Effective Action Planning and Implementation

 

Introductory Paragraph

The last three steps in the SPF approach build upon the Assessment phase in which community-specific needs are identified and sufficient Capacity-Building has occurred to be able to implement solutions. The Planning, Implementation, and Evaluation phases are tightly interwoven. Since all three phases utilize the Assessment data in an integrated way, they are presented together in this single article. The Planning phase can be summarized as using the buy-in and wisdom of the coalition members to prioritize which goals can be realistically achieved and which actions should be implemented. Since the Evaluation phase will provide metrics on the effective ness of those actions and progress towards those goals, it is important for planning priorities to be established with evaluation processes and outcomes in mind. If the Planning phase fully engages the coalition membership, there is likely to be more buy-in and accountability during the Implementation phase, as well as a deeper celebration of successful outcomes in the Evaluation phase.

Key Information

Planning Substance misuse is a complex problem which a community can address by numerous strategies. An action plan requires the coalition to make choices about which solutions to implement. The specific approaches different communities will choose to take varies widely. The by-word for the planning process is prioritization which helps to simplify both the complexities of the task at hand and to focus on achieving results. Realizing that the Planning phases is the mid-point of the five SPF phases provides an opportunity to use two navigational points -- the data-driven and outcomes orientation of SPF. The data-driven component is based upon the Assessment phase and ensures that Implementation choices are grounded in the current needs of the community and not upon previous efforts, which may feel subjectively easier, but be less objectively effective. The outcomes component ensures that the Planning phase identifies strategies can be measured in the Evaluation phase, that they are based upon best practices, and that they align to S.M.A.R.T. goals. This acronym stands for Specific, Measurable, Achievable, Relevant, and Time-Bound. A small number of optimal SMART goals will drive the Implementation phase and can be developed by the coalition by balancing three simple criteria -- impact and capacity and timing:

• Impact. The Assessment phase identifies various gaps and additional service needs. Since the coalition cannot provide solutions to all problems at once, it is useful to identify those outcomes which are immediately achievable. If certain coalition members are skeptical that any level of change is likely on a certain potential goal, then it may be better to shift focus to goals which will have more buy-in. Some of this may be influenced by what coalition members feel that the community-at-large will be most likely to support. Working on strategies which will have the highest impact helps the coalition to have successes which can build traction for more success.

• Capacity. When formulating these plans, it is important that expectations are realistic and that the actions identified can be achieved. Even when action plans are revised due to changing data and lessons learned, achieving progress is important to keep participants energized and motivated so communities may consider planning for small and early wins first. Communities can use the strategies contained in the SAFE Solutions dashboard to help lead discussions on which strategies to implement within their community.

Part of creating an achievable action plan is identifying and securing any financial and other resources that are necessary. There are a variety of funding sources that support planning and programs. Sources of funding include:

• Local or state government (grants or direct funding)
• Federal grants
• Funding through philanthropic organizations
• Support from the business/corporate community
• Funding from grassroots and direct fundraising campaigns and events

What is important is that the action plan develops steps to secure any needed financial resources. Without funding, community groups may be unable to meet their goals and objectives. More funding is not always feasible, so coalitions may need to consider alternate, innovative avenues.

• Timing.

Once the group as a whole or sub-group agrees to an action plan, it is important to create timelines to complete each activity. As steps are taken to address both short- and longer-term goals, trust is built between the members working toward a common outcome. As with the actions themselves, the timelines need to be reasonable and achievable. Having a range of timelines helps keep members engaged and have a sense of accomplishment. Some coalitions will have short-term goals that can be achieved in 30 or 60 days, mid-term goals that are several months out, and long-term goals that can be expected to take a year or more.

The following guidelines are useful in developing an action plan:

• Ensure that a diversity of populations within a given community are served. Due to differences in language, culture, and experiences, communities addressing any public health issue must develop action plans that can achieve desired outcomes for all people within the community.
• Include a variety of strategies to work across the continuum of care, with implementations in prevention, recovery, and access to treatment services.
• If the coalition is large enough to have a sub-committee to perform the Assessment phase and to develop a suite of possible interventions, then they should engage the full coalition in the process of prioritizing the specific strategies to implement.
• If possible include strategies which impact broad systemic and policy changes.
• Strategies should increase awareness, build education, enhance skills, build capacity, improve access, or fill gaps.
• Action plans are living documents and will need to be constantly reviewed and revised to address the new realities and lessons which are learned through the Evaluation phase.

Implementation

A set of action items can be added to achieve each the intended outcome of each SMART goal.

Many community coalitions - especially those with a large number of members - will break into working groups or committees around each strategy or objective. Naturally, those members who are subject matter experts and work in specific fields can take the lead in developing a plan and outlining the details for that specific strategy.

It is important for all participants to know what part of the action plan they are responsible for leading. This lays the groundwork of expectations between members and trust that each participant will carry out their portion of the plan. These responsibilities should be clearly spelled out in writing so there is no confusion or misunderstanding. Although a coalition member may be helping to coordinate the activities of members, it is the responsibility of each member to be accountable and help achieve progress. For example, coalition members not tasked with a specific strategy can still help to track milestones, maintain community momentum, and update key community stakeholders as progress is made.

