Best Practices for Implementation
If you are working to implement a violence prevention program, policy, or practice, you want to know what has worked for others in the field. By basing your decision on the best available evidence, you can have greater confidence that your program can help bring about the changes you desire in your community. CDC's Violence Prevention Technical Packages provide evidence-based recommendations that will provide a strong foundation to your work.
CDC's Technical Packages have three components:
- The strategies lay out the direction or actions to achieve the goal of preventing violence.
- The approaches include the specific ways to advance the strategy. This can be accomplished through programs, policies, and practices.
- The evidence for each of the approaches in preventing violence or its associated risk factors is included as the third component.
There are a number of things to consider in selecting and implementing programs, practices, or policies to advance prevention strategies. This general guidance is intended to orient you to implementation best practices. We will use "program" to simplify the language in talking about what you might implement, and the suggested implementation guidance is how you can best put it into practice.
How do we define program implementation?
Implementation is defined as "a purposeful set of specific activities that result in individual or organizational use of an innovation."(DVP ASAP [PDF 238KB]). It is important for you to know what kind of program you want to implement as well as be able to answer questions about why and how.
- Is the program a good fit for the issue and the defined community?
- Who is going to be involved – both in program delivery but also program participation?
- How will you ensure that the program is delivered effectively and to the right people?
Why is implementation important to your program?
The success of your program depends on how well it is implemented. Poor implementation of a program reduces the chances of achieving the results you want and will not be a good use of your resources. In order for evidence-based programs to work, they need to be implemented consistently and with high quality (Durlak, 2013).
How can you make high quality implementation happen?
There are many factors to consider during implementation from violence prevention research to practice.
Implementation is a complex process, and it can be difficult to achieve full implementation right away without a comprehensive plan. Implementation plans can be flexible according to your organization, the community that you serve, and what outcomes you would like to see. And implementation quality can change over time, depending on staff and organizational context. The National Implementation Research Network describes 4 stages involved in implementation:
- Exploration--determine your readiness to implement;
- Installation--gather the resources to do the work of implementation;
- Initial Implementation--start putting the program in place; and
- Full Implementation--when at least 50% of implementers are administering the program effectively and as intended.
Implementation drivers are factors that increase the chances of achieving high quality implementation. Lists of these factors vary, depending on the source, but there are some commonalities:
Program and setting
- Ensure the program is a good fit for the community
- Make sure the program is seen as needed and beneficial
- Pilot test the program in the setting before moving toward fuller implementation
- Integrate the new program with existing programming if possible
- Community must be ready for the program
- Trained to deliver the program
- Skilled with expertise and/or experience in program implementation
- Deliver the program as intended
- Supportive and effective leadership
- Administrative support
- Resources, such as data support tools
- Positive work climate
- Coordination with other agencies
- Ongoing technical assistance
How do I get started?
The first step is to identify where and to whom you want to deliver the program. This involves thinking about the problem you are trying to prevent in your community – that is, the "who", "what", "when", "where" and "how".
The second step is to think about the risk and protective factors associated with the problem in your community – that is, what factors may be putting your target population at greater risk for experiencing or perpetrating violence? What factors may protect or buffer this risk?
Third, which programs are going to make a difference in preventing the violence from happening in the first place or that might be useful in lessening violence that is already occurring? The program you select should be aligned with the data in your community and fit with your setting and organizational characteristics.
Finally, think about what else you might need to assist you with planning, implementation, tracking progress, and informing others about the impact you are having.
The following table describes the steps to help guide your decisions in planning, developing, and evaluating your violence prevention program.
|Description and Guiding Questions||Implementation Checklist|
|What problem are you trying to prevent?||
Gather data to help you understand the "who", "what", "when", "where", and "how" associated with the type of violence you are trying to prevent.
Define your audience and locale
These data can come from a variety of sources – for example:
|Identify risk and protective factors||
Use data and evidence to understand what factors may be putting your target population or community at risk for or protecting (buffering) them from experiencing or perpetrating violence.
