Years ago I attended a conference where I first learned of the work of Dean Fixsen and heard the phrase implementation science. What I most remember about his presentation is a PowerPoint slide he showed that to this day continues to haunt me:
The table is taken from Joyce and Showers (2002) where the authors were interested in studying the percent of teachers who actually utilized a new skill they had learned in practice. If you take a few minutes to study the table, you will see that for the new skill to be used in the classroom, it was necessary to:
- Discuss the theory behind the new skill
- Demonstrate the new skill
- Allow teachers to practice the new skill and get feedback on their performance
- Coach the teachers on the new skill in the real-world classroom
And if you take away the final component – coaching in the real-world – use in the classroom drops from 95% to 5%!
I have spent two decades of life energy in classrooms working on my own degrees, and another half-dozen years teaching in classrooms. Most of the time the learning took place in classrooms, and most of it was discussing theory in a group setting. Now can you begin to understand why this slide haunts me?
I know education is about a lot of things, but students today need knowledge and skills that they can use in the real world, and we are failing them in so many ways (while we continue to up the price of education).
Implementation Science Applied to Addiction Management
This study has implications that go far beyond the classroom. The field of implementation science is all about understanding what it takes for evidence-based practices to actually be used in practice. It’s the science that fills the gap between research and practice. While the field continues to remain unknown to most who work in the addiction treatment field (and sadly other healthcare settings), I believe the principals of implementation science can and should be used by anyone desiring to overcome addiction, trauma, or any behavioral health problem.
How do you implement the principals from implementation science into your day-to-day efforts to change difficult things?
- Learn more about implementation science. Like most things in life, knowledge is power. So take some time to read up on what we know about successful behavior change. A solid place to start is Implementation Research: A Synthesis of the Literature. You can also watch Dean Fixsen in action giving an overview of the topic on YouTube. I will add that the field has not done the best job of developing resources for the general public, so know that there is no need to become a scholar on this stuff, just gain enough insight to know that the key ingredient to successful behavior change is coaching.
- Get coaching. I know, you saw this one coming. It’s not easy teaching an old dog new tricks (or even a young one for that matter)! Those who have struggled with addiction and engaged in treatment know that behavior change is hard work. But it can be a lot easier if you find people who have successfully implemented new routines, skills, and behaviors into their life, and get them to coach you on doing the same. This idea is of course what sponsors are all about in 12 Step programs. We know that exercise, mindfulness meditation, eating right, learning to manage emotions, and successfully overcoming relapse triggers all require skills that can benefit from coaching. But know that I am not advocating you spend your precious time and money on general life coaching. This field is littered with many unlicensed helpers who often mean good, but have no business coaching others. While I know there are some solid general life coaches out there, seek out experts with a track record in the specific skills you want to acquire.
- Utilize intensive outpatient treatment instead of residential. Why would this be so you ask? Because principals of implementation science tell us that when you learn and practice new skills in real-world settings the outcomes are better. My good friend Dennis McCarty and his colleagues recently published Substance Abuse Intensive Outpatient Programs: Assessing the Evidence where they concluded that intensive outpatient is as effective as residential for most individuals, at a fraction of the cost. There are a number of reasons for this, but an important one is because they force those in treatment to practice new skills in the real world.
I know education is a life-long process and am hopeful that one day my haunting will end. I do seek out experts to help me learn things that are important to me, and am often amazed at how a little coaching can take me a lot farther than I ever imagined.