IHP 670 Module 6 Milestone Two Example

Milestone Two: Putting Steady Steps Into Practice

[Student Name]

Southern New Hampshire University

IHP 670: Program Design, Planning and Evaluation

Module Six Milestone Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone Two: Putting Steady Steps Into Practice

Good design guarantees nothing when delivery falls apart. This milestone plans how Steady Steps will move from paper to practice across Alder County's senior centers and primary care clinics: in what order, with whom, with what checks on quality and with what responses to the barriers likely to arise.

Why Implementation Quality Matters

Durlak and DuPre (2008) reviewed more than 500 studies of prevention and health promotion programs and found that the level of implementation clearly affected outcomes: programs delivered well achieved better results, often two to three times larger effects, than those delivered poorly. They also found that perfect implementation is rare, that positive results are possible when most core elements are delivered and that implementation is shaped by community factors, provider characteristics, the program itself and the organizational and support systems around it.

Assessing Site Readiness

Damschroder et al. (2009) merged many implementation theories into one framework spanning five areas: the program itself, the wider community and policy environment, the host organization's culture and resources, the individuals doing the work and the rollout process. Using that framework, the coordinator visited each senior center and clinic and rated readiness on space, leadership support, staff capacity, reach into priority populations and competing demands.

What the Readiness Review Found

Five senior centers had suitable space, supportive directors and existing exercise participants; two had space but little staff time; and two rural centers had strong community ties but poor flooring and limited parking. In primary care, one hospital system's clinics already screened for fall risk and had an electronic referral function; the other had neither. These differences will shape the order of rollout and the support each site receives.

Phase One: Preparation

In months one to four, the department will hire the coordinator and analyst, sign agreements with partners, certify twelve instructors through the tai chi program's standard training and a separate course for the seven-session group program, build the electronic referral pathway in the first hospital system and produce recruitment materials reviewed by the older adult advisory group.

Phase Two: Pilot

In months five to eight, classes will start at three sites chosen for diversity: a high-readiness center in the county seat, a rural center with strong community ties once its flooring is repaired and a center serving a large population of adults living alone. Referral from primary care will begin in the clinics already screening. The pilot will test recruitment, attendance, fidelity and referral follow-up before expansion.

Lessons From a Community Translation

Li et al. (2008) translated their tai chi fall prevention program into community senior centers and showed that locally trained instructors could run it faithfully, with measurable gains in participants' physical function. Their approach, standardized instructor training, a structured protocol and observation of classes, informs Steady Steps' fidelity monitoring.

Fidelity and Adaptation

Each program has core elements that must be kept, such as session frequency, the sequence of movements and progression, and adaptable elements that sites can change, such as class time, music and snacks. The coordinator or a lead instructor will observe two sessions in every class series using the program's fidelity checklist, and attendance will be recorded at every session. Proposed changes to core elements require the coordinator's approval and will be documented.

Phase Three: Scale-Up

From month nine to month 24, classes will expand to all nine senior centers and the YMCA, reaching about 40 class series a year. The second hospital system will add screening and referral after its electronic record is updated. Sites with lower readiness will receive extra coordinator time and a peer mentor from a pilot site.

Recruitment and Retention

Enrollment will draw on four channels: primary care referrals, senior center newsletters and announcements, faith communities in rural townships and a presence at the annual screening fair, now reframed as an enrollment event. Materials will use photographs of local participants and plain language tested with the advisory group. To keep people coming, instructors will call participants who miss two sessions in a row, classes will include social time and participants who complete a series will receive a certificate and an invitation to monthly alumni classes. The pilot will test which channels produce the most enrollment from priority groups.

The Referral Workflow

In participating clinics, medical assistants will ask the three screening questions at annual visits for patients 65 and older. Patients screening positive will receive a brief assessment by the clinician, who can place an electronic referral to Steady Steps. The coordinator will receive referrals daily, call each patient within a week to explain options and schedule a class, and report enrollment back to the referring clinic. This closed loop answers physicians' concern that referrals disappear, which the needs assessment identified as a reason they rarely screened.

Phase Four: Sustainment

In months 25 to 36, responsibility for scheduling and hosting will shift progressively to senior centers and the YMCA, and referral will become routine clinic practice. Milestone Three will address funding for this phase.

Timeline and Roles

The table summarizes phases, key tasks and lead roles.

Table 1. Implementation Timeline

Note. Composite plan for Steady Steps.

Barriers and Responses

Likely barriers include low enrollment among men and rural residents, attendance drop-off in winter, instructor turnover and clinicians who do not refer. Responses include recruiting through veterans' groups and farm organizations, offering indoor practice videos in winter, training four backup instructors and giving clinics monthly reports on how many referred patients enrolled and improved.

Monitoring Implementation

The coordinator will track monthly enrollment by priority group, average attendance, fidelity scores, referrals made and completed and rides provided. A dashboard shared with partners will flag sites falling below targets, such as attendance under 60%, for support.

Conclusion

Steady Steps' implementation plan matches rollout to site readiness, tests key processes in a diverse pilot, protects core elements while allowing local adaptation and anticipates barriers. Because implementation quality shapes outcomes, this plan is as important as the program design itself.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3-4), 327-350. https://doi.org/10.1007/s10464-008-9165-0

Li, F., Harmer, P., Glasgow, R., Mack, K. A., Sleet, D., Fisher, K. J., Kohn, M. A., Millet, L. M., Mead, J., Xu, J., Lin, M. L., Yang, T., Sutton, B., & Tompkins, Y. (2008). Translation of an effective tai chi intervention into a community-based falls-prevention program. American Journal of Public Health, 98(7), 1195-1198. https://doi.org/10.2105/AJPH.2007.120402