Implementation Science: The Path from Science to Service

Public sector entities, non-profits, and funders alike want their projects and services to be based in evidence. But the journey from research findings to routine practice can be long and arduous, and people cannot benefit from evidence-based interventions if the interventions never reach them. Research on health care systems and public health has shown that evidence-based practices (EBPs) take an average of 17 years to be incorporated into routine general practice, and only about half of all EBPs actually reach widespread clinical usage.1 As a result, patients often do not receive treatments that have been proven to be effective, and in the worst case, they receive unnecessary or harmful treatments.

The field of implementation science evolved in response to these concerns, and offers key insights into what works — and what doesn’t — when it comes to integrating evidence-based strategies into public and social-sector endeavors. Implementation science research examines “the factors that influence the full and effective use of innovations in practice”2 in order to find ways to bridge the “science-to-service” gap. It takes a multidisciplinary approach, often driven by teams of academic and operational partners, which seeks to understand barriers and design interventions that can be successfully integrated into daily practice.

What’s going wrong along the pathway from science to service? In many cases, ineffective implementation methods are to blame:3 information dissemination alone, training (even high-quality training) alone, funding or incentives alone, compliance requirements alone. The pattern here is clear: these methods are not effective in isolation. They don’t change the roles and functions of service providers, nor do they take a multilevel approach to addressing individual and organizational behavior or systemic change.

Flawed implementations can yield a few common problems. An evidence-based practice may be adopted, but not with fidelity. Or it might be adopted with fidelity, but quickly abandoned, or only used in a fraction of target sites. Depending on whether these problems are recognized and addressed, evaluations of these programs can yield flawed data on the efficacy of a practice.

Successful integration of EBPs requires usable innovations, effective implementation, and enabling contexts. Implementation teams are critical to planning and driving the success of an implementation process, though there is not a one-size-fits-all blueprint for what these teams should look like. Research has identified four common stages present in successful implementation processes:4

  1. Exploration: Recognizing and assessing the need for resources to help move research into practice.
  2. Installation: Acquiring or repurposing the resources necessary for implementation, and preparing for new practices. This can include hiring and training activities, as well as setting up tools for assessment.
  3. Initial Implementation: The innovation/EBP is first put into use, and practitioners/staff attempt to use their skills and training in context.
  4. Full Implementation: 50% or more of the intended practitioners use the innovation with fidelity and good outcomes; the “new” is now standard.

Work from these stages can overlap or occur somewhat out of sequence. Regardless of how neatly an implementation process fits into this framework, it’s clear that assessing and building readiness, planning carefully, and integrating improvement frameworks are all key to getting evidence into practice.

This post was written by Celeste Middleton, Summer Associate.

Learn more about implementation science by checking out:

You can find information on applying implementation science to early childhood care and education here:

1. Bauer. M.S., Damschroder, L., Hagedorn, H., Smith, J., and Kilbourne, A.M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1). doi:10.1186/s40359-015-0089-9
2. Implementation Science Defined. (2015). National Implementation Research Network.
3. Fixsen, D.L., Blase, K.A., Duda, M.A., Metz., A.J., Naoom, S.F., and Van Dyke, M.K. (2010). Implementing evidence-based practices: Are we falling down on the job? National Implementation Research Network.
4. Implementation Stages. National Implementation Research Network.

City of Richmond Employment and Training Department Receives Prop 39 Construction Pre-Apprenticeship Award

RichmondBUILD training graduates standing at RichmondBUILD WallOn June 8, 2017, the California Workforce Development Board announced awards for Proposition 39 Construction Pre-Apprenticeship Pipeline for Ex-Offenders, a $2.85 million program to build pre-apprenticeship programs serving formerly incarcerated job-seekers with a focus on women. The City of Richmond Employment and Training Department (E&T) was one of four entities to receive a training implementation grant, in the amount of $637,500 over a period of two years.

