Search

Abstract: Objective: Illustrate the value of a strategy used for measuring the costs and resources used in the implementation process over and above the costs of the intervention itself in the context of a two-arm randomized controlled trial. Methods: Counties in California and Ohio (sites) were invited to implement Multidimensional Treatment Foster Care (MTFC), an alternative to congregate care for youth. Participating sites (n =53) were randomized to one of two implementation strategies, (1) Community Development Teams (CDT) where sites share information and move through the implementation process as a cohort facilitated by an MTFC purveyor or (2) Individual Implementation (IND: “as usual”) where sites work individually with the MTFC purveyor. The implementations were monitored using the Stages of Implementation Completion (SIC) measure of a number of observable activities, developed as part of the trial to segment the implementation process into 8 stages of implementation. Resource data gathered from the implementation purveyors and site participants were used to map costs onto each of the 8 stages to generate total cost measures stratified by type of resource and stage of implementation for each of the study arms. Results: The SIC provided a feasible costing template to map costs onto observable activities and to enable the examination of important differences in implementation strategies for an evidence-based practice. The average total implementation cost prior to program start-up of CDT was $133,106; IND costs $118,699. While CDT costs more in a number of stages, it resulted in fewer county staff hours being used and shorter mean times to implementation than IND. In cases where rapidity of implementation of reducing staff time required for implementation is valued, then CDT would be the preferable implementation approach. Conclusions: The SIC is a useful tool for determining implementation resources needed for new evidence-based practice programs for youth and particularly for comparing different implementation strategies that might be tried in pilot programs. [Copyright &y& Elsevier]

Federal welfare reform, local service collaborations, and the evolution of statewide information systems inspired agency interest in evidence-informed practice and knowledge sharing systems. Four agency leaders, including the Director, Deputy Director, Director of Planning and Evaluation, and Staff Development Program Manager championed the development of a learning organization based on knowledge management throughout the agency. Internal department restructuring helped to strengthen the Planning and Evaluation, Staff Development, and Personnel units, which have become central to supporting knowledge sharing activities. The Four Pillars of Knowledge framework was designed to capture agency directions in relationship to future knowledge management goals. Featuring People, Practice, Technology and Budget, the framework links the agency's services, mission and goals to the process of becoming a learning organization. Built through an iterative process, the framework was created by observing existing activities in each department rather than being designed from the top down. Knowledge management can help the department to fulfill its mission despite reduced resources. [ABSTRACT FROM AUTHOR]

Led by the agency director, the agency engaged in a Strategic Review, based on a comprehensive assessment of agency performance that identified strategies to improve organizational effectiveness through increased data-informed practice and knowledge management. The Strategic Review gathered information on staff perceptions, perceptions of external stakeholders, changing citywide and neighborhood demographics, policy mandates, and budget and workload issues. The need for the review was based upon multiple, substantial changes not addressed in the 2000 Strategic Plan, including the 2004 merger of the Department of Human Services and the Department of Aging and Adult Services, changes among the executive management team, transitions among key political entities, new policy mandates and changing budget allocations. This case study describes the Strategic Review process and content, summarizing key challenges and lessons related to addressing workload demands, fostering positive staff attitudes, balancing internal and external information needs, and integrating data use and planning processes across the agency. [ABSTRACT FROM AUTHOR]

Falls are a major public health problem for older adults, and community-based organizations play a key role in educating seniors about falls prevention (FP). We conducted a qualitative process evaluation at six sites to report community-based centers' perspectives on adoption, adaptation, and sustainability of an evidence-based multifactorial FP model. Wide dissemination of new health-oriented programs requires marketing to center directors, who must consider sustainability options. The diversity and independence of community-based organizations, together with current staffing and funding limitations, suggest that fidelity to multifactorial evidence-based interventions will be difficult to achieve. [ABSTRACT FROM AUTHOR]