illustrates the progress of a random sample of counties as delineated on the SIC. Because the study is ongoing, progression through the stages continues and at this point, few counties have had the opportunity to reach the final stages. This “lack of opportunity” (i.e., right censoring) is illustrated by the shaded region on the figure. Said differently, some counties might not have data in Stages 6–8 not because they chose to not complete the activities, but because they are not yet at a point in time in which completion of such activities is appropriate. includes data for some but not all of the participating counties, as a means of illustrating the different patterns of implementation behavior that counties might display. Although, for some of the later stages, most of the counties have censored observations as noted above, the results from participation in initial stages are more complete. As can be seen, those that have been most successful also have been those who have completed the majority of activities. For example, county R completed the majority of implementation activities in each of the stages and successfully achieved competency in Stage 8. On the other hand, county F progressed far in the process despite skipping multiple activities, but then discontinued and ceased operating before achieving competency. Similarly, county H began skipping activities early on in the implementation process and discontinued shortly after initiating program start-up. This illustration exemplifies the potential importance of thoroughly completing the recommended implementation activities.
provides data related to the average length of time spent per stage as well as the average proportion of activities completed per stage, across all 56 sites. As can be seen, some stages are more or less completed on average. For example, Stage 2 shows that on average, only 55 % of activities are completed. On the other hand, it is evident from the number of sites in a stage that there is a large drop in the number of sites moving forward to Stage 3 from Stage 2. Again, the shaded region indicates stages that not all counties have had the opportunity to complete at the time of this writing. Taken together, and illustrate how several counties ceased progress after Stage 2 (consideration of the feasibility) or Stage 3 (readiness planning), but that by and large, if a county progressed to Stage 4, that they continue on in the implementation process. This suggests that if stakeholders are successful in completing the pre-implementation phase (i.e., stages 1–3) and move onto stage 4 where staff are hired, that the likelihood of continuing is strong. Moreover, once they reach Stage 4, a high proportion of activities are completed on average. Therefore, an important future analysis will include an examination of CDT strategies in stages 1–3 and if their interactive nature contributed to stakeholder behavior.
Average length of time spent in, proportion of activities completed, and the number of sites that advance to and are thus included in each stage
Nevertheless, and clearly show variability among sites in the number of activities that are completed in each stage. In Wang et al. (2010)
, county-level predictors of early engagement were reported. A key finding from that study (which examined the role of county demographic variables) was that system leaders appeared to be most influenced in Stage 1 (engagement) by their objective need for an alternative to group home placements in their county. They also were more likely to consider implementing MTFC in counties with positive organizational climates, as measured using standardized organizational measures. These outcomes suggest that the SIC might successfully assess and define the behaviors of stakeholders during the phases of implementation in meaningful ways.