Exploration-Stage Implementation Variation

Abstract

The present study examines the effect of agency-level implementation variation on the cost-effectiveness of an evidence-based parent training program (Positive Parenting Program: “Triple P”). Staff from six community-based agencies participated in a five-day training to prepare them to deliver a 12-week Triple P parent training group to caregivers. Prior to the training, administrators and staff from four of the agencies completed a site readiness process intended to prepare them for the implementation demands of successfully delivering the group, while the other two agencies did not complete the process. Following the delivery of each agency’s first Triple P group, the graduation rate and average cost per class graduate were calculated. The average cost-per-graduate was over seven times higher for the two agencies that had not completed the readiness process than for the four completing agencies ($7,811 vs. $1,052). The contrast in costs was due to high participant attrition in the Triple P groups delivered by the two agencies that did not complete the readiness process. The odds of Triple P participants graduating were 12.2 times greater for those in groups run by sites that had completed the readiness process. This differential attrition was not accounted for by between-group differences in participant characteristics at pretest. While the natural design of this study limits the ability to empirically test all alternative explanations, these findings indicate a striking cost savings for sites completing the readiness process and support the thoughtful application of readiness procedures in the early stages of an implementation initiative.

The Triple P Implementation Framework: the Role of Purveyors in the Implementation and Sustainability of Evidence-Based Programs

“…Implementation can also be defined through the distinctions between diffusion, dissemination, and implementation, and the continuum between passive and active approaches to knowledge transfer (Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004). The distinctions between these concepts can be described as the difference between letting it happen (diffusion; e.g., Rogers, 1995), helping it happen (dissemination, research on facilitators, and barriers to program uptake; e.g., Brownson, Colditz, & Proctor, 2012), and making it happen (implementation; e.g., Fixsen et al, 2005). Diffusion literature informs up to the point of deciding to adopt an innovation but does not explain how to implement that innovation with fidelity (Rogers, 1995), nor is diffusion sufficient to reliably produce and sustain positive benefits to consumers (Fixsen et al, 2005).…”

“…The distinctions between these concepts can be described as the difference between letting it happen (diffusion; e.g., Rogers, 1995), helping it happen (dissemination, research on facilitators, and barriers to program uptake; e.g., Brownson, Colditz, & Proctor, 2012), and making it happen (implementation; e.g., Fixsen et al, 2005). Diffusion literature informs up to the point of deciding to adopt an innovation but does not explain how to implement that innovation with fidelity (Rogers, 1995), nor is diffusion sufficient to reliably produce and sustain positive benefits to consumers (Fixsen et al, 2005). As the field of implementation science advances, focus has turned to strategies and processes that improve uptake and outcomes (Proctor, Powell, & McMillen, 2013).…”

“…Engaging with a knowledgeable source such as the program purveyor at this stage increases the likelihood of successful implementation (Panzano & Roth, 2006). The main activities of this phase reflect key attributes that Rogers (1995) identified as influencing dissemination, such as compatibility of the innovation with the existing social system and relative advantage of the new innovation over other treatments.…”

Supporting Parenting to Promote Children's Social and Emotional Well-being

“…All training modules are developed and delivered using best practices in adult education. Planning and preparing the community, organization, and practitioners prior to training considerably increases practitioners' ability to benefit from the training and apply with fidelity the knowledge, skills, and strategies they have learned (Romney, Israel, & Zlatevski, 2014). Further developing their competence and maintaining fidelity is achieved through regular Peer Support Network meetings, linking with the Triple P Practitioner website, workshops, and symposia.…”

Issues in Professional Training to Implement Evidence‐based Parenting Programs: The Preferences of Indigenous Practitioners

“…This may enhance the likelihood of program sustainability in the face of other potential barriers to implementation including broader community capacity and crises, receptivity to parenting support services, and the priority, approval and funding given to sustain a family support program. Careful community and organisational consultation and preparation are proven facilitators to program implementation and ongoing success (Romney, Israel, & Zlatevski, 2014).…”