Participants in the proposed program will take part in regular cohorts of the highly acclaimed RichmondBUILD construction training program and will also receive training and instruction in the Multi-Core Curriculum (MC3) pre-apprenticeship program, a nationally recognized construction training curriculum. Of the 80 participants that will be enrolled, it is anticipated that 100% will complete the MC3 Pre-Apprenticeship training and will attain the industry-identified MC3 certificate. Fifty percent of participants in the program will be female ex-offenders.

The program will build upon the strong ties between RichmondBUILD and regional construction trade unions to provide participants with the opportunity to enter into pre-apprenticeship, earn industry-valued credentials and lead to apprenticeship or direct employment in the construction trades. The E&T anticipates that 45 out of the 80 program participants will be placed in state-approved apprenticeships over the course of the project period.

GPG is pleased to have had the opportunity to work on this successful workforce development grant proposal for the City of Richmond Employment and Training Department.

A Guide to School Employee Well-Being Through Collaboration, from Kaiser Permanente and the Kaiser Permanente Office of Labor Management Partnership

In June 2017, Kaiser Permanente’s Office of Labor Management Partnership released A Guide to School Employee Well-Being Through Collaboration, a roadmap for districts, schools, and teacher and classified employee unions interested in developing and implementing employee well-being programs. The guide was developed in collaboration with multiple unions, administration associations, and researchers. The guide specifies concrete steps for building collaboration around well-being efforts, and includes real-world examples from districts that have successfully and collaboratively launched employee well-being initiatives.

The guide, which uses the term ‘well-being’ as a phrase that can go beyond physical and mental health to include other factors, such as job satisfaction and quality of relationships, consists of two parts. The first part describes how labor management collaboration can help build a successful school employee well-being program, while the second part is a step-by-step guide for collaboratively planning and implementing a well-being program.

Several California school districts, including San Leandro Unified School District and Elk Grove Unified School District, have developed robust wellness programs and initiatives using strong labor management partnerships. Highlights from San Leandro Unified School District’s robust school employee wellness efforts through labor management partnership can be found in the guide and on the Kaiser Permanente Thriving Schools website.

About the Kaiser Permanente Office of Labor Management Partnership: Kaiser Permanente has been engaged in a labor management partnership with the Coalition of Kaiser Permanente Unions since 1997, called the Labor Management Partnership (LMP). One of the many roles the LMP plays is to offer guidance and resources for others interested in building a labor management partnership in any workplace. The Kaiser Permanente LMP provides its expertise in labor management collaboration to the Kaiser Permanente’s Thriving Schools effort, which is dedicated to improving health in K-12 schools, including that of staff and teachers.

GPG provided support for this effort by conducting interviews with key stakeholders from the field to gather feedback on early drafts of the guide, reviewing draft materials, and facilitating feedback and discussion sessions with union and district stakeholders.

Additional resources on how to start school employee well-being initiatives are available on the Thriving Schools website, which includes recordings of the national webinar series in addition to sample activities and promotional materials.

City of Richmond Employment and Training Department Receives Workforce Accelerator Fund 5.0 Award

Workforce Accelerator Fund logoThe California Workforce Development Board and the Employment Development Department Workforce Accelerator Fund supports the design, development, and implementation of projects that accelerate employment and re-employment strategies for California job seekers. The City of Richmond Employment and Training Department (E&T) received a $150,000 award for the RichmondBUILD Contractors Resource Center (CRC). With this funding, the CRC will develop tools, strategies, and processes that provide opportunities to embed the program in the statewide or regional workforce system. The CRC model, originally supported by a Workforce Accelerator Fund 3.0 grant, is designed to help small local construction contractors develop the knowledge and skills needed to successfully bid on, obtain and carry out contracts with major construction firms, and anchor institutions.

As part of this project, Richmond E&T will create an extensive series of integrated training modules for CRC trainees on topics such as estimating, bidding, back office operations, bonding, and human resources, that are adaptable and can be shared with other entities planning to replicate the CRC model. They will also share the model through developing and delivering a comprehensive presentation on the CRC model at local, state and national conferences; providing information on establishing local policies that support participation of local contractors in major development projects; and hosting quarterly visits and tours for entities interested in replicating the CRC model.

