Externalizing and Effective Implementation

Rather than recommending changes to what you do, here we provide advice about how to implement what you do well. These effective implementation components may increase the chances that your program is delivered in the way you intended, and that the effective intervention components are best able to drive behavior change.

Our analysis found that the most effective interventions for reducing externalizing behavior had one or more of these three implementation components:

• Staff training or supervision – Focus on training staff for their roles as part of the startup process and provide ongoing supervision, coaching, and technical assistance to help staff implement the program with quality.
• Simplified service delivery or complex delivery paired with strong implementation – A simplified or streamlined delivery approach can be more effective than a complex approach – but complex approaches pay off if there is appropriate support to implement them well.
• A lack of reported implementation problems – Incorporate implementation monitoring into Continuous Quality Improvement (CQI) or other feedback improvement loops to ensure it is an ongoing process.

Together, these three components reinforce the notion that supporting strong implementation is necessary to produce positive impacts on behavioral outcomes. The interrelatedness of the three recommendations is important. For example, a strong approach to monitoring implementation coupled with training and support for frontline staff can help balance any necessary service delivery complexity.

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