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Can we speed the testing, implementation and spread of management innovations in a systematic way to also contribute to scientific knowledge? Researchers and implementers have developed an approach to test and revise a local version of an innovation during its implementation. The chapter starts with a case example of an application of this combination of implementation and quality improvement sciences and practices (improve-mentation). It then summarizes four examples of this approach so as to help understand what improve-mentation is and how it is different from traditional quality improvement and traditional implementation of evidence-based practices. It considers gaps in knowledge that are hindering both more use of improve-mentation to generate scientific knowledge about spread and implementation, as well as more use of improve-mentation by health care service organizations and researchers. It closes by proposing fruitful research and development that can address these knowledge gaps to speed the implementation, sustainment and spread of care and management innovations.

Up to this point, we have examined many components that make up the Trauma Ecology Model (TEM). In this chapter, the implementation of TEM in organisations and healthcare systems is explored. The aim is to guide organisations through the process of implementation completely. Practical strategies will be provided for each of the six stages of the Fixen model of implementation. This chapter also includes discussion of potential challenges as well as suggestions for resolving some common issues faced in the implementation literature. You will find the Trauma Ecology Model Fidelity Measure (TEM-FM) in the Appendix a useful resource. As you navigate through each stage, I discuss how best you can utilise the TEM-FM to assess and monitor your organisations progress against clear objectives. As you read this chapter, think about your individual organisational context, and how best to apply this implementation science approach in a meaningful way. This chapter provides a generic implementation guide based on the implementation science literature, as such, we don’t unpack how to implement each component of TEM as specific and non-specific trauma organisations may have some diverging needs. Rather, I provide a framework which can be used by individual organisations as a guide to support implementation at different points in the TEM.

Youth and young adults with emotional and/or behavioral difficulties (EBD) face particularly difficult challenges in their efforts to fit into adult roles and functions. The purpose of this chapter is to assist providers, educators, and administrators from the mental health, education, child welfare, justice/corrections, and adult service system sectors understand (a) a practice for improving the progress and outcomes for young people in transition, and (b) how this practice model is implemented in communities to impact the lives of youth in transition to adulthood. This is accomplished in two major parts in this chapter. The first part provides an overview of the Transition to Independence Process (TIP) model, a description of its status as an evidence-supported practice, and tools and strategies that support its implementation in communities and regions across North America. The TIP model is further illustrated through a description of how it is applied with a young person. The second part of the chapter provides an overview of implementation science, a description of how its strategies and tools can guide the implementation of an intervention or model; and an illustration of a large-scale TIP implementation initiative with collaboratives of agencies and schools. This chapter concludes with implications regarding the importance of having effective transition-to-adulthood models; and ensuring the implementation and sustainability of these to improve the progress and outcomes of youth and young adults with EBD.

Alternative education settings (AES; i.e., self-contained alternative schools, therapeutic day treatment and residential schools, and juvenile corrections schools) serve youth with complicated and often serious academic and behavioral needs. The use of evidence-based practices (EBPs) and practices with Best Available Evidence are necessary to increase the likelihood of long-term success for these youth. In this chapter, we define three primary categories of AES and review what we know about the characteristics of youth in these schools. Next, we discuss the current emphasis on identifying and implementing EBPs with regard to both academic interventions (i.e., reading and mathematics) and interventions addressing student behavior. In particular, we consider implementation in AES, where there are often high percentages of youth requiring special education services and who have a significant need for EBPs to succeed academically, behaviorally, and in their transition to adulthood. We focus our discussion on: (a) examining approaches to identifying EBPs; (b) providing a brief review of EBPs and Best Available Evidence in the areas of mathematics, reading, and interventions addressing student behavior for youth in AES; (c) delineating key implementation challenges in AES; and (d) providing recommendations for how to facilitate the use of EBPs in AES.

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.

Knowledge mobilization (KMb) offers an approach to conducting impactful research. In this chapter, we describe ways to remove barriers to understanding and implementing a KMb approach. We do this by examining the broad scope of KMb, thinking about how it has evolved over time, and focusing on core intent rather than terminology debates. Our goal is to offer a pragmatic series of stepping stones that form a KMb pathway. These steps include: (1) asking good questions; (2) aligning your work with what has already been done; (3) acquiring new and diverse knowledge; (4) adapting knowledge to a specific context; (5) applying knowledge in the real world; and (6) assessing what works and what doesn't throughout your journey. We argue that this process will identify and support successful implementation of nuanced, novel, and meaningful solutions to real-world problems. Following the KMb pathway will guide you toward becoming an impactful academic who creates a lasting research legacy and a positive mark on the world.

Implementing any evidence-based practice into complex systems is hugely difficult. Implementing peer support is very much at an early stage in most systems around the world. This chapter examines the implementation of peer work into health and social care systems by drawing on an ecological perspective. The wider sociocultural context is considered, while the organisational context and how this shapes both the peer and service delivered is further explored. Some tips are provided across the ecology of factors that the research describes as being important to implementation.

Using data from the National Longitudinal Transition Study (NLTS) and the National Longitudinal Transition Study-2 (NLTS2), this study compared the post-high school outcomes of young adults with learning disabilities (LD) or emotional/behavioral disorders (EBD) in 1990 and 2005. These cohort comparisons reveal how the results of special education have changed over that time period as evidenced in the post-high school outcomes of nationally representative samples of youth. The extended data collection time period of NLTS2 (2001–2009) also enabled an assessment of the evolution in the post-high school outcomes of young adults with LD or EBD who had been out of high school up to 8 years. The post-high school outcomes considered included high school completion, postsecondary education enrollment and completion, employment status and wages, and community integration as illustrated by living arrangements and criminal justice system involvement. Findings for both the NLTS/NLTS2 cohort comparisons and the longitudinal analyses from NLTS2 indicate progress in efforts to improve outcomes for youth and young adults with LD or EBD but also underscore the work ahead in setting these groups on a path to successful adulthood. Implications for practice and research are discussed.

There is considerable heterogeneity between primary care systems that have evolved in individual national cultural environments. Models of Child Health Appraised (MOCHA) studied how the transfer of models or their individual components can be achieved across nations, using examples of combinations of settings, functions, target groups and tracer conditions. There are many factors that determine the feasibility of successful transfer of these from one setting to another, which must be recognised and taken into account. These include the environment of the care system, national policy-making and contextual means of directing population behaviour – in the form of penalties and incentives, which cannot be assessed or expected to work by means of rational actions alone. MOCHA developed a list of criteria to assess transferability, summarised in a population characteristics, intervention content, environment and transfer (PIET-T) process. To explore the process and means of transferability, we obtained consensus statements from the researchers on optimum model scenarios and conducted a survey of stakeholders, professionals and users of children’s primary care services that involved three specific health topics: vaccination coverage in infants, monitoring of a chronic or complex condition and early recognition of mental health problems. The results give insight into features of transferability – such as the availability and the use of guidelines and formal procedures; the barriers and facilitators of implementation and similarities and differences between model practices and the existing model of child primary care in the country. We found that successful transfer of an optimal model is impossible without tailoring the model to a specific country setting. It is vital to be aware of the sensitivity of the population and environmental characteristics of a country before starting to change the system of primary care.