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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

Implementation staff

  • Trained to deliver the program
  • Skilled with expertise and/or experience in program implementation
  • Deliver the program as intended

Organization

  • 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.

  • What is the violence-related problem(s) that needs to be prevented?
  • Who is experiencing it? Who or what else is affected?
  • When and where is the problem occurring?
  • How often does the problem occur?

Define your audience and locale

These data can come from a variety of sources – for example:

  • police reports, medical examiner reports, vital records
  • hospital charts, registries
  • population-based surveys, other community surveys
  • census data
  • findings from needs assessments
  • findings from evaluations (e.g., interviews, surveys, focus groups)
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.

  • What are the risk factors for the violence in the specific population or community where the work will occur?
  • What are the protective factors that may buffer the risk for the violence in the specific population or community where the work will occur?

Risk and protective factors

  • Gather information from the research literature to understand the types of factors that put people at risk or protect them from violence (e.g., see CDC’s Connecting the Dots)
  • Review other relevant resources (e.g., information from CDC’s Veto Violence, fact sheets)
  • Gather information that is specific to your population or community. Consider conducting an assessment or using a “prevention system” to help you.
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.

  • How relevant is the program for my selected target population or community?
  • Does it address the risk and protective factors identified for my target population or community?
  • Does it need to be adapted to fit my target population or community?

Selection

  • Gather more information about the program (e.g., from existing registries or the developer to learn more about the program and to see if implementation manuals, guides, or tools are available)

Program fit

  • Assess alignment with organization belief, mission, values, and practices
  • Ensure program will fit into your community
  • Identify potential barriers, challenges, and solutions
  • Determine what may need to be adapted to fit your target population or community (see resources below for more information on adaptation)
Identify  resources

Assess your capacity, strengths, opportunities, and partnerships.

  • Do I have the necessary resources to implement the program?
  • Does it fit into existing programs or activities or will this be something that is added on?
  • What level of effort, skill sets, and stakeholder support will be needed?
  • Where can I find assistance, tools, and on-going support for implementation?

Organizational Readiness

  • Assess organizational capacity, climate, culture
  • Assess fit with current programs, activities, and priorities
  • Assess resources for implementation (funding, staff, training, informational tools, templates)
  • Obtain leadership/ administrative support
  • Find collaboration partners within your community
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.

  • How will the implementation team be identified, selected, trained, monitored, and supervised?
  • How will protocols and standard operating procedures be developed and communicated?
  • Where will the program be implemented (i.e., sites or setting)?
  • What’s the plan for recruiting participants, implementing the program, engaging relevant stakeholders?
  • How will issues, problems, or other challenges be tackled (e.g., weekly meetings)?

Program Plan

  • Staffing and stakeholders (plan, execute, evaluate)
  • Determine roles and responsibilities
  • Staff training and support (coaching, access to intervention experts, turnkey resources)
  • Identify implementation sites
  • Protocols and standard operating procedures
  • Develop communication plan
  • Develop plan for on-going technical assistance
  • Develop plan for continuous program improvement
Implement the program

Leverage your existing capacity, strengths, opportunities, and partnerships to deliver the program you have identified and to increase implementation quality.

  • How much pre-testing may be necessary?
  • What do I need for on-going monitoring and evaluation of the program?
  • What mechanisms are in place to ensure implementation quality?
  • How is fidelity being tracked and reported?
  • What strategies will be used to communicate with all of the relevant stakeholders?

Establish, pre-test, monitor, and improve the systems in place to deliver your program

  • Recruitment of participants
  • Staffing, training, supervision, support
  • Delivery of program components and activities
  • Fidelity measures and reporting
  • Partnerships and collaboration
  • Communication strategies
Track progress

Ensure that you have data systems in place to measure and report outcomes as well as mechanisms to communicate and promote successes.

  • Which outcomes are being tracked?
  • How will they be reported and to whom?

Program impact

  • Outcome measures and reporting
  • Communicate successes
Plan for the future

Be proactive to ensure that the program can be sustained.

  • What mechanisms are in place for continuous quality improvement to ensure sustainability?
  • What mechanisms are in place to retain staff, program components, data systems and other resources for long-term sustainability?
  • How can the information about program successes be used for sustainability purposes?
  • Who can be a champion and help you identify new partners and support to continue the program?

Program sustainability

  • Contribute own lessons learned to add to implementation source
  • Identify ongoing funding and support
  • Incorporate program into existing organizational infrastructure
  • Partnerships (existing and new)

What are some implementation resources I can use?

Implementation Science

Program Adaptation

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.
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