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. 2023 Jun 21:4:26334895231154285.
doi: 10.1177/26334895231154285. eCollection 2023 Jan-Dec.

Trajectory of external implementation support activities across two states in the United States: A descriptive study

William A Aldridge 2nd  1 , Rebecca H Roppolo  1 , Shannon D Chaplo  1 , Ariel B Everett  1 , Sherra N Lawrence  1 , Christina I DiSalvo  1 , Devon R Minch  1 , Jessica J Reed  1 , Renée I Boothroyd  1
Affiliations

Trajectory of external implementation support activities across two states in the United States: A descriptive study

William A Aldridge 2nd et al. Implement Res Pract. .

Abstract

Background: Reporting on strategies to advance implementation outcomes is imperative. The current study reports descriptive information about external implementation support (EIS) provided over 5 years to 13 regions in North Carolina and South Carolina scaling an evidence-based system of parenting and family supports. Regional support teams operating through the Implementation Capacity for Triple P (ICTP) projects employed core practice components (CPCs) for EIS as proposed by Aldridge et al. and further operationalized by members of The Impact Center at FPG Child Development Institute, UNC-Chapel Hill.

Method: Practice activities associated with CPCs were developed and iteratively refined across the study period. ICTP regional support teams systematically tracked their use of CPCs and related activities following each substantive support interaction. Tracking included the duration of time a CPC was employed and the use of specific practice activities associated with that CPC. Data were aggregated by month of the relationship to account for differential start dates across regions.

Results: From November 2016 through December 2021, ICTP support teams tracked 749 support interactions with Triple P regions in North Carolina and South Carolina. Monthly support decreased year over year, though dose varied considerably. Patterns of CPC use indicated a high dose of "foundational" and "co-design" CPCs early, followed by a blended and more diverse use thereafter, with some notable trends. Practice activities considered essential to influencing intended practice outcomes were characterized by higher rates of use. Like CPCs, practice activities were used dynamically across the study period.

Conclusions: This descriptive study offers a case study for how EIS might be operationalized, tracked, and employed. Findings suggest several interpretations that might refine our understanding and use of EIS. Although the nature of this practical report precludes generalizability of findings, directions for future research and practice are discussed.

Keywords: facilitation; implementation mechanisms; implementation practice; implementation strategies; implementation support practitioner; intermediaries; technical assistance.

Plain language summary

More needs to be known about how external support providers work with organizational, system, and community partners to improve their efforts to implement innovative programs and practices. Although a handful of models of external support have emerged in the literature, support strategies or activities are not often tracked systematically or prospectively. In the current study, we report on the adoption, operationalization, and use of a recently proposed model of external support across 13 regions in North Carolina and South Carolina scaling an evidence-based system of parenting and family interventions. Teams of external support providers tracked their activities using the model across more than 5 years. Results provide a description of what external support might look like across long-term support engagements, noting key patterns about dose of support and use of activities that might be responsible for influencing intended support outcomes. The study offers several findings that might refine our understanding and use of external support strategies. In addition, the study lays groundwork for examining additional research questions, such as the feasibility of support processes and whether and how support activities influence support outcomes.

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Figures

Figure 1
Figure 1
External Implementation Support Theory of Change (Aldridge et al., 2023)
Figure 2
Figure 2
Average Dose of Core Practice Component by Month of Support
Figure 3
Figure 3
Use of Essential Activities Within CPC 1 (Build Collaborative Relationships) by Month of Support
Figure 4
Figure 4
Use of Essential Activities Within CPC 2 (Reinforce Leaders’ and Teams’ Self-Regulation of Effective Implementation Performance) by Month of Support
Figure 5
Figure 5
Use of Essential Activities Within CPC 3 (Assess Implementation Capacity, Implementation Performance, And Progress Towards Intended Outcomes) by Month of Support
Figure 6
Figure 6
Use of Essential Activities Within CPC 4 (Facilitate Collaborative Agreements About Implementation Performance Goals on Which to Focus Support) by Month of Support
Figure 7
Figure 7
Use of Essential Activities Within CPC 5 (Provide Adult Learning on Implementation Science and Best Practices to Leaders and Teams) by Month of Support
Figure 8
Figure 8
Use of Essential Activities Within CPC 6 (Facilitate the Development of Implementation Capacity) by Month of Support
Figure 9
Figure 9
Use of Essential Activities Within CPC 7 (Facilitate Leaders’ and Teams’ Application of Skills, Resources, and Abilities Within Their Context) by Month of Support
Figure 10
Figure 10
Use of Essential Activities Within CPC 8 (Provide Supportive Behavioral Coaching to Leaders and Teams) by Month of Support
Figure 11
Figure 11
Use of Essential Activities Within CPC 9 (Facilitate Collective Learning and Adaptive Problem Solving) by Month of Support
Figure 12
Figure 12
Use of Essential Activities Within CPC 10 (Transition Out of Intensive Implementation Support) by Month of Support
See this image and copyright information in PMC

References

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