A Resource Guide for Implementing Complex System Change in State Title V CYSHCN Programs
This guide is designed to help Title V CYSHCN program leaders and their partners reflect on, plan for, and engage in long-term systems transformation. System change is not about implementing a single evidence-based program. Instead, it is about aligning people, processes, policies and practices across sectors to improve outcomes for children and youth with special health care needs (CYSHCN) and their families.
About Implementation Science
Explore how ideas that improve health move from research into real-world practice and how implementation science focuses on turning proven solutions into actions that work in everyday communities.
How to Use This Guide
This implementation guide is designed to help Title V CYSHCN teams in the planning, implementation, and tracking of system-level changes.
The guide includes:
- Structured tables for each phase, including activities to consider.
- Tools to use, organized by levels of complexity in their use: basic, intermediate, and advanced.
- Suggested technical assistance (TA) providers to support implementation, with additional information about how to request TA to use the tools.
- Case studies used to illustrate examples of systems change in action.
These resources allow teams to assess their progress, document key activities, and identify areas for improvement or future planning. At the end of the guide, you will find terminology for each phase, and answers to frequently asked questions. This tool encourages continuous reflection by guiding teams to assess both their current phase of implementation and also revisit earlier stages or anticipate future ones.
Importantly, this guide can be used at any point in the implementation process—whether you are just beginning, in the midst of a systems change initiative, or looking to refine existing efforts. Its flexible design allows teams to enter wherever they are and build toward sustained, evidence-informed improvements.
Phases of Implementation
Case Studies
These case studies briefly describe the implementation activities of four state Title V CYSHCN programs as they recently embarked on various types of system change to improve the system of services for CYSHCN in their states. They are intended to provide examples of activities that may take place during each implementation phase. The case studies also demonstrate that implementation is often nonlinear and adaptive. They are high-level snapshots of how the phases of implementation can unfold in practice. The activities were gleaned from implementation stories shared by the states in a peer session facilitated by the National MCH Workforce Development Center at an Implementation Think Tank in 2025 and in subsequent interviews. States have been de-identified; further information is available on request.
Additional Information
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Acknowledgement
This guide was adapted with permission from the following resources developed by the National Implementation Research Network (NIRN), FPG Child Development Institute, University of North Carolina at Chapel Hill:
National Implementation Research Network (2013). Stages of Implementation Analysis: Where are we now?
National Implementation Research Network (2020). Implementation Stages Planning Tool.
The National Center for a System of Services for CYSHCN is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,500,000 with no funding from nongovernmental sources. The information or content are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.
Last Updated
01/30/2026
Source
American Academy of Pediatrics