Phase 2: Installation

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 installation stage is to build the necessary infrastructure and support for the “launch” of the system change. During this stage, you will identify and make structural or functional changes—such as adjusting policies, roles, or workflows. You will also ensure that your implementation team has the appropriate skills, training, and capacity to move forward. This is the time to develop a detailed implementation plan, be clear on each team member’s roles and responsibilities, establish regular team meetings, define goals, assess your data systems, and create feedback loops with partners and community members to support continuous improvement and engagement.

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Installation Phase Activities

Examples of installation 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

Launched a small Title V-funded pilot with one stakeholder site
Formed an implementation/steering workgroup, built partnerships, secured leadership support and board approvals
Created measures for program data collection, defined metrics and created intentional feedback loops
Applied for grants to scale the initiative more broadly
Identified and leveraged existing resources, structures and system processes: collaboratives, conferences, webinars, and training modules
Partnered with a local university to streamline payment for paid roles and new positions
Developed implementation guides, recruitment materials, and portals to house the initiative
Planned implementation steps using prioritization/impact tools

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, and/or omit activities as needed:

Activities to Consider

Revisit implementation team membership. Is this still the right group?
Define roles and responsibilities for each implementation team member, and consider identifying different “champions” from different sectors.
Ensure the implementation team has the appropriate knowledge, skills, functions, and authority to support development and improvement of the program/practice
Convene with the implementation team regularly to track progress of installation and edits to the implementation plan.
Identify structural and functional changes needed to make your system change (eg, policies, restructuring of programs, funding).
Consider what additional partners or feedback from the community you may need.
Develop the implementation plan.
Finalize and clearly define the goals, outcomes, or changes you would like to achieve, and how you will measure success. Define both long-term and short-term outcomes.
Consider developing decision-making strategies for making adaptations if you do not receive the desired outcomes.
Identify and evaluate appropriateness and sustainability of data systems or other metrics that will be used to track progress towards intended outcome(s).
Develop and use feedback loops to engage family leaders and community partners.

In Case Study #3 - Family & Youth Partnership, the team formed an internal workgroup, developed guidebooks and recruitment materials, and partnered with a university to streamline payment for family leaders. These key installation activities set the stage for meaningful family engagement.

Tools to Consider During Exploration

These tools can be useful during installation and have been successfully used by CYSHCN teams in their efforts to transform systems.

Implementation Plan Template

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

PDSA Cycles

Rapidly identify an issue and a needed change, measure the impact, and make an informed plan to improve.

Measurement Table and Logic Model

Make an explicit statement of the activities that will bring about change and the results you expect to see for the community. Keep participants moving in the same direction by providing a common language and point of reference.

Implementation Supports Checklist

Identify the supports needed to support effective implementation and scaling of evidence-informed practices, programs, and policies.

CDC’s Program Evaluation Framework

Plan effective public health strategies, improve existing programs, and demonstrate the results of resource investments.

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.

Installation Phase Outcomes

The implementation team has the tools and support needed to function well.
Infrastructure, policies, and procedures are in place to collect, analyze, and use data to track progress.
The core components of the change are clear, and there is a plan in place to achieve them.
The plan’s long- and short-term outcomes are clearly defined and achievable.
Bi-directional communication takes place across partners, community members/families, and leaders.

Installation 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.

Core Components

Family or Community Partnerships

Facilitators

Barriers

Needs

Assets

Data and Outcomes

Phases of Implementation

Phase 1: Exploration

In this phase, teams examine the current systems for opportunities to improve care for CYSHCN, identify core components of the system-level change, and assess feasibility of the system-level change.

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