for scaling up or scaling out of the program or

practice have been identified.

A new implementation cycle for the scale-up / scale-out has

been started.
32 Australian Institute of Family Studies

Appendix C: Implementation considerations

checklist
This tool will guide you through important considerations for implementing programs and practices. Use the
prompting questions to explore whether the program or practice you have in mind is a good fit and feasible for
your context and circumstances. Use the checklist to make sure you have collected all the information about the
program or practice that you need in order to have an informed response to each of the guiding questions. This
information may be found by:
l searching menus or repositories of evidence-informed programs and practices8
l reading the program or practice manuals and guidelines
l communicating directly with the program or practice developer.

There are no right or wrong answers to the questions. Rather, they should be used to guide your research and
your thinking about what program or practice to implement at your agency or service.

8 Several such menus/repositories exist; for example, Communities for Children Facilitating Partners Evidence-based Programme
Profiles (apps.aifs.gov.au/cfca/guidebook/), the Early Intervention Foundation Guidebook (guidebook.eif.org.uk/), and the California
Evidence-Based Clearinghouse for Child Welfare (www.cebc4cw.org/).
 Implementation in action 33

Questions to be considered by the Checklist to ensure you have the information

Topic / issue implementing agency or service provider you need to inform your choice
STAFF & TRAINING SUPPORT
Staffing l How many staff will be needed (at a Staffing requirements
minimum) to deliver the program or
practice successfully over time? Minimum qualifications required for
l Are the staff you need already employed program staff
at your service or agency, or will new staff
need to be recruited?
l Does the program or practice you are
considering specify qualification or
education requirements for practitioners?
Are these consistent with the common
qualifications in the workforce that is
available to you?
l How will staff turnover be addressed? What
approach will you take to ensuring any new
staff that join the implementing team have
the required training and support to deliver
the program or practice?
Training l What training is required for staff to be able Compulsory training requirements –
to deliver the program or practice? both basic pre-training and ongoing
l Can this training be delivered by the (e.g. booster) training activities
agency or service provider internal staff, or
will it require external support? Minimum number of trainees for a training
to be conducted (if relevant)
l If external:
– Is this training support available in How to access external training support
Australia, or will you need to access a (if required)
trainer from overseas?
– Does the provision of training depend
on a minimum number of trainees?
How many staff will attend training?
Supervision / l What existing supervision and coaching Supervision and coaching practices
Coaching practices and processes (e.g. opportunities defined by the program or practice
for reflective practice, regular case review
meetings, role playing practice issues, etc.) Who delivers this supervision and who
does your agency or service already use? delivers coaching (internal/external)
Could you integrate supervision/coaching
in the new program or practice into existing Minimum qualifications/experience/
processes? training required to be a supervisor and
a coach
l Does the program or practice require a
particular approach to supervision and/or How and when supervisors and coaches
coaching for staff involved in its delivery? will be trained and when they will work
– If the program or practice specifies a with the program or practice practitioners
specific approach for supervision, who
will need to deliver the supervision
and coaching? Can you access or train
someone locally, or are supervisors and
coaches based overseas?
l If using internal supervisors and coaches:
– Do program or practice supervisors and
coaches require additional training and/
or professional development before and
during delivery? What qualifications
do internal supervisors and coaches
currently have?
l If the program or practice specifies a
particular approach to supervision and
coaching do you have the capacity to
meet the supervision and coaching
requirements?
34 Australian Institute of Family Studies

Questions to be considered by the Checklist to ensure you have the information

Topic / issue implementing agency or service provider you need to inform your choice
PROGRAM / PRACTICE CHARACTERISTICS
Target population l Is the program or practice designed for use The target population for the program
with the target population you want to use or practice
it with?
l Is there evidence to support the Evidence to support the effectiveness of
effectiveness of the program or practice the program or practice
when used with the target population?
Referral pathways l How many referrals do you currently Any minimum referral/caseload
receive a year and what are your referral requirements
pathways?
l Does the program or practice you are
considering specify the number of ongoing
referrals needed?
l If the number of referrals are specified do
you have the capacity to meet the referral
requirements of the program or practice?
How will these referrals be secured? That
is, who will refer clients to the program or
practice?
l Do referral pathways depend on the
involvement of partner organisations?
Program / Practice l Is the program or practice, and how it is The most recent version of program or
descriptions and used, described in a manual or guide in a practice manuals or guides
details sufficiently detailed way for your agency or
service to integrate it into daily practice? Service policies or procedures, and values
l Are the program or practice materials freely or mission documents
accessible in the public domain?
l How well does the program or practice
description fit with your current services,
priorities, and organisational values and
mission?
Costs l Are there costs associated with acquiring Cost information collected for all available
and using the program or practice? items
Consider for example:
– purchase of program materials and guides Funding source(s) that are available for
the first 2–3 years of program or practice
– purchase of licenses implementation
– initial and ongoing training and
supervision costs (including travel costs
and fees for trainers)
– staffing (including backfill)
– data systems and other infrastructure
needed to run the program or practice
– funding required to maintain the program
over time
– client expenses
l What funding is available to cover 2–3 years
of program or practice implementation
costs?
Program / Practice l Does the program or practice allow for Core program or practice components
adaptability local and/or cultural adaptations? that are non-negotiable
l What are the non-negotiable program or
practice core components that cannot
be adapted locally and/or for particular
target populations such as Aboriginal and
Torres Strait Islander, CALD or LGBTQI
communities?
 Implementation in action 35

