Best Practices for Scaling Effective Interventions
In conjunction with the co-founders of the National Implementation Research Network (NIRN), I recently co-authored Scaling Effective Innovations in the journal Criminology & Public Policy, an article that outlines the importance of scaling effective programs in order to reach social impact. The following are a few of the best practices identified in the report:
- Understand the target audiences: Effectively scaling programs first requires attention to defining the denominator, or population of interest for the scale-up effort, as well as the numerator, or the number of children and families who could be receiving the program.
- Focus on scaling proven programs: Attempts to scale ineffective or harmful programs are a waste of time, money, and opportunity, so programs must reliably produce positive outcomes for the population of interest. Given that we are focused on scaling interaction-based programs that require service providers to use the program within a larger systems context, there is a great deal of complexity involved in “scaling up.” It may be difficult to assess the quality of the program for the children and families who are receiving it, as good fidelity measures for programs are not common.
- Ensure adequate implementation capacity: There needs to be a focus on developing local/site implementation capacity, so that each site using the program can sustain it over time. Scaled use of an effective program depends first on scaling implementation capacity to support, sustain and improve high quality replications of the program. There is complexity inherent in maintaining and increasing the numerator – the number of recipients of the program cannot continue to increase without attention to sustaining the quality of the program by those already providing it. Implementation teams may be one key factor in supporting programs at scale, helping to ensure sustainability of the program, and maintaining local implementation capacity. One team cannot support a program at scale; it would be like one teacher supporting all classrooms in a school. Given this, teams that support implementation must be present at multiple levels to support high quality use of the program over time. It truly is a whole systems effort that is required to effectively scale programs.
- Purposeful design leads to high-fidelity use: Human service systems are legacy systems made up of an accumulation of fragments of past mandates, good ideas, beliefs, and ways of work that evolved over many decades as legislators, leaders, and staff have come and gone. These legacy systems can be fragmented, siloed, and inefficient. To realize social impact, organizations and systems need to be designed, or re-designed, on purpose to produce and sustain high-fidelity use of effective programs.
The good news is that transformation of systems may require only small changes. It has been shown that transformed systems retain approximately 80 percent of the original system. In sum, developing local implementation capacity and implementation teams may be the way forward if we want to ensure high quality implementation of effective programs into service delivery systems.
Amanda Fixsen, Ph.D. is the director of implementation at Invest in Kids. With a background in applied behavior analysis, social work research, and implementation science, she pursues her interest in how human and health services can be effectively implemented and scaled up in real-world contexts.