Implementation Framework
System change doesn't happen in a straight line. Our framework doesn't pretend it does.
Our Implementation Framework supports change at the practice level and the system level, helps providers and workforce teams put new approaches into action, and helps leaders align policy, financing, governance, and data around the needs of children, youth, and families. It's grounded in implementation science, tested across real systems of care, and built to be used as an active road map by leaders.
Get implementation support from our technical assistance team.
Our Publications
Weeks, A. (2021). Important factors for evidence-based implementation in child welfare settings: A systematic review. Journal of Evidence-Based Social Work, 18:2, 129-154.
Weeks, A. (2022). Culturally adapting evidence-based and informed practices to meet client population needs and ensure appropriate allocation of scarce resources: A systematic review. Human Service Organizations: Management, Leadership & Governance.
Weeks, A., Altman, D., Khavar, V., Lorthridge, J. & Irons, A. (2021) What Human Service Leaders Need to Know about Supporting Staff to Implement Evidence-Informed Programs. Human Service Organizations: Management, Leadership & Governance.
Olson, J. R., Azman, A., Estep, K. M., Coviello, K. A., Robshaw, S. & Bruns, E. J. (2021). Influences of Inner and Outer Settings on Wraparound Implementation Outcomes. Global Implementation Research and Applications, 1(2), 77–89.
Why Is It A Circle?
Most frameworks are drawn as a line with an endpoint. Ours isn't, because that's not how change actually works in systems of care.
Implementation doesn't stop once a new practice or policy is up and running. Real systems keep moving, policy shifts, funding changes, staff turnover, new data, new priorities. Those shifts often mean revisiting work you thought was finished.
That's not failure. That's the job. Effective implementation and system transformation require ongoing learning, adjustment, and shared decision-making, which is exactly what a circular model is built to hold. It's a framework that encourages leaders to revisit stages as the context changes.
Why Three Phases?
Some frameworks break implementation into many discrete steps. We intentionally distilled ours into three, because three phases match how change actually unfolds in real-world systems: what has to happen before change begins, what happens as it's introduced and tested, and what it takes for change to actually stick.
- Pre-Implementation: work that occurs prior to change beginning;
- Initial Implementation: work that occurs as new practices, programs, workflows, or system strategies are introduced, tested, and refined and;
- Maintenance: ongoing work once those changes are embedded in routine operations and sustained over time.
This isn't a simplified version of "the real thing." A framework only works if the people using it can actually remember and apply it: providers, supervisors, agency leaders, cross-system partners, and youth and family experts. Accessible and repeatable was a design requirement for us.
Three Phases of the Implementation Framework
Pre-Implementation: Build Readiness, Alignment & Capacity for Change
During this phase, partners prepare for successful implementation by assessing readiness, clarifying the population of focus, fully understanding current care pathways, identifying barriers and gaps, aligning leadership, engaging stakeholders, and developing a shared implementation plan. At the practice level, this may include preparing providers and workforce teams for a new intervention or care process. At the system level, it may include aligning policy, financing, governance, service array design, and cross-agency priorities to support the desired change.
Initial Implementation: Start the Change, Gather Data, Make Improvements
Initial implementation begins when the new practice, program, workflow, or system change effort is first put into use. During this phase, early implementation of the change is tested, feedback is gathered, and rapid improvement cycles are used to make adjustments. At the practice level, this may include coaching staff, adjusting workflows, refining documentation, or testing a new process for delivering services. At the system level, it may include testing referral pathways, data-sharing processes, cross-agency roles, financing strategies, accountability structures, and new ways for helping families to access care.
Maintenance: The Change is Embedded in Existing Structures
Maintenance occurs when the practice, program, workflow, or system change becomes embedded within ongoing infrastructure, routines, resources, and expectations. The work is no longer viewed as a time-limited project, but as a standard part of operations. At the practice level, this may mean the intervention is built into supervision, training, documentation, and quality review processes. At the system level, it may mean the change is reflected in policy, contracts, funding structures, monitoring routines, leadership agendas, data reporting, and continuous quality improvement processes.
Why is sustainment on the outside? I usually see it as its own phase.