Richmond E&T will also support the implementation of the CRC model by providing technical assistance to interested communities that intend to develop the model; strengthening existing CRC partnerships with anchor institutions, local government, major developers and general contractors, and labor unions to enhance small contractor training and expand opportunities; and providing information on funding and sustainability models for CRCs.

GPG is proud to have had the opportunity to work on this successful workforce development grant proposal for the City of Richmond Employment and Training Department and the CRC to continue its work.

The California Labor Management Initiative Convenes its First Summer Institute

The California Labor Management Initiative (CA LMI) held its first Summer Institute on June 19-21, 2017 in San Diego, CA. The two-day meeting offered an opportunity for labor-management teams from across the state to convene, collaborate, and learn from national experts and local experiences. The Institute also included an optional pre-conference day for teams new to labor management collaboration.

The Institute convened 21 district teams composed of superintendents and other district staff, school board members, and teacher and classified union leaders, with seven of those teams also attending the pre-conference day. In total, over 200 people attended the institute and had the opportunity to hear from experts (including Michael Fullan and Pedro Noguera) and practitioners in the field speak about the tools and concepts integral to successful labor management collaboration.

CA LMI participants in table discussions

District teams in discussion at the 2017 CA LMI Summer Institute

The pre-conference included an overview of the CA LMI and its work to date, an introduction to collaborative structures and Michael Fullan’s Coherence Framework, and research on the positive impacts of labor management collaboration. In addition, it showcased the journey of Santa Clara Unified School District’s path to genuine labor-management collaboration.

Over the next two days, teams were welcomed by State Superintendent Tom Torlakson, heard keynote presentations from Michael Fullan (see video below for Fullan’s breakout session) and Pedro Noguera, had critical time for district team discussion and planning, and attended breakout sessions on various topics (see the meeting website for a list of breakout session topics).

To learn more about the CA LMI, visit the CA LMI website, where you can find additional resources, photos, videos, and information about past convenings.

GPG is pleased to have supported this event by providing meeting design, preparation, and logistical support.

City of Richmond Employment and Training Department Receives Environmental Workforce Development Job Training Grant

US EPA LogoThe City of Richmond Employment and Training Department was one of 14 organizations to receive FY 2017 Environmental Workforce Development Job Training Grants (EWDJTG) Program funding from the EPA. The $200,000 award will be used to operate an environmental job training program for residents of Richmond.

The EWDJTG program is designed to help individuals learn the skills needed to secure employment in the environmental field. These grants help prepare people for green jobs that reduce environmental contamination and provide more sustainable futures for the communities most affected by solid and hazardous waste contamination. The program focuses particularly on recruiting, training and placing unemployed and underemployed individuals who have to overcome a variety of barriers to employment. Many are from low-income neighborhoods. The training programs also serve dislocated workers who have lost their jobs as a result of manufacturing plant closures, minorities, tribal members, transitioning veterans, ex-offenders and other individuals who may have faced barriers to employment.

The funded Richmond program will offer nearly 300 hours of training in a variety of environment and construction related workforce skills, including topics such as: HAZWOPER (Hazardous Waste Operations and Emergency Response), Lead Abatement, Asbestos Abatement, Confined Space Entry, OSCA (Refinery Safety), OSHA-10 (Occupational Health and Safety Administration) training, Pre-Apprenticeship Construction, and Solar Technology. Participants will be able to obtain an array of certificates that increase the likelihood of post-training employment. Upon completion of the program, individuals will receive a year of follow up support focused on obtaining and retaining employment. Of the expected 60 participants enrolled in the program, 85% (51) will complete the program, and 75% (45) will be placed in environmental positions, while an additional 8% (5) will pursue further training prior to employment. This is the third award for EWDJTG funding received by the City of Richmond since 2013.

