Thanks to an innovative collaboration between two units at the UNC Frank Porter Graham Child Development Institute (FPG), stronger and more expanded behavioral health resources will be available for youth and families across the state of Virginia. FPG’s National Implementation Research Network (NIRN) and Impact Center have partnered to merge their practice models, tools, and resources for the Virginia Evidence-Based Practices Transformation Zone project. This effort, which offers integrated guidance and technical assistance to support Virginia’s implementation efforts, is led by Principal Investigator Sherra Lawrence, MA, a senior implementation specialist at FPG and Co-Principal Investigator Stephanie Kennedy, MSW, MPH, an implementation specialist with NIRN.
 
Lawrence and Kennedy are working with The Center for Evidence-based Partnerships at Virginia Commonwealth University (CEP-Va) to use implementation science best practices to effectively implement behavioral health programs across Virginia. Using implementation science ensures that research-based strategies are utilized for fidelity, quality, and sustainability. 

State leaders engaged the FPG team to learn more about implementation science best practices and build implementation capacity as a state. The NIRN team recommended using a transformation zone approach, often likened to a “learning laboratory,” that enables testing, problem-solving, and improving systems within a vertical slice of the system before scaling. Through this approach, the NIRN and Impact Center teams and VCU are working at three different levels—local, intermediary support, and leadership governance—to ensure efficient, effective, and sustainable implementation of evidence-based practices. The team is testing new approaches on a small scale with all three levels, learning from those efforts, and then scaling up those learnings across the whole system.
 
One of the hallmarks of the transformation zone approach is including representation from all levels of a system from the start. This makes it easier to identify and communicate throughout those levels and address any issues or barriers that arise. By using implementation science and the transformation zone approach, the state is infusing implementation science into their expansion efforts, which will strengthen this and other behavioral health initiatives. “We always say to use a ‘go slow now to go fast later approach,’ taking the time to strengthen, examine, test, learn, and improve,” said Kennedy.
 
So far, the transformation zone initiative has supported the formation of linked teams at the state and local levels, development of a Theory of Change—a comprehensive description and illustration of how and why a desired change is expected to happen in a particular context—and the creation of a data-driven and replicable process for selecting participating sites. At the outset of this initiative, a team of state leaders selected an initial evidence-based program to be implemented in the transformation zone. The ultimate goal is to use lessons learned from this to inform statewide strategies and implementation of future evidence-based practices.
 
While The Impact Center and NIRN use similar approaches to implementation science in their work, each group’s projects are often in different disciplines and fields. This project offers the opportunity to merge their approaches and tools. Guided by the collaborative leadership structure of Kennedy and Lawrence, the team includes members from both the Impact Center and NIRN.

“What we know from implementation science research is that evidence-based programs and practices aren’t going to be effective if they are not implemented well,” said Lawrence. “Implementation science helps people slow down and put the infrastructure in place to implement programs with fidelity, which we believe ultimately leads to desirable outcomes for families and children.”

Lawrence said that the processes they established are similar to the ways that each group works with an external partner. They developed working agreements on how to make decisions, determine which tools and resources to use, and communicate effectively as a team. “We didn’t choose a NIRN way or an Impact Center way of doing things,” said Lawrence. “We developed this project's way of doing things.”
 
The team generally alternated between using a NIRN tool and an Impact Center tool for specific teachings with each group. At other times, they examined how NIRN and the Impact Center would explain a concept and then created a new hybrid tool that has the learnings from both groups.
 
Kennedy said that it has been beneficial that NIRN and the Impact Center use different language to describe their teachings. “While that can get a little confusing, bumpy, and even frustrating sometimes, ultimately that gives us a larger library to help communicate implementation science to our partners,” she said. “So, if one set of language isn't resonating, we have a whole other set of tools, resources, and language that we can pull out and tailor to what they need.”
 
Lawrence added that the collaboration has benefited her as a practitioner. “With the experience I have now of how NIRN works, I have expanded my toolbox and can bring that into other work that I do,” she said.

“My hope is that not only are they successful in this particular initiative, but that what they take away from this project is that building systems and structures goes far beyond any one evidence-based practice or initiative,” said Kennedy. “This is something that they're investing in themselves so they can replicate this capacity building going forward.”

Lawrence and Kennedy believe that this project furthers FPG’s mission of improving outcomes for children and families by improving how evidence-based programs are being implemented in Virginia by family-serving organizations. “What we know from implementation science research is that evidence-based programs and practices aren’t going to be effective if they are not implemented well,” said Lawrence. “Implementation science helps people slow down and put the infrastructure in place to implement programs with fidelity, which we believe ultimately leads to desirable outcomes for families and children.”
 
“My hope is that not only are they successful in this particular initiative, but that what they take away from this project is that building systems and structures goes far beyond any one evidence-based practice or initiative,” said Kennedy. “This is something that they're investing in themselves so they can replicate this capacity building going forward.”