Encircling the entire model is Sustainment, highlighting that sustainability is not a final step, but a guiding consideration woven through every phase. From the earliest stages of planning, partners should consider what is required to maintain the change over time, including fit with existing structures, funding, workforce capacity, policies, data systems, leadership expectations, and community needs. At the practice level, this means selecting and supporting interventions that can be delivered with quality and adapted as conditions change. At the system level, this means building the financing, governance, contracts, cross-agency agreements, monitoring routines, and accountability structures needed to make the change part of standard operations. Sustainment requires adaptability. As systems evolve, partners may need to revisit planning activities, test new workflows, or adjust implementation strategies. In this way, sustainment is about protecting the core purpose of the work while continuing to learn, adapt, and respond to changing conditions.
Fit & Feasibilty
Helps partners determine whether the selected practice, program, strategy, or system change effort is the right solution for the identified need. This includes assessing whether the approach aligns with family and community needs, organizational capacity, workforce skills and knowledge, system priorities, available resources, financing structures, and long-term feasibility.
Factors Affecting Implementation
Recognizes that implementation is shaped by real-world conditions, including policy, funding, leadership, governance, workforce capacity, provider readiness, staff attitudes, data infrastructure, cross-agency relationships, and community context. These factors must be understood, monitored, and addressed throughout the process.
Care Pathways & Interruption Points
Focuses on how children, young people, and families move through systems of care, including where they enter, where they experience barriers, where services are delayed or disconnected, and where earlier support could prevent deeper system involvement. Understanding care pathways and interruption points (points where the expected or planned sequence of care is broken, delayed, or diverted) helps partners identify the most effective points to intervene, improve access, strengthen transitions, and better align community-based care.
Continuous Quality Improvement
Embeds ongoing feedback, reflection, and data-informed decision-making throughout implementation. CQI helps partners understand what is working, what is not working, who is being reached, where gaps remain, and what changes are needed to improve practice quality, system performance, and outcomes over time.
Taken together, these elements reflect Innovations Institute’s commitment to implementation that is accessible, practical, responsive to local context, and grounded in data, feedback, and lived experience. The framework supports both practice-level implementation and broader system transformation by helping partners align services, workforce development, policy, financing, data, and accountability structures around the needs of children, young people, families, and communities. We use this framework, along with supportive tools and resources, to guide thoughtful, evidence-informed change that can be adapted, strengthened, and sustained over time.
System Level
Payor Scan
- Identification and review of contracts, policies, manuals, and regulations related to MRSS
- Identification of current children crisis services funding mechanisms and authorities
- Identification of current children’s crisis providers to be included in Practice Level –
Provider Scan
- Review of identified payor and system documents for comparison to MRSS best practice standards.
Practice Level
Provider Scan
- Structured interviews with all providers identified through the System Level Scan
- Analysis and comparison of current practices to MRSS best practices
By completing both the System Level - Payor Scan and the Practice Level - Provider Scan, we identify opportunities for advancement. This includes a comparative analysis of current provider practices against established payor standards, as well as a comprehensive assessment of system support and provider practices against MRSS best practices. Through this dual approach, we unearth potential drivers of variance and develop a robust technical assistance plan tailored to your unique needs, identifying trends, areas of strength, and actionable steps to propel you towards your goals with confidence and clarity.
MRSS System Readiness Tool (SRT)
Designed to:
- Help system leaders assess system readiness
- proactively prioritize indicators known to be associated with modern systems design and improved outcomes for identified populations
SRT indicators are a mix of evidenced-based standards (e.g., response times), expert application of evidence-based tenets that incorporate state/local context and experiences, and voiced youth and family preferences. Use of the SRT is an evidence-informed approach to system installation of MRSS that is adaptable and accounts for the complexities of behavioral health care delivery. Implementation science and care pathway frameworks are foundational to the SRT.
Have Your Own Framework?
Our Implementation Framework reflects how we approach the work. It's grounded in implementation science and tested across real systems-of-care. Sometimes our partners have other preferred frameworks, models, or improvement process in motion: Active Implementation Frameworks, EPIS, CFIR, SMART, PDSA and CQI cycles, agency-specific playbooks, or something built in-house over years of hard-won experience.
When that's the case, we don't ask partners to set that aside and adopt ours instead. We meet them inside the framework they already have, bringing implementation science expertise to strengthen it rather than replace it. Whether we're introducing our model or working inside yours, the goal is the same: durable, well-supported change that improves the lives of our communities.