GPG was proud to have the opportunity to work on this successful workforce development grant proposal for the City of Richmond Employment and Training Department.

Quickly and Collaboratively Set Meeting Agendas with Lean Coffee

Pen and sticky notesIn-person, virtual, conference–the latest model for meetings is entirely crowd-sourced. Designed in Seattle in 2009, Lean Coffee is a structure for meeting participants to gather without a pre-set agenda and collaboratively identify and prioritize topics for discussion.

The Lean Coffee model differs from traditional meeting designs in that the agenda for the meeting is democratically generated as part of the meeting process. As its name suggests, the format for a Lean Coffee is simple and aims to provide the least structure necessary for a coherent and productive meeting. The process is as follows:

  1. KanbanCreate a structure. Set up a simple “kanban board” that includes columns for: 1) To Discuss, 2) Discussing, and 3) Discussed. Throughout the meeting, discussion topics or questions will be moved from column 1 to 2, and then from 2 to 3.
  2. Generate discussion topics. Distribute post-it notes, pens, and dot stickers to participants. Meeting participants write one topic for conversation per post-it note and add each note to the “to discuss” column. The decision to limit the number of ideas (and when) rests with the meeting facilitator. When enough topics have been posted, participants share a 1-2 sentence introduction for each of their suggested topics.
  3. Vote on topics. Each participant gets two dots to stick on the topics they wish to vote for. The facilitator then tallies the dots and identifies the highest-interest topics of conversation.
  4. Discuss high-interest topics. The meeting facilitator announces the time limit for the discussion (45 minutes to 1.5 hours is recommended), and can choose to apply a time limit to each post-it note topic (5 to 10 minutes is recommended). As the discussion begins for each topic, the facilitator moves the post-it note to the “being discussed” column. When the discussion is finished that post-it note is moved to the “discussed” column to provide a visual representation of the meeting flow and allow participants to track items as they are discussed.

Lean Coffee enables meeting participants to have an open-ended conversation that is democratically directed, increasing ownership and participation. The model ensures that ideas the team collectively wants to emphasize can be discussed and agreed upon.

While this approach does not replace the need for structured meeting designs with pre-selected topics and activities, GPG has found that using Lean Coffee as a facilitation method is useful and adaptable for a variety of situations. For example, including a Lean Coffee session near the end of a half- or full-day meeting can provide an opportunity for participants to lift up important topics that were not included in the agenda or did not arise in earlier conversation, or to propose topics that were discussed but that need further attention from the group. An additional benefit of this approach is the documentation of all discussion topic ideas. For a group that meets multiple times, topics that did not receive enough votes for discussion at a previous Lean Coffee session might inform the next Lean Coffee opportunity.

Learn more about the Lean Coffee history and approach at

Webinar Highlights and Recording: Research to Policy: Evidence-Informed Opportunities for Advancing the Needs of Young Dual Language Learners in California Education Policy

In California, nearly 60% of children from birth to age five are Dual Language Learners, meaning they are learning both English and another language at the same time. This is a major asset for the Golden State. However, ensuring that California’s Early Learning system is able to support multilingualism requires building awareness, building capacity, and making investments in the program and workforce that serve our diverse youngsters.

The National Academies of Science, Engineering, and Medicine (NASEM) recently released a consensus study, “Promoting the Educational Success of Children and Youth Learning English: Promising Futures.” (Also see report highlights) that can aid in these efforts. The Promising Futures report evaluates research on the development of Dual Language Learners (DLLs) and English Learners (ELs) from birth to age 21, and makes recommendations on policy, practice, and research and data collection to better support and educate DLLs/ELS from birth to grade 12.

