Implementation science brings the "how" to help partners make real impacts for children
When it comes to developing programs that truly help children and families, it often begins with a "what."
For partners of the UNC Frank Porter Graham Child Development Institute (FPG), the "what" is often better outcomes for children and families. That's where the "how" comes in, says Oscar Fleming, DrPH, and that's why successful programs call on implementation specialists, like those at FPG's National Implementation Research Network (NIRN).
"You want better outcomes for women and kids, and you have a strategy. Is that strategy evidence-based? How do you find that evidence, how will you go about selecting it and preparing for it?" says Fleming. "We use evidence to strengthen our partners' capacities to deliver, and we evaluate the program, looking at implementation over time."
Partners across the UNC-Chapel Hill campus, and the nation, engage FPG implementation scientists who can develop and execute proven implementation strategies to facilitate the uptake of evidence-based practices into research and practice, tailor methods to the needs of a particular population, setting, or content area to ensure sustainable impacts, as well as develop the appropriate measures for assessing and improving implementation over time.
"Our implementation specialists at FPG are unique in their abilities to partner with groups across so many areas of expertise. This is what makes our capacity-building so strong and such a great fit for our partners here on campus and across the country who are working so hard to improve the lives of children and families," says Allison Metz, PhD, a developmental psychologist and a senior research scientist who leads FPG's Implementation Division.
"FPG has a name recognition in the state that has allowed those of us at NIRN – like Oscar and me, and our teammate Nakenge Robertson, MBA – to be at the table for conversations that are really valuable in shaping the lives of kids," says Laura Louison, MSPH, MSW.
One program all three are deeply involved in is NC Integrated Care for Kids (NC InCK), a child-centered service delivery and state payment model aimed at improving the quality of care and reducing expenditures for children insured by Medicaid or CHIP (NC Health Choice). The program is in a 2-year planning phase of a 7-year model serving children in five central North Carolina counties and led by UNC-Chapel Hill and Duke University, as well as NC DHHS, community partners, and a coalition of children and families in the represented counties.
NC InCK aims to integrate services for children, including physical and behavioral health care, food, housing, early care and education, child welfare, mobile crisis response services, juvenile justice, and legal aid. In 2022, the program enters a 5-year implementation period. The model is funded by up to $16M from the Centers for Medicare & Medicaid Services (CMS) for infrastructure and capacity building.
"The goal of InCK is to help ensure that children and families with complex needs have everyone who is involved in their care talking with each other and coordinating services," says Louison. "This is a model that could both provide care differently for kids and pay for it differently."
What sets this program apart, Louison says, is that NIRN was involved from the start, helping to develop the proposal and set up the program for what it needs to succeed. Bringing together a multifaceted team where individuals have different areas of expertise and skillsets, including family members with lived experiences, ensures that what the team is building is not only responsive to community needs but is also sustainable.
"When you're trying something new and complex, it is valuable to have a group of people who can guide the project and be accountable for implementation," says Louison. "Now we're figuring out what people we need to hire and what kind of conversations need to happen in agencies where we are coaching the staff so that this is all set up in a very intentional and thoughtful way."
Fleming also leads the evidence-based decision-making core for the National Maternal and Child Health Workforce Development Center, which is housed in the UNC Gillings School of Global Public Health. The center helps Maternal and Child Health (MCH) Services Title V Block Grant Program leaders in states and territories across the nation tackle complex challenges through training, collaborative learning, coaching, and consultation.
"Our center is focused on helping the public health professionals who are funded through the maternal and child health block grant to effectively assess the need and understand their context, select and align programs with that need, and then evaluate them effectively over time," he says.
MCH encompasses a life course perspective, from women's health, including reproductive health, to healthy pregnancy and delivery, to early childhood development and child health on through adolescence.
"We might be working with a state to figure out how to scale up developmental screening for young children and to integrate screening tools, as well as the data that comes out of it, into a statewide platform," says Fleming. "We might also work further upstream to help them think about what developmental screening approach they want to use in the first place, based on their needs and their capacity."
Fleming says NIRN specialists are particularly focused right now on viewing evidence through an equity lens, considering whether the available evidence may reinforce or exacerbate inequities in child development systems.
"We have to ask why certain communities are not receiving a service now, or why they might not be interested in the service that is being offered – what has been going on historically, what is going on right now, and how can we reimagine the system to work better. These things might be based on race, rural issues, income, and many other reasons," he says. "We're not only looking at this in our projects, but we're trying to figure out what this should look like internally, on an implementation team."