Framework 2: Getting To Outcomes

The Getting To Outcomes strategic framework presents a 10-step model and a series of supports that help organizations achieve maximum benefit from any high-quality or prevention EBP.

Also known as GTO, Getting To Outcomes was developed in 2004 by RAND Health (of the RAND Corporation) in collaboration with the University of South Carolina, with support from the Centers for Disease Control and Prevention. A preliminary version of GTO was developed in 1999 with support from the Center for Substance Abuse Prevention of SAMHSA.

RAND and the University of South Carolina originally designed the GTO framework for programs to prevent young people from using alcohol, tobacco, and illicit drugs. Use of the GTO framework has led to increased capacity in prevention programs and better overall performance and program results.

 

GTO Framework

Steps 1 through 6 of the GTO framework are for planning the program. Steps 7 and 8 are for tracking and evaluating the program. Steps 9 and 10 are for improving the program and ensuring that it endures.

 

The Getting To Outcomes framework focuses on the following 10 phases of implementation: Focus, Target, Adopt, Adapt, Readiness, Plan, Monitor, Evaluate, Improve and Sustain. 

  • Discuss the importance of a vision (or mission) statement in your first meetings.
  • Do a needs and resource assessment. This doesn’t have to be expensive or take a long time to put together. Ask, “What are the underlying needs and conditions in the environment?” Gather data (facts), and interview experts and relevant clients. Define your problem.
  • Decide exactly what you’re trying to improve and the clients with whom you will work. Prioritize tasks, and narrow the scope of your work.
  • Take stock of your resources: previous programs, facilities, volunteers and staff, and budget. Begin talking to your funding sources to ensure you will be able to afford a new program.
  • Plan a program to address the problem you’ve defined.
  • Define your target population and what you hope to achieve.
  • Set your goals and write them down, even as ambitious statements. These are what you hope to accomplish over the long term.
  • List your desired outcomes. These are specific and will help you judge your success. What will you achieve? When will you achieve it? Who will achieve it? And how will you know it’s been achieved?
  • Search online and in libraries for candidate programs, and talk to others in your field. Make sure the content area of these programs matches your need.
  • Find a program with evidence that shows it has worked with a population as close as possible to your target population.
  • Assure your funders that the program you will adopt is based on good research – that it has a strong evidence base and that you have done your homework in selecting it.
  • Determine how well the program you’ve chosen fits your target group and environment. Some customization will likely be needed, but must be done carefully so that it does not undermine the parts of the program that work.
  • Compare your target population to the population that displayed improvements after they went through the evidence-based program you are considering. If they are very different, you may need to adapt the program.  
  • Talk to stakeholders to determine whether there will be community buy-in for your program.
  • Be honest. If the program doesn’t look like a good fit, don’t be afraid to go back to the drawing board and find a more appropriate program.
  • Determine what customization will be necessary for the program you have selected.
  • Assess whether your organization has the resources, such as funding and collaborations, to make your program work.
  • Select the right people and train them.
  • Make sure that they have what they need, in terms of staff, time, and authority to run the program.
  • Make sure that they clearly understand what their roles will be.
  • Make sure your people fully understand what is expected of them.
  • Ask if your organization is highly motivated to do this program, practice, policy or intervention?
  • Check out the who, what, when, where, and how of Getting To Outcomes. You can develop a plan by answering the following questions:
    • Who is running your program?
    • What roles will each person have? What are the components of your program? What will be accomplished?
    • When will you launch your program? On what schedule will specific things happen? By when will certain things be accomplished? How long will specific activities take?
    • Where is your program going to take place?
    • How will all tasks be accomplished? How will you ensure that activities are carried out with fidelity—that is, according to the guidelines laid out in the evidence-based program you are adopting?
  • Outline everything.
  • Keep stakeholders informed and involve them as much as possible in the planning process.
  • Make sure your staff are ready to proceed and your group of participants are in place. 
  • Create a start date and a full timeline.
  • Determine how you are going to collect data on your program.
  • Get started.
  • Track the program as it is running. This is called a process evaluation, since it tracks the implementation of your program. You should plan your process evaluation before the program launches.
  • Monitor implementation. List any surprises and how you have dealt with them.
  • Answer the following questions:
    • Have things happened on schedule?
    • Which activities have taken place according to plan and which have not?
    • Have you carried out your program with fidelity?
    • What corrections have you had to make on the fly?
    • What corrections still need to be made?
  • Ask staff and program recipients how things are going.
  • Evaluate whether you have achieved your desired outcomes. If not, determine why. This is called your outcome evaluation.
  • Determine how you will collect your evaluation data. How will you measure achievement of your desired outcomes? Will you use oral interviews or written surveys?
  • Decide how you will analyze and interpret the data you collect.
  • Make a record of what you’ve learned about your program’s effectiveness, using the information you have collected from the process evaluation and the outcome evaluation.
  • Review steps 1 through 8. What have you learned? How can you improve the program?
  • Consider making program changes, expansions, or reductions, if appropriate.
  • Make program changes based on a wide variety of inputs, such as from the process evaluation, the outcome evaluation, staff, clients, and the community.
  • Consider whether the program has been successful enough to keep it going. 
  • Retire (or suspend) the program if the problem you addressed in step 1 no longer exists. However, even if your original target population has ‘graduated’ from the program, you might still have a new target population with problems that need to be addressed.
  • Anticipating staff turnover, try to include as many staff as possible in the initial training.
  • Share news of your program’s success with funders, so their support will continue.