Questions to be considered by the Checklist to ensure you have the information

Topic / issue implementing agency or service provider you need to inform your choice
PROGRAM / PRACTICE SYSTEM AND IMPLEMENTATION
Tools and systems l What data collection tools, data Any data collection tools that are
management systems and processes do compulsory to use for the program
you currently use? or practice
l Does the program or practice require the
compulsory use of any additional tools Any data management processes or
and systems (e.g. tools for collection and systems that are compulsory to use for
analysis of client or program outcome data; the program or practice
regular re-accreditation)?
– If yes, do you have the capacity to collect
the data that is required by the new
program or practice?
Implementation l Does the program or practice have specific Implementation outcomes defined
model implementation quality standards you by the program or practice standards
have to meet (e.g. fidelity requirements, (e.g. fidelity standards to be met)
mandatory one-off or continuous
implementation activities)? Any activities required to deliver the
l Will the implementation of the program program/practice with sufficient quality
or practice require the involvement of the (e.g. regular booster trainings; regular
program developer – either for parts of the assessment meetings with program
implementation or on an ongoing basis? developer, program briefing meeting with
management staff)
l Does the program or practice
require activities other than training If and how the program developer needs
(e.g. accreditation, reporting, program to be involved (e.g. training only; readiness
briefings) to establish a team of assessment plus training; ongoing
practitioners able to deliver the program involvement under a license, etc.)
or practice?
l Will leadership and management staff
have the capacity to implement the new
program or practice (e.g. time, resources,
attend implementation leadership training)
 36

READINESS THINKING TOOL® R = MC² Motivation

Readiness Program or practice-specific Capacity
General Capacity

This form can help you think about an organisation’s readiness to implement a new program, policy, practice or process.

1. Write down the program or practice you are considering: __________________________________________

2. Reflect and consider whether the areas below are challenges or a strength for your program or practice. Discuss your rationale with colleagues also involved in
implementation.
Australian Institute of Family Studies

Motivation Degree to which we want the program or practice to happen Challenge Strength Unsure
Relative advantage This program or practice seems better than what we are currently doing.
Compatibility This program or practice fits with how we do things.
Simplicity This program or practice seems simple to use.
Ability to pilot Degree to which this program or practice can be tested and experimented with.
Observability Ability to see that this program or practice is leading to outcomes.
Priority Importance of this program or practice compared to other things we do.
Program or practice-specific Capacity What is needed to make this particular program or practice happen?
Program or practice-specific knowledge & skills Sufficient abilities to do the program or practice.
Champion A well-connected person who supports and models this program or practice.
Supportive climate Necessary supports, processes, and resources to enable this program or practice.
Inter-organisational relationships Relationships between organisations that support this program or practice.
Intra-organisational relationships Relationships within organisation that support this program or practice.
General Capacity Our overall functioning
Culture Norms and values of how we do things here.
Climate The feeling of being part of this organisation.
Innovativeness Openness to change in general.
Resource utilisation
Ability to acquire and allocate resources including time, money, effort, and
technology.
Appendix D: Readiness Thinking Tool®

Leadership Effectiveness of our leaders.

Internal operations Effectiveness at communication and teamwork.
Staff capacities Having enough of the right people to get things done.
Process capacities Ability to plan, implement, and evaluate.

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 READINESS THINKING TOOL®

Discussion questions

Which is currently the greatest challenge for implementation? Where would more information and data be helpful? How can you
get these data?

Which is the greatest strength? Where do you have differences with your colleagues?

Which areas do you think would be most important to address

early on in your project?
Implementation in action

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Appendix E: Implementation plan template

The Implementation Plan Template is designed to support the Implementation Team (or other decision makers) to develop and update an implementation
plan throughout implementation stages 2, 3 and 4.
Australian Institute of Family Studies

The Implementation Activity Tracker, at the very back of the document, can be used help structure Implementation Team meetings. It is a useful tool to help
track and log the ‘agreed actions’ that are listed in the implementation plan.

