Statewide Implementation of Evidence-Based Programs

By Fixsen, Dean; Blase, Karen et al. | Exceptional Children, Winter 2013 | Go to article overview

Statewide Implementation of Evidence-Based Programs


Fixsen, Dean, Blase, Karen, Metz, Allison, Van Dyke, Melissa, Exceptional Children


For the past several decades, considerable scientific and policy interest and research activity have focused on developing evidence-based practices and programs, evidence-informed practices and programs, and other innovations intended to produce better outcomes for exceptional children. Past and current efforts to diffuse, translate, transport, disseminate, mandate, incentivize, and otherwise close the "science-to-service gap" have not been successful in getting the growing list of evidence-based programs routinely into practice. D. L. Fixsen, Naoom, Blase, Friedman, and Wallace (2005) defined evidence-based programs as

   collections of practices that are done within
   known parameters (philosophy, values, service
   delivery structure, and treatment components)
   and with accountability to the consumers
   and funders of those practices ....
   Such programs, for example, may seek to integrate
   a number of intervention practices
   (e.g., social skills training, behavioral parent
   training, cognitive behavior therapy) within
   a specific service delivery setting (e.g., office-based,
   family-based, foster home, group
   home, classroom) and organizational context
   (e.g., hospital, school, not-for-profit community
   agency, business) for a given population
   (e.g., children with severe emotional
   disturbances, adults with co-occurring disorders,
   children at risk of developing severe
   conduct disorders). (p. 26)

In an extensive review of the diffusion and dissemination literature, Greenhalgh, Robert, MacFarlane, Bate, and Kyriakidou (2004) characterized many of the past and current approaches as "letting it happen" or "helping it happen" (p. 593). That is, researchers publish their findings and leave it to others to read the research and make good use of the evidence-based program. Some program developers also publish manuals, create web sites, and offer workshops to make available more detailed information to potential practitioners and others to help it happen. Although these predominant letting it happen and helping it happen approaches are necessary, they are not sufficient for reliably producing intended outcomes of research in practice (e.g., Balas & Boren, 2000; Clancy, 2006).

Greenhalgh et al. (2004) identified another, newer category of activity they called "making it happen" (p. 593). In this group of activities, purveyors (i.e., developers who are supporting the use of a particular evidence-based program) and other implementation teams take responsibility for supporting practitioners, supervisors, and managers as they attempt to make full and effective uses of evidence-based programs and other innovations in their daily interactions with children, families, and stakeholders. Greenhalgh et al. concluded that "A striking finding of this extensive review was the tiny proportion of empirical studies that acknowledged, let alone explicitly set out to study, the complexities of spreading and sustaining innovation in service organizations" (p. 614). That is changing. The content for the making it happen approaches identified by Greenhalgh et al. is being operationalized in current research on implementation. For example, D. L. Fixsen et al. (2005) conducted an extensive review of the implementation evaluation literature, and Blase, Fixsen, Naoom, and Wallace (2005) provided qualitative reviews of best practices in use by successful purveyor groups and implementation teams. The science base for implementation is growing out of these more organized and testable "best practices" for implementation. The field is on the verge of having evidence-based implementation methods to reliably realize the promise of evidence-based programs in practice to benefit exceptional children, their families, and society. Society, in this context, means the universe of social relationships that bind together human beings.

Based on this body of work, a formula for successful uses of evidence-based programs in typical human service settings can be characterized as:

Effective interventions x effective implementation = improved outcomes

Note that the formula for success involves multiplication.

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