In addition, the report includes recommendations specific to early childhood. Chapter 4: Capacities and Influences on Language Development reviews the evidence on young children’s underlying capacity for dual language development and examines the factors that may influence the full expression of this capacity among DLLs in the United States. Chapter 5: Promising and Effective Early Care and Education Practices and Home Visiting Programs for Dual Language Learners, reviews relevant research on guiding principles, programs, practices, and strategies that promote positive developmental and educational outcomes for DLLs in home visiting programs and Early Childhood Education (ECE) settings and provides relevant research on features of high-quality ECE for infants and toddlers generally, combined with the developmental literature on DLLs reviewed in earlier chapters, to arrive at findings and conclusions about effective practices for the youngest DLLs.

On May 31, 2017, GPG facilitated a well-received Webinar: From Research to Policy: Evidence-Informed Opportunities for Advancing the Needs of Young Dual Language Learners in California Education Policy. Funded through the generous support of the Heising-Simons Foundation and Sobrato Family Foundation, the webinar reviewed essential elements of the report and examined the ways in with the report can be incorporated in advocacy work in California. The webinar featured presentations from the following experts on Dual Language Development and early learning advocacy:

  • Anya Hurwitz, Sobrato Early Academic Language (SEAL) Deputy Director;
  • Deborah Kong, Early Edge California;
  • Linda Espinosa, University of Missouri, Columbia (emeritus); and
  • Vickie Ramos Harris, Advancement Project.

A recording of the webinar is available at the following link:

Los Angeles Universal Preschool Receives Grant to Expand Early Learning

The need for high-quality early learning opportunities in LA County is profound: in 2016, LA County’s Alternative Payment childcare voucher program served nearly 7,000 children from low-income families.1 However, during that same year, there were more than 44,500 eligible children on the waiting list.2
Through a $3 million dollar Early Head Start-Child Care (EHS-CC) Partnership grant from the U.S. Department of Health and Human Services, Los Angeles Universal Preschool (LAUP) will expand its capacity to address this substantial need. Specifically, this grant will enable the expansion of high-quality early learning programs within nine high poverty ZIP codes and neighborhoods (including areas that are part of the Los Angeles Promise Zone and South Los Angeles Transit Empowerment Promise Zone (SLATE-Z)). The LA County Child Care Planning Committee has ranked the vast majority of these ZIP codes as high for eligible children needing services, with 66 to 96 percent of eligible children remaining unserved. In these ZIP codes alone, additional preschool slots are needed for over 6,000 children.3

This grant will allow LAUP to improve and expand quality services to 122 infants, toddlers, and their families, by drawing on its existing infrastructure that has supported more than 700 providers and 115,000 children ages birth to five since 2005. Through the EHS-CC Partnership, LAUP will work closely with providers over three years to help teachers and parents develop the knowledge, skills, and attitudes that best support young children in achieving school and life readiness. Children and their families will be enveloped in a system of supportive care that enhances learning as well as physical and emotional development.

The proposed program will use a mixed-delivery system in which center and family child care home partners offer services aligned with the Early Head Start program performance standards. Child Care Partner sites will provide ten hours of care five days per week, for 48 weeks per year. LAUP’s multifaceted approach will:

  • Improve the quality of services provided by Child Care Partners already serving infants and toddlers. LAUP will provide resources and guidance on the development of classroom activities to teachers and directors. Coaches will work with each Child Care Partner site to create high-quality infant and toddler environments and provide support and guidance on instructional techniques, health and safety requirements, and assessment tools. As a result, children and families will receive more comprehensive services including health screenings, nutrition services, and social and family support services).
  • Expand the number of spaces available through center-based and family child care providers. EHS-CC Partnership funding will allow existing high quality early learning programs within the LAUP network, to expand and extend comprehensive services to more children and families.

In order to both improve quality and expand services, LAUP will leverage a range of existing services and efforts. LAUP’s participation in Quality Start LA (a voluntary quality rating and improvement system (QRIS)), with partners First 5 LA, the Los Angeles County Office of Education (LACOE), the Office for the Advancement of Early Care and Education, and the Child Care Alliance of LA will provide an array of quality improvement services to nearly 500 state-funded preschools and infant and toddler child care programs. LAUP will educate its EHS-CC Partnership Child Care Partners about the Quality Start LA QRIS and the benefits of participating.

