The Stages of Implementation Completion (SIC), originally developed with funding from the National Institute of Mental Health, is an 8-stage tool of implementation processes and milestones, with stages spanning 3 implementation phases (pre-implementation, implementation, and sustainability).
The Stages of Implementation model focuses on the following 8 phases of implementation activities: engagement, consideration of feasibility, readiness planning, staff hired and trained, fidelity monitoring, services and consultation begin, ongoing services, consultation, fidelity monitoring, feedback, and competency.
The first step in the implementation process, Engagement, includes learning about the EBP, expressing interest to the developer or purveyor of the practice, discussions amongst decision-makers at the provider organization, and ultimately deciding whether to move forward with active steps to adopt the program.
Engagement with the EBP developers or purveyors is a critical step to ensure that providers are well-prepared for deciding if the implementation is one that they would like to pursue or not.
A provider organization might be engaged with multiple EBPs at a time before deciding which one to consider moving forward with implementing. Some providers spend a single day in the engagement stage before moving on in their implementation, whereas others spend a greater amount of time before feeling ready to consider moving forward.
During the Pre-Implementation Phase, decision-makers need to determine if it is feasible for them to implement well the EBP. This entails learning from the developer or purveyor about program expectations, often over a series of contacts, meeting with stakeholders to determine the need that is being filled and if it is realistic for the selected EBP to meet that need.
Also part of the process is collecting information to ensure that the organizational infrastructure is in place to support the EBP and if not, if it will be feasible to create the necessary supports during the Readiness Planning Stage.
Although a provider organization can begin considering feasibility of implementation internally, to adequately consider the feasibility of program implementation it is necessary to engage in ongoing discussion with the developer or purveyor.
Readiness planning involves the nuts and bolts of preparing an organization to implement an EBP successfully.
During this stage, critical implementation activities are completed, such as:
Reviewing and problem-solving referral criteria and the referral process.
Preparation of infrastructure needs including budgetary needs and funding sources.
Transparent discussions with involved stakeholders who are invested in the program meeting community needs.
Many EBPs have specific readiness materials and procedures that are worked through in a collaborative process with the developer or purveyor. The Readiness Planning stage has been demonstrated to be one of the most important to complete thoroughly to yield a sustainable program.
The first Stage in the Implementation Phase is the hiring and training of staff. Although apparently straight-forward, there are critical decisions that are needed to determine the fit of potential staff with the EBP being implemented.
Reallocation of staff from an existing position to one on the new EBP team is sometimes an efficient method of staffing a new program, but should be conducted with caution. An understanding of staffing needs as determined during Readiness Planning is essential for positive staffing decisions.
Importantly, the timing of staff hiring should be close in proximity to EBP training to maximize efficiency. Training should occur in close proximity to serving clients to maximize the program delivery and preserve resources.
Establishment of the fidelity monitoring system is highly variable across EBPs. Activities include pragmatic activities such as ensuring that fidelity instruments and technology needs are reliable and accessible to providers, establishment of feedback loops, and inclusion of leadership in monitoring program progress.
Known as the "Stage of Firsts," this stage establishes the launch of all critical components of the EBP delivery including screening, assessing, and providing services to the first client under the EBP. The aggregate of completing all program components initially is captured in this stage. Thorough completion of Pre-Implementation activities predicts successful completion of program launch activities.
The "Ongoing" stage of implementation is typically the longest stage in the implementation process. During this period, newly adopting organizations often are supported with coaching or consultation in competent program delivery.
Critical program components are operationalized and the quality delivery of key components is monitored. This stage includes an overall assessment of the ongoing infrastructure, as well as the clinical and delivery of program component needs.
This highly active stage of implementation often involves an ongoing dialogue between the program within the organization, the organization as a whole, and the developer or purveyor, to allow for ongoing alterations that are contextually important.
The development of Competency in the EBP delivery is uniquely defined by each EBP. Criteria include markers such as meeting fidelity standards for a sustained period, general program operations, and obtaining certification by the developer or purveyor in the EBP model.
The development of Competency is the entrée into Sustainability activities; once competency is achieved, successful programs will continue to support the program through systematic reviews and checks to ensure that the program continues to operate with Competency.
Predictive Ability of Scores. SIC scores have predicted variations in implementation behavior. Findings from a large-scale implementation trial of Treatment Foster Care Oregon (TFCO) suggested that sites completing implementation thoroughly (high proportion) and relatively rapidly (duration) had the highest probability of initiating services.
Replication. In response to a need for psychometrically sound and standardized implementation method, the SIC team has produced adaptations for more than 22 child and family-focused practices (e.g., Multisystemic Therapy, Multidimensional Family Therapy) across a range of service sectors. This has made it possible to evaluate SIC performance under varying implementation contexts.
Accessibility. The SIC has been programmed into a website that serves as an interactive tool to contribute an evidence-driven approach to the dialogue between purveyors who provide technical assistance (e.g., consultation, coaching) to agency stakeholders throughout the implementation process.
EBP specific implementation protocols have been defined and are outlined on the SIC website, including:
- Collaborative Care
- Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
- Housing First
- Multidimensional Family Therapy (MDFT)
- Multisystemic Therapy (MST)
- Parenting with Love and limits (PLL)
- Treatment Foster Care Oregon (TFCO)
The SIC framework and structure are applicable across a range of practices. The Universal SIC, developed recently to address the need for a general measure of implementation process and milestones that was not EBP specific, has demonstrated applicability across a range of EBPs and service sectors.
Hendricks, C., Chamberlain, P., Saldana, L., Padgett, C. Wang, W., & Cruden, C. (2014). Evaluation of 2 implementation strategies in 51 child county public service systems in 2 states: Results of a cluster randomized head-to-head implementation trial. Implementation Science, 9, 134–149.
Palinkas, L., Brown, C., Saldana, L., & Chamberlain, P. (2015) Association between inter-organizational consensus on use of research evidence and stage of implementation of an evidence-based practice. Implementation Science, 10(Suppl 1), A20–21.
Saldana, L. (2014). The stages of implementation completion for evidence-based practice: Protocol for a mixed methods study. Implementation Science, 9, 43–54.
Saldana, L., & Chamberlain, P. (2012). Supporting implementation: The role of community development teams to build infrastructure. American Journal of Community Psychology, 50(3–4), 334–346.
Saldana, L., Chamberlain, P., Wang, W., & Brown, C. (2012) Predicting program start-up using the stages of implementation measure. Administration and Policy in Mental Health, 39, 419–425.