R = MC<sup>2</sup> readiness building process: A practical approach to support implementation in local, state, and national settings

Domlyn, Ariel M.; Scott, Victoria; Livet, Melanie; Lamont, Andrea; Watson, Amber; Kenworthy, Tara; Talford, M. C.; Yannayon, Mary; Wandersman, Abraham

doi:10.1002/jcop.22531

Cited by 37 publications

(38 citation statements)

References 45 publications

(66 reference statements)

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“…The downstream impact of TA has received less attention, perhaps due to inherent measurement challenges associated with conducting evaluation research in complex settings. According to the Interactive Systems Framework for Dissemination and Implementation (ISF), TA is a support system element designed to build delivery system capacity, which, in turn, enhances implementation toward a set of desired outcomes [ 24 , 89 ]. As such, intervention (e.g., programmatic) outcomes are most appropriately monitored and measured in relation to the delivery system—that is, the setting/system receiving direct TA services.…”

Section: Discussionmentioning

confidence: 99%

A scoping review of the evaluation and effectiveness of technical assistance

Scott

Jillani

Malpert³

et al. 2022

Implement Sci Commun

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Background Although the benefits of evidence-based practices (EBPs) for advancing community outcomes are well-recognized, challenges with the uptake of EBPs are considerable. Technical assistance (TA) is a core capacity building strategy that has been widely used to support EBP implementation and other community development and improvement efforts. Yet despite growing reliance on TA, no reviews have systematically examined the evaluation of TA across varying implementation contexts and capacity building aims. This study draws on two decades of peer-reviewed publications to summarize the evidence on the evaluation and effectiveness of TA. Methods Guided by Arksey and O’Malley’s six-stage methodological framework, we used a scoping review methodology to map research on TA evaluation. We included peer-reviewed articles published in English between 2000 and 2020. Our search involved five databases: Business Source Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycInfo, and PubMed. Results A total of 125 evaluation research studies met the study criteria. Findings indicate that publications have increased over the last two decades, signaling a growth in the recognition and reporting of TA. Technical assistance is being implemented across diverse settings, often serving socially vulnerable and under-resourced populations. Most evaluation research studies involved summative evaluations, with TA outcomes mostly reported at the organizational level. Only 5% of the studies examined sustainability of TA outcomes. This review also demonstrates that there is a lack of consistent standards regarding the definition of TA and the level of reporting across relevant TA evaluation categories (e.g., cadence of contact, and directionality). Conclusions Advances in the science and practice of TA hinge on understanding what aspects of TA are effective and when, how, and for whom these aspects of TA are effective. Addressing these core questions requires (i) a standard definition for TA; (ii) more robust and rigorous evaluation research designs that involve comparison groups and assessment of direct, indirect, and longitudinal outcomes; (iii) increased use of reliable and objective TA measures; and (iv) development of reporting standards. We view this scoping review as a foundation for improving the state of the science and practice of evaluating TA.

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Section: Discussionmentioning

confidence: 99%

A scoping review of the evaluation and effectiveness of technical assistance

Scott

Jillani

Malpert³

et al. 2022

Implement Sci Commun

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“…In some cases, individual and/or contextual capacity building may need to precede and/or be used conjointly with other implementation strategies. For example, Donmlyn et al [ 35 ] propose a pre-implementation process of engagement, assessment, feedback and prioritization, and strategizing to increase readiness and capacity in general as well as specific to a particular innovation. Contextual barriers have been identified as critical across a range of settings and innovations [ 36 – 38 ]; ECE faces a number of contextual barriers of its own for use of EBPs, especially related to obesity prevention [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior

Swindle

Rutledge

Martin

et al. 2022

Implement Sci Commun

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Background The current study sought to (1) describe a new classification approach for types of implementer behavior and (2) explore the implementer behavior change in response to tailored implementation facilitation based on the classifications. Methods A small-scale, cluster-randomized hybrid type III implementation trial was conducted in 38 early care and education classrooms that were part of the Together, We Inspire Smart Eating (WISE) program. WISE focuses on 4 evidence-based practices (EBPs), which are implemented by teachers to promote nutrition. External facilitators (N = 3) used a modified Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) to complete immersion (i.e., observations) and thematic content analyses of interviews to identify the characteristics of teachers’ behavior at varying levels of implementation fidelity. Three key factors—attitudes toward the innovation, fidelity/adaptations, and influence—were identified that the research team used to classify teachers’ implementation behavior. This process resulted in a novel classification approach. To assess the reliability of applying the classification approach, we assessed the percent agreement between the facilitators. Based on the teachers’ classification, the research team developed a tailored facilitation response. To explore behavior change related to the tailored facilitation, change in fidelity and classification across the school year were evaluated. Results The classifications include (1) enthusiastic adopters (positive attitude, meeting fidelity targets, active influence), (2) over-adapting adopters (positive attitude, not meeting fidelity targets, active influence), (3) passive non-adopters (negative attitude, not meeting fidelity targets, passive influence), and (4) active non-adopters (negative attitudes, not meeting fidelity targets, active influence). The average percent agreement among the three facilitators for classification was 75%. Qualitative data support distinct patterns of perceptions across the classifications. A positive shift in classification was observed for 67% of cases between the mid-point and final classification. Finally, we generated an expanded classification approach to consider additional combinations of the three factors beyond those observed in this study. Conclusions Data from this study support the ability to apply the classification approach with moderate to high reliability and to use the approach to tailor facilitation toward improved implementation. Findings suggest the potential of our approach for wider application and potential to improve tailoring of implementation strategies such as facilitation.

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“…Prior research warns that neglecting to address factors that affect adoption seriously jeopardizes the success of any project seeking to introduce a new idea into an organization and assessing readiness is one way of understanding and anticipating likely barriers and facilitators of innovation adoption in a given school district (Greenhalgh et al, 2004). Using the R = MC 2 readiness heuristic and its associated Readiness Diagnostic Scale (Domlyn et al, 2021) proactively identifies potential barriers to successful implementation, as well as strategies to address identified barriers. The Wandersman Center has formalized a Readiness Building System that uses R = MC 2 to build readiness using: (1) a readiness diagnostic scale, (2) feedback reports, (3) prioritization of readiness subcomponents, and (4) a readiness action plan and change management strategies to build readiness (Wandersman Center, 2019).…”

Section: Establish Accountability For the Innovation Through Mousmentioning

confidence: 99%

Using readiness to understand implementation challenges in school mental health research

Splett

Perales²,

Miller

et al. 2022

Journal Community Psychology

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Schools and research partners are increasingly implementing complex, multicomponent interventions and school‐wide frameworks to better meet students' social, emotional, behavioral, and academic needs; however, in the research and real‐world contexts, implementation is often fraught with many challenges and barriers to success. This study explores implementation barriers encountered during a randomized controlled trial testing effects of one complex intervention strategy—the Interconnected Systems Framework—from the lens of a practical model for conceptualizing organizational readiness—the Interactive Systems Framework for Dissemination and Implementation. Implementation of the Interconnected Systems Framework was explored via focus group and key informant interviews with school and mental health professionals, and research team members responsible for implementing the intervention in randomly assigned study schools. Results from inductive thematic analysis of verbatim transcripts identified three primary implementation challenges: staff turnover, inadequate leadership buy‐in, and insufficient time for training/planning. Each challenge is explored from interview participants' perspectives and the extant literature, then connected to recommendations from implementation science to help others avoid similar challenges in their well‐intentioned efforts to address the mounting concern for students' wellbeing.

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R = MC² readiness building process: A practical approach to support implementation in local, state, and national settings

Abstract: Effective implementation of evidence-based interventions is a persistent challenge across community settings.Organizational readinessor, the motivation and collective capacity of an entity to adopt and sustain an innovationis important to facilitate implementation. Drawing on the

Cited by 37 publications

References 45 publications

A scoping review of the evaluation and effectiveness of technical assistance

A scoping review of the evaluation and effectiveness of technical assistance

Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior

Using readiness to understand implementation challenges in school mental health research

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R = MC2 readiness building process: A practical approach to support implementation in local, state, and national settings

Abstract: Effective implementation of evidence-based interventions is a persistent challenge across community settings.Organizational readinessor, the motivation and collective capacity of an entity to adopt and sustain an innovationis important to facilitate implementation. Drawing on the

Cited by 37 publications

References 45 publications

A scoping review of the evaluation and effectiveness of technical assistance

A scoping review of the evaluation and effectiveness of technical assistance

Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior

Using readiness to understand implementation challenges in school mental health research

Contact Info

Product

Resources

About

R = MC² readiness building process: A practical approach to support implementation in local, state, and national settings