Factors influencing implementation are things that inform, support (facilitators), or hinder (barriers) efforts to deliver effective practices and maintain them over time. They can include characteristics of the practice; the people involved; clinics, organizations, systems, and communities; and other factors. Understanding these facilitators, barriers, and other influences can be essential for deciding what practice to use for a specific mental health need, improving its fit for a setting and community, and making the practice work and last. Factors influencing implementation are sometimes referred to as barriers/facilitators or contextual determinants.
Why This Topic Matters for Implementation
Understanding the factors influencing implementation can be useful when preparing for a new practice, implementing the practice, and sustaining its use. While preparing for a new practice, understanding these factors can help with (1) selecting what practice to use for an identified mental health need and community (including fit between the practice and community); and (2) deciding what support is needed to implement a new practice and address barriers to practice success. Once a practice is being used, monitoring these factors can help identify and address new challenges and needs to maintain its effectiveness and sustain it into the future. Identifying these factors, prioritizing them, and addressing them can be challenging because they can be complicated, occur at multiple levels of an organization or setting, and change over time—and they can interact with each other.
Key Components
Factors influencing implementation can be related to:
- The practice: What it is and the resources it requires; what is known about how well it works, and how well it fits or can be adapted for a specific setting and population.
- People served by the practice: This includes patients, clients, caregivers, and families. Who they are; their needs, motivations, knowledge, and perspectives; and how these interact with providers, practices, or organizations.
- Individuals who deliver the practice: Who they are; their needs, motivations, knowledge, skills, and perspectives; and their relationships with the people served by the practice and their organization.
- Organizations: How the organization as a whole works; leadership, staffing, culture, communication, values, priorities, relationships, and physical infrastructure (including technology); the organization’s approach to and readiness for making changes; the other available services and supports; and how accessible they are. These factors apply to specific clinics or sites within organizations.
- Systems and communities: Factors outside the organization; laws, policies, funding, politics, partnerships with other organizations, cultures, values, and community needs.
How We Can Help
What We Can Do
- Help you build consensus among a team on what a project’s roadblocks are and how to move the project forward
- Teach you to identify factors that inform, support (facilitators), or hinder (barriers) efforts to deliver effective practices and maintain them over time
- Support you in prioritizing which barriers to delivering or maintaining a practice to address and when/how to address them
- Assist you in selecting what effective practice to use for an identified mental health need and community
Support We Have Provided
- We held a three-session learning series focusing on enhancing the capacity of organizational leaders in design and implementation of trauma informed and trauma responsive services. The sessions supported leader readiness, selecting strategies that facilitate trauma responsive culture, and incorporating communication strategies to increase buy-in and implementation.
- We consulted with agency suicide prevention leaders implementing the Zero Suicide framework across one state. The consultation focused on the role of an implementation team in supporting change, how to identify key members, preparing team members for their role, and qualities of effective change teams.
- We held an in-person interactive workshop at a state behavioral health conference that included a brief overview of barriers and facilitators to implementation and their importance throughout the phases of implementing mental health practices. Facilitators led participants through a small group activity to identify barriers and facilitators to a new intake process at a behavioral health organization, and then prioritize the barriers to be addressed during early implementation, based on their importance and addressability.
Key Resources
Factors Influencing Implementation Infographic
This infographic provides an overview of factors influencing implementation, their key components, and why they matter when implementing a new effective mental health practice. The…
Contextual Determinants Affecting Implementation: Qualitative Interview Guide
This practical, user-friendly, five-question, semi-structured interview guide helps identify and understand the factors that may influence the implementation and sustainment of a practice.
Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS)
This quantitative survey asks about factors influencing implementation and their importance. It can be used with people in the organization or team to help identify…
Prioritizing Implementation Barriers: Toolkit for Designing an Implementation Initiative
This toolkit helps implementation teams determine which barriers are most important to address when implementing a practice. This tool assumes that the team has already…
The Hexagon: An Exploration Tool
This is a discussion and scoring tool assessing six key indicators to inform selection of a practice. This tool assumes that the team has already…
Evidence-Based Strategy Selection Worksheet
This is a worksheet to guide selection of a practice based on 8 criteria, including descriptions of each criterion. This tool assumes that the team…