 

Supporting Materials

The GTO toolkit has been applied to a range of prevention areas, such as teen pregnancy, Positive Youth Development, and underage drinking. GTO guides have also been used for improving outcomes for homeless veterans, home visiting programs for new parents, alcohol and drug use, violence prevention, and emergency preparedness.

GTO has been tested in various rigorous implementation research studies in nonclinical, community-based settings, which often have low capacity that undermines implementation quality and outcomes. Those studies have shown that communities improve their ability to run programs with quality when they used GTO.

Further, GTO has been tested in various randomized controlled trials of an evidence-based teen pregnancy prevention program and an underage drinking prevention program. GTO has also been used to incorporate an evidence-based, dual-disorder treatment program, called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking—Veterans Edition (MISSION–Vet), into case management teams serving homeless Veterans (Hybrid Type 3 cluster-randomized trial of an implementation support strategy).

The GTO model can be used in any prevention program. It has been used widely by agencies, schools, community coalitions, prevention practitioners, community service organizations, and adolescent and youth program services.

For example, the following have all used the GTO framework: SAMHSA, the Centers for Disease Control and Prevention, the National Center on Homelessness Among Veterans, the Philadelphia (Pa.) Department of Behavioral Health and Intellectual Disabilities, and many community organizations.

Learn more about Getting To Outcomes Improving Community-based Prevention

Acosta, J., Chinman, M., Ebener, P., Malone, P. S., Paddock, S., Phillips, A., Scales, P., & Slaughter M. (2013). An intervention to improve program implementation: Findings from a 2-year cluster randomized trial of Assets—Getting To Outcomes. Implementation Science, 8, 87. PMC3751245

Chinman, M., Hunter, S., Ebener, P., Paddock, S., Stillman, L., Imm, P., & Wandersman, A. (2008). The Getting To Outcomes demonstration and evaluation: An illustration of the prevention support system, American Journal of Community Psychology, 41(3–4), 206–224.

Chinman, M., Acosta, J., Hunter, S. B., & Ebener, P. (2015). Getting To Outcomes®: Evidence of Empowerment Evaluation and Evaluation Capacity Building at Work. In D. Fetterman, S. Kaftarian, & A. Wandersman. (Eds.), Empowerment Evaluation: Knowledge and Tools for Self-assessment, Evaluation Capacity Building and Accountability (2nd ed.). Thousand Oaks, CA: Sage.

Chinman, M., Acosta, J., Ebener, P., Malone, P. S., & Slaughter, M. (2016). Can implementation-support help community-based settings better deliver evidence-based sexual health promotion programs: A randomized trial of Getting To Outcomes®. Implementation Science, 11, 78. DOI 10.1186/s13012-016-0446-y. PMC4886421

Last Updated: 09/14/2017