LAUP’s partnership with both the LA Promise Zone and SLATE-Z Promise Zone will also facilitate collaboration with dozens of public, private, and community-based organizations that are working together to improve the lives of children and families in the target high poverty zip codes (see map above).

GPG is proud to have supported LAUP’s application to the U.S. Department of Health and Human Services, Office of Head Start, which resulted in this grant award.

1. Child Care Alliance Los Angeles, LA County Facts accessed at on 6/25/17.
2. Ibid.
3. Data accessed at on 6/25/17.

Sonoma County Department of Health Services Receives Grant to Prevent Cavities in Young Children

Quality oral health care is especially important for young children, not only because tooth decay is the most common chronic health problem among California’s children, but because tooth decay is the number one reason children are absent from kindergarten.1

In March 2017, Sonoma County Department of Health Services Dental Health Program was selected as one of 15 FY 2017 grantees for the California Department of Health Services’ Dental Transformation Initiative (DTI) Domain 4: Local Dental Pilot Projects (LDPPs) program. The grant will fund efforts to treat and prevent cavities in Sonoma County’s youngest Medi Cal-enrolled children over a four-year period.

Through the County’s pilot program, Cavity-Free Sonoma, the County Department of Health Services’ Dental Health Program (DHP) will work in collaboration with the Sonoma County Dental Health Network and other partners to make progress towards the network’s overarching goal that 75% of local five year olds are cavity-free by 2020.2 Specifically, the pilot is oriented to achieve the Centers for Medicare and Medicaid Services (CMS) “Triple Aim” in dental health for Medi-Cal eligible children age 6 and under in Sonoma County:

  1. Improved dental health among Medi-Cal eligible children
  2. Medi-Cal Dental Program cost-savings
  3. Improved patient experience of dental care

The DHP and its partners will achieve these outcomes through three primary activities:

  1. Implementation of a standardized caries risk assessment (assessment for cavities);
  2. Outreach and service-provision by a cadre of Community Dental Health Workers; and
  3. Use of a mobile application that reinforced improved dental health habits and supports consistent dental health care.

Adopting a standardized caries risk assessment will ensure that children are screened for dental decay (caries) through appropriate and frequent treatment that is standardized no matter where across the county the child receives care. This will help caregivers identify dental disease early to treat preventatively and manage decay when it occurs.

During the first year of the grant, DHP will hire and train a cadre of Community Dental Health Workers to perform the caries risk assessment, provide culturally competent care management, increase clinic capacity, and ensure that care is coordinated and consistent. The Community Dental Health Workers will be stationed at partner clinics to work directly with families and children accessing care at those locations. Recruiting Dental Health Workers from the community will ensure that children and families receive the culturally competent support they need to build skills and knowledge related to oral health and dental disease prevention.

Finally, coordinating care and increasing families’ access to information will be supported through the development and use of the Sonoma Smile mobile application. The mobile app will serve as a family’s personal dental record, and is a low-cost tool for caregivers and patients to improve oral health literacy, dental decay prevention, and disease management. For example, the app will provide dental appointment reminders and have a function for parents to track the frequency of their child’s tooth brushing. At the same time, the app will enable Community Dental Health Workers and other care providers to more efficiently access care records and treatment plan information. In addition, the app will remain in the public domain and has the potential to be scaled across the United States.

These three strategies – a standardized caries risk assessment, Community Dental Health Workers, and a mobile app – work together to improve access to and delivery of preventative oral health care. This will result in significantly less dental decay among low-income children in Sonoma County, improving their oral health while decreasing oral health costs for county providers.

More information about the DTI Domain 4 Local Dental Pilot Projects, including a list of selected projects, is available at

1. First 5 Association of California.
2. See Sonoma County Dental Health Network Strategic Plan 2017-2020 for more information on the network.