Aim of project
Scope of project
Timeline

Implementation Team
members (roles)

Implementation Implementation Implementation stage Agreed action(s) Person responsible Time frame
barrier or enabler strategy to address to action or due date
barrier or maintain
enabler
Appendix E: Implementation plan template
The following guiding questions may help you and your colleagues in developing and updating your implementation plan. Use them as questions to prompt
discussion. There are no guiding questions provided for Stage 1 because the implementation plan is developed in Stage 2.

Guiding questions relevant to Stage 2: Plan and prepare

What data will you collect and monitor?
For example, this might include data collected to monitor:
§ implementation outcomes that are identified in section 5.3 of this guide to monitor implementation quality (e.g. program fidelity, acceptability,
appropriateness, feasibility, etc.), or
§ program outcomes that are identified in section 4.1_

How will you collect and monitor the data?

§ Do your existing data collection systems include the data you require, or do you need to develop your own tools and processes to collect and
monitor implementation or program outcome data?
For example, this might include:
§ Who will be responsible for creating or adapting data collection tools and data management systems?
§ Who will collect and/or input the data?
§ Who will analyse and report the data?
§ Who needs to use the data for decision making / who will the data be circulated to?
How will staff skill development be supported throughout the implementation process?
For example, this might include:
§ initial and booster training
§ coaching in program- or practice-specific skills
§ updating role and position descriptions to include program or practice skills
§ reallocation of work tasks technical assistance from program or practice experts within or outside of the agency or service.
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Describe how you will approach staff training and skill development over time, taking into consideration how to adapt the approach to accommodate
staff turnover.
For example, this might include:
§ how to integrate new managers and practitioners who commence employment after the initial program or practice training is provided, or
§ seeking staff feedback on training, or more generally exploring implementation enablers and barriers with staff.
Australian Institute of Family Studies

How will you obtain and maintain staff buy-in and foster a supportive change climate across the agency or service?
For example, this might include:
§ how leadership will promote and communicate about the new practice or program across the agency or service
§ how staff will be supported to give the new initiative a try, and to make mistakes and learn from them
§ ensuring there is sufficient time and space to pace implementation appropriately.

What planning can you do now, and/or what safeguards can be put in place now to promote program or practice sustainability?
For example, this may include:
§ gathering information that will be useful for developing a sustainable funding plan for program costs for the next one to four years
§ planning for providing ongoing skill development for staff in the long-term,
§ how to address staff turnover, particularly at the manager/supervisor level.
Guiding questions relevant to Stage 3: Initiate and refine
How will you know if your implementation strategies and actions should be improved? Who is going to make the decisions and changes, and how?
For example, this might include:
§ What information would trigger a discussion about changes to process?
§ Would decisions about changes sit with the implementation team, or other decision maker(s)?
§ Whose responsibility is it to ensure changes are made, and who needs to approve those changes?
Is the program or practice being implemented well (according to the indicators of quality implementation that you are monitoring)?

Which changes are you observing in the implementation quality monitoring data?
For example, this might include:
§ Are you achieving the implementation outcomes you planned for?
§ Which monitoring tools, systems and processes were useful and which were a challenge to use? Are revisions required to monitoring tools and
processes?
Implementation in action
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Guiding questions relevant to Stage 4: Sustain and scale

Describe how you will maintain program implementation quality over time.
For example, this might include:
Australian Institute of Family Studies

§ capacity-building to support practitioner skill maintenance and continuous learning to be able to fully sustain the program or practice (e.g.
training internal, identifying additional skills for practitioners to develop)
§ continue to use information collected from monitoring data to respond to required changes needed to improve implementation strategies and
actions using continuous improvement cycles
§ handover plan for training and work tasks when new staff come on board (especially senior management) including ensuring new managers are
provided with your implementation plan.
Who will be involved in reviewing implementation monitoring data, and when will it be reviewed and discussed?
For example, this may include:
§ hiring an external coach or training an internal coach to continue to review and provide feedback on implementation quality indicators
§ developing a timeline for reviewing implementation quality (quarterly, annually or aligned with funding cycles).

What needs to be planned for if you decide to expand and scale up?
For example:
§ if/how to expand the program or practice to other teams or sites
§ What teams or sites would benefit most? How would those decisions be made?
§ What learnings from this implementation process will inform and support an expansion/scaling up of the program or practice? How can these
learnings be summarised and communicated?
Implementation action tracker
The Implementation Action Tracker can be used to structure Implementation Team meetings.

Implementation strategy Agreed action Key actions since last update Key actions prior to next update

Barriers or enablers Key learnings Feedback (practitioners, leadership) Proposed solution or change if the program
identified or practice is scaled up and expanded
Implementation in action
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