Risk and protective factors
|Select the approach and program||
CDC’s Technical Packages include a range of strategies to prevent violence from happening in the first place as well as to lessen the immediate and long-term harms of violence. They are intended to work together and to be used in combination in a multi-level, multi-sector effort to prevent violence. For each strategy, the technical package highlights approaches with evidence in preventing violence or the risk factors associated with the violence.
Once you assess the needs and strengths of your community, you will be able to make decisions about which approaches and programs are best suited to your context and which sectors may need to be involved to implement them.
Assess your capacity, strengths, opportunities, and partnerships.
|Create your plan||
Using information from the previous steps, create your implementation plan. Ensure that your plan includes a feedback process to identify and tackle challenges.
|Implement the program||
Leverage your existing capacity, strengths, opportunities, and partnerships to deliver the program you have identified and to increase implementation quality.
Establish, pre-test, monitor, and improve the systems in place to deliver your program
Ensure that you have data systems in place to measure and report outcomes as well as mechanisms to communicate and promote successes.
|Plan for the future||
Be proactive to ensure that the program can be sustained.
What are some implementation resources I can use?
- Joseph Durlak. The importance of quality implementation for research, practice and policy. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Research Brief, 2/1/2013.
- National Implementation Research Network - NIRN provides information on the best practices and science of program implementation.
- Public Safety Canada – Guide on the Implementation of Evidence-Based Programs.
- Melanie Barwick - Internationally recognized expert in the field of knowledge translation whose work has informed and helped to advance translation of research to practice.
- CDC’s Interactive Systems Framework (brief on Applying Science, Advancing Practice) – Information and guidance on three systems of program implementation: Prevention Synthesis and Translation, Prevention Support, and Prevention Delivery.
You may need to adapt the selected program to fit your target population or community. Program adaptations include any additions, deletions, and modifications to the program content or program delivery methods. You should consider and plan ahead for any adaptations and assess whether those changes may affect the program’s effectiveness. You may determine that adaptations are necessary to make the program more relevant, feasible, culturally appropriate, understandable, engaging, and more appropriate with other characteristics of the target population and delivery setting.
You can find more information on program adaptation at the following websites:
- Youth.gov – Presents information on how to incorporate the selected program into the everyday life of your organizational setting.
- Futures Without Violence - Provides guidance on how to adapt youth violence prevention programs.
Prevention Systems (examples)
- Communities that Care – A system that takes communities through a well-defined and structured process to prevent adolescent problem behaviors and promote positive youth development. More information about the Communities that Care prevention system are available from the EPIS Center as well as from Blueprints for Healthy Youth Development.
- PROSPER (Promoting School-Community-University Partnerships to Enhance Resilience) is a practitioner-scientist partnership model that links researchers with established program delivery systems within a state to deliver and sustain effective programs for promoting positive youth development and strong families. It is a delivery system model to help facilitate translation of prevention science into widespread community practice.
CDC Resources and Tools
- Violence Education Tools Online (VetoViolence) – A free online source of violence prevention trainings, tools, and resources. The site offers training, tips and tools designed specifically for prevention practitioners.
- Principles of Prevention – Training that introduces users to the fundamental aspects of violence and violence prevention.
- Understanding Evidence - Educates practitioners and community advocates about the value of making evidence-informed decisions around violence prevention.
- Public Health Approach – Training on a systematic, scientific approach for understanding and preventing violence.
- EvaluACTION – Resources on program evaluation and how to apply it to prevention work.
- Connecting the Dots – Research brief on connections between different forms of violence and how these connections affect communities.
CDC Violence Prevention Data Systems
- NVDRS - National Violent Death Reporting System is a state-based surveillance system that pools data on violent deaths from multiple sources (coroner or medical examiner reports, law enforcement reports, crime lab data, and vital statistics records) into a usable, anonymous database.
- NISVS - National Intimate Partner and Sexual Violence Survey is a telephone survey that assesses experiences of intimate partner violence, sexual violence, and stalking among adult women and men in the United States.
- YRBSS - Youth Risk Behavior Surveillance System monitors health risk behaviors that contribute to the leading causes of death and disability among young people in the United States.
- BRFSS - The Behavioral Risk Factor Surveillance System is the world's largest telephone health survey system, tracking health conditions and risk behaviors.