MCHwork: Transforming Learning

Session 4.3: Facilitators and Barriers — Moving from Priorities to Action

Introduction

Once Title V agencies have selected their priorities, the next step is turning those priorities into action. However, the path from planning to successful implementation is often complex. Every program, organization, and community has a unique mix of factors that can either help (facilitators) or hinder (barriers) progress. Understanding these factors is a critical step in designing an effective implementation strategy for the MCH Block Grant.

This session introduces a framework for systematically exploring the facilitators and barriers that can impact your MCH initiatives. By analyzing five key categories (1) the Intervention itself, (2) the Individuals involved, (3) the Inner Setting of your organization, (4) the Outer Setting of the broader community, and (5) the Implementation Process, you can build consensus, focus resources effectively, and tailor your implementation plan for success.

Join us below as Dr. W. Oscar Fleming walks through this framework using the example of establishing a medical home for adolescents.

READY: Analyzing the Intervention

Video 1: Moving from Priorities to Action: Understanding Facilitators and Barriers

This video introduces the core concepts of facilitators and barriers. It explores the first category of the framework, the Intervention, using the example of implementing new technology to capture health information within an adolescent medical home. The video demonstrates how a single aspect of an intervention can be both a facilitator for one group (adolescents) and a barrier for another (providers).

Resources to Dig Deeper and Tools to Use:

• The Consolidated Framework for Implementation Research (CFIR) Website. Explore the implementation science framework that informs this session. The site provides detailed definitions of each category (or "domain") and related concepts.
• Using the Consolidated Framework for Implementation Research (CFIR) in Implementation Research and Practice. This article from The Center for Implementation provides a detailed overview of the CFIR's five domains and practical tips for applying the framework.
• The Hexagon Tool (National Implementation Research Network). An interactive tool designed to help organizations evaluate the fit and feasibility of a new program or practice by considering factors like need, resource availability, and existing evidence.

SET: Understanding the People and the Place

Video 2: Facilitators and Barriers Related to Individuals and the Inner Setting

This video explores the human and organizational elements of implementation. It explores the Individuals category, showing how personal beliefs and perspectives (like those of parents or clinic managers) can influence success. It also examines the Inner Setting, focusing on how an organization's internal shared values and practices and capacity for partnership can serve as powerful facilitators or significant barriers.

Resources to Dig Deeper and Tools to Use:

• Change Management Toolkit (UC Berkeley). This toolkit provides practical resources, checklists, and guides for leading teams and organizations through the process of change, from assessing readiness to communication planning.
• Identifying and Analyzing Stakeholders and Their Interests (Community Tool Box). A practical guide for identifying key stakeholders, understanding their perspectives, and developing strategies to gain their support for an initiative.
• Organizational Readiness for Implementing Change (ORIC). A validated survey tool that can be used to assess staff motivation and institutional capacity for undertaking a major organizational change.

GO: Navigating the Context and the Process

Video 3: Facilitators and Barriers Related to the Outer Setting and Implementation Process

This final video examines the external environment and the "how-to" of implementation. It explores the Outer Setting, using the example of legal consent requirements to show how external policies and social norms can impact a program. It then focuses on the Implementation Process itself, highlighting how strategies like co-design can generate buy-in and tailor a program for success. The video concludes by summarizing how to use this analysis to take action.

Resources to Dig Deeper and Tools to Use:

• A Primer on Policy, Systems and Environmental Change (University of Illinois Chicago). This guide offers a clear introduction to influencing change at a systems level, which is essential for addressing facilitators and challenges found in the outer setting.
• People with Lived Experience (PWLE) Learning Bundle (National MCH Workforce Development Center and MCH Navigator). A learning resource with detailed steps for authentically engaging community members and clients in co-designing programs and policies to ensure they meet real needs.
• Developing an Action Plan (Community Tool Box). This resource provides a straightforward framework for turning your analysis of facilitators and challenges into a concrete, strategic action plan with clear steps, timelines, and responsibilities.