As work begins on implementing the plan, a process begins whereby actions are taken, effectiveness is assessed, and modifications to the plan are made. The constant evaluation of progress is an ongoing effort. Often, goals are added and changed, and sometimes changes are made in those responsible for implementing parts of the plan. It is important to have the expectation from the start that almost nothing goes exactly as planned.

Evaluation

Within an effective action plan, communities should identify and outline a series of performance indicators that align with their goal(s) and track progress. Shared accountability ensures that progress is being made towards achieving desired outcomes. The data can be used to report back to key stakeholders in the community on the progress that is being made, but it also can be used to revise any details related to the action plans as needed if strategies aren’t going as intended, so that all involved can collectively improve the desired outcomes.

Accountability and monitoring of progress are an ongoing process. As is the case with many aspects of community response, strategies and actions are constantly adjusted. Generally, the performance management process has four components:

• Identify Appropriate Performance Indicators - Determine agreed upon markers of achieving success.
• Conduct Performance Measurement - Leverage available data; collect new data to measure short-term and longer-term outcomes.
• Monitor and Report Performance Measurement Results - Share cross-sector performance management data, insights, challenges, and successes.
• Quality Improvement - Celebrate even small wins together, share what is working, and build on positive momentum to achieve continued progress. Use evidence of limited results or setbacks as learning opportunities that can be used to improve strategies and action plans.

Communities might initially collect only baseline data, but the benefits of tracking data trends over time include accountability, monitoring changes with statistical significance to act more swiftly, influencing policy, and being able to communicate and raise awareness about a particular problem. The identified lead should determine the frequency on how often to collect data and coordinate collection efforts to regularly monitor data.

It will be up to each community to decide what data to collect and report, and what data should be made public. The data report should continually educate and drive informed decision-making. Data used to track the number and locations of overdoses, for example, can provide the community with the knowledge of where overdoses are taking place and what hot spots exist. This allows a community to focus resources where they are needed by adding or expanding services like those related to prevention, harm reduction, and connection to services through peers or other means. Other parts of the reports may include available treatment and recovery housing beds, Naloxone distribution numbers, number of prescribed MAT in various settings, and number of interventions. What is required is what is needed to first guide strategy and then be able to track the effectiveness of those strategies over time.

Analysts may choose a variety of methods for sharing their data, including Geographic Information Systems (GIS), line graphs, bar charts, tables, and pie charts. It is critical for an analyst to use care when displaying and illustrating data because it is important to find a balance between creating a visualization that is effective and provides a picture for their audience, but also doing it in a way that accurately displays the data rather than skews the interpretation. Charts and graphs should be easy to read, aesthetically pleasing, well-labeled, include the totals for columns and rows, be scaled accurately, and developed with the audience in mind. Illustrate the most important information and keep the graphic simple. Research best practices or ask for help if you are not well versed in the creation of charts and graphs.

To maintain a strong data infrastructure, communities have a variety of options. Investments in off-the-shelf software systems are available for purchase and can help to combine and monitor data from various state and local organizations, provide a connection to services, and serve as a tool for tracking system performance indicators and outcomes over time. If there is limited funding available, communities can do this using spreadsheet or database software (like Microsoft Excel or Access).

A targeted data collection and analysis effort will enable decision makers to develop effective approaches to achieve results. Continued communication and sharing of data is key. This will lead to greater collaboration between agencies that have and share data as well as other community stakeholders involved with developing and implementing strategies and programs. These community stakeholders can help "translate" the data from multiple sources to help with decision-making. Often new partnerships are forged when the data reveals what needs to be addressed and who can effectively address those identified needs.

Another common lesson learned from experience is that decision makers need to be willing to experiment and constantly adjust the approaches they take. Even at the local level, aspects of this epidemic change and sometimes change rapidly. Leaders need to continually collect and analyze data in order to detect these changes and make adjustments.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform.  Currently limited information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

Available Tools and Resources

• SAMHSA provides a summary of best practices in the planning domain in "A guide to SAMHSA’s strategic prevention framework"

• SAFE Project. The Community Playbook includes a template for building an action plan and for setting S.M.A.R.T. goals. Coalitions can use the SAFE Solutions dashboard to help lead discussions on which strategies to implement within their community.

• One resource explicitly focused on implementation is the National Implementation Research Network, which has public health implementation as one of its four focus themes.

• Although it is dated, Durlak and DuPre (2008) is worthy of review because it provides a meta-analysis of over 500 research findings on the implementation process.

• There are many resources that discuss how to improve cultural competence in the areas of substance use and mental health. SAMHSA has examined this issue in great detail.

• Typically, it will take a combination of several strategies to improve cultural competence. Therefore, it is important that there be as much input as possible when considering what needs to be done in a given community. SAFE Project’s resources for diverse populations provides links to a suite of resources for a variety of populations.

Promising Practices

SAFE Solutions is an ever-growing platform.  Currently limited information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.