Phase 1: Exploration

At a Glance

Each phase of the implementation process includes 4 components: activities, tools, outcomes and self-reflection. Select one below to jump directly to that component.

Activities Tools Outcomes Self-Reflection

The goal of the exploration phase is to identify the changes needed to improve the system of services for CYSHCN in your state/jurisdiction. This phase is also focused on building needed relationships key to the system-change effort; this includes relationships with family and community leaders. It is important not to rush through this phase, as it is the true foundation for all the work that follows. At the same time, it is okay if your team must revisit this phase after piloting something, or if your CYSHCN program needs change over time.

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Exploration Phase Activities

Examples of exploration phase activities recently carried out by Title V CYSHCN programs in their work to enhance systems of services for CYSHCN in their states include:

Example Activities from Title V CYSHCN Programs

Conducting a system-needs assessment using a strengths-based (SOAR) approach, with system-support mapping, benchmarking similar programs, and reviewing national and state data sets to identify gaps
Creating an aim statement and a logic model for system innovation
Organizing a needs assessment group (example: university partners, clinicians, family leaders, Title V administration, Medicaid/state health insurance)
Determining potential drivers for shifting organizational culture toward person-centered care
Conducting discovery of potential technological systems

Use the list below to consider which activities might be relevant for your system-change effort at this phase, keeping in mind that the change process is not always linear, and you will likely return to this phase over time. Teams may do these activities in a different order or may not do some activities listed. You may also download a PDF version of this list.

Activities to Consider

Form an implementation team and identify implementation “champions.”
Grow relationships and engage with community members, family leaders, youth, and partners to discuss their needs and ensure buy-in.
Identify/collect relevant data to better understand the systems challenge. This may include:
- Analyzing needs assessment results with particular emphasis on understanding what system-level changes are needed and the root causes of any issues
- Other internal strategic processes to surface the need for system change
Identify your state’s/jurisdiction’s existing assets, such as partnerships or other related initiatives or programs that could be leveraged to launch a system-level change.
Consider writing an aim statement for your change initiative to help team members and partners keep a central goal in mind.
Determine what change(s) your team could or would like to make by:
- Learning about other state/jurisdiction practices
- Researching potential innovations aimed at various levels of systems of care (eg, an evidence-based intervention or model)
- Utilizing a framework (Iceberg Model or Water of Systems Change)
After identifying potential system changes, assess the feasibility of implementing these changes. Assessing feasibility could include the use of a specific tool, but could also include a more informal assessment done by talking with system actors, including family leaders, clinicians, and other people with lived experience.
Consider what milestones you would like to have throughout the implementation process.
After identifying potential system changes, assess the potential impact of the change(s). Tools such as the impact matrix (linked below) can help understand the potential impact.
After identifying potential system changes, assess your Title V program’s capacity to lead this change(s). The National MCH Workforce Development Center and AMCHP have tools.
Name the outcomes you would like to have throughout the implementation process.

Download Activity Table

In Case Study #2 - Pediatric Care Coordination Community of Practice, the team convened stakeholders, used a System Support Mapping activity, and held regional meetings to identify gaps in care coordination. This exploration laid the groundwork for what later became a Community of Practice.

Tools to Consider During Exploration

These tools can be useful during exploration and have been successfully used by CYSHCN teams in their efforts to transform systems. You may also download a PDF version of this list of tools.

Implementation Plan Template

Guide the development of an implementation plan at any phase of implementation.

Terms of Reference

Outline the objectives, responsibilities, and operational guidelines for organizations and committees, ensuring clarity and accountability in their functions.

Team Roster (Handout)

Identify potential team members and/or other partners with different types of knowledge and skills.

Iceberg Model

Develop a shared understanding of the origin of a problem by collectively identifying key events and underlying trends, structures, and mental models.

Challenge and Aim Statement

Create concise and focused descriptions that articulate specific problems, opportunities, or goals within a given context.

Impact Matrix

Evaluate strategies, interventions, tasks, projects, or ideas according to their impact and effort.

FESAT

Plan, assess, and improve family engagement.

30 30

Monitor progress and document anticipated action steps in ongoing work.

Action Plan

Prioritize and stay on task by naming tasks to be done and updating progress.

Exploration Phase Outcomes

System-level implementation team to guide the work
Strong engagement of champions for change, such as family leaders, providers, other individuals with lived experience, local and state-level staff, community partners
Clear sense of what changes your state/jurisdiction CYSHCN system needs
Clear description of proposed system change, including the “core components,” and initial ideas for launching the change
Assessment of feasibility for implementing a proposed program or system change

Exploration Phase Self-Reflection

Use the self-reflection questions below to prompt your thinking about the change you want to make at this phase. The reflection table can be used at any point in the system change, to process your learning and identify next steps. Begin by having each team member do individual self-reflection, then share the responses with other team members as part of a larger group discussion. The group discussion can be used during ongoing team meetings or progress check-ins. Core components are the essential parts of an intervention or innovation. You can think of them like the “active ingredients” that allow your intervention to work. Core components can be developed and refined over time but are the “what” to the system change you are hoping to make. Start by naming your core components below. You may also download a PDF version of the self-reflection questions to take your own notes.

Core Components

Family or Community Partnerships

Facilitators

Barriers

Needs

Assets

Phases of Implementation

Phase 2: Installation

In this phase, teams identify the key resources and infrastructure needed to implement the system-level change and build monitoring and evaluation plans to monitor if the changes are working.

Phase 3: Initial Implementation

In this phase, teams put the system-level intervention(s) in practice, work through unexpected challenges, and based on monitoring and evaluation results, make adjustments to improve how the intervention is delivered.

Phase 4: Full Implementation

In this phase, teams have fully integrated the system change into practice, ensure the change can be sustained over time, and assess whether the change can be replicated in other settings, or scaled up