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 will invariably identify numerous 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 an action plans, it is important that expectations are realistic and that select actions which are prioritized can be achieved by the coalition. It is important for communities to consider planning for small and early wins first, so that tangible progress will keep participants energized and motivated. 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. These include local, state, or federal government grants, funding through philanthropic organizations, and support from the business community or fundraising campaigns. The action plan should identify steps to secure financial resources to meet their goals and objectives. More funding is not always feasible, so coalitions may need to consider alternate, innovative avenues in their action plans.

• Timing. Once the coalition 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. 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

During the Implementation phase of SPF, a set of action items can be added to achieve 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 SMART goal to delineate details implementation objectives. Naturally, those members who are subject matter experts and work in specific fields can take the lead in implementing specific strategies. 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 one coalition member may be helping to coordinate the activities of other members, it is the responsibility of each member to be accountable and help achieve progress. For example, even coalition members who are 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 proceeds 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. If focus and prioritization are the by-words for planning, the by-words for implementation are accountability and flexibility.

Evaluation

Three verbs which summarize the Evaluation phase are calibrate, celebrate, and communicate. The calibration involves evaluation of what worked well during implementation, what did not work, and what can be learned to launch a new SPF cycle of assessment, capacity-building, planning, and implementation. Celebration uses the documentation of even small wins for coalition members to share successes and to build positive momentum to achieve continued progress. The communication of evaluation results can be used to report outcomes back to funders and to advocate for the coalition mission with local and state decision-makers.

There are two types of evaluations -- Process evaluations and outcome evaluations:

• Process evaluation documents accountability and that the implementation was done with fidelity. This focus is primarily on outputs and is often required for purposes of grant funding or communication with stakeholders. Did the coalition do what it said it was going to do? Were the activities within the action plan implemented? The identification of any action steps that were not implemented is likely to lead to staffing or resource issues and warrants examination of leadership, communication, and sustainability.
• Outcome evaluation measures effectiveness. Here, the focus is on impact. With the most synoptic view, we can reflect upon whether or not the proverbial “ladder is up against the right wall.” If it is, and a major redefinition of strategies is not in order, then we can examine what is or isn’t working, and make course corrections as needed. These adjustments are usually made by change detection or pre-post measure, that compares current conditions to baseline conditions. This is a process in which measurable progress towards the short-term or mid-term outcomes expressed

in the logic models and S.M.A.R.T. goals can be documented. Revision of long-term outcomes can be evaluated at this time as well. It should be noted that impact can also be documented through qualitative data. Often a compelling story can be told that is useful in promoting advocacy efforts. The conditions surrounding health equity are complex and documenting progress in this domain may be best served through the use of a narrative that is articulated by a variety of community members most affected by the action plan.

A solid plan outlines a series of performance indicators which can be used to track progress towards SMART goals.

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 - 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.