CFIR Definitions Compared with Principles from Gendreau and Colleagues
Damschroder et al. (2009) Gendreau, Goggin & Smith (1999)
Category CFIR definition Category Damschroder et al. (2009)
Innovation characteristics
Characteristics associated with the core components (“the essential and indispensable elements of an intervention”) or the adaptable periphery (“adaptable elements, structures, and systems related to the intervention and organization in to which it is being
implemented”; p. 3) . Examples of constructs: adaptability of intervention, intervention quality, cost
Program factors
These principles are related to the specific intervention (called program) such as: the need for the intervention (referred to as program) is demonstrated, there is scientific evidence to support the intervention, stakeholders agree that the intervention is needed and is in line with agency’s values and practice; the
intervention is cost-effective, there is a pilot phase of the program.
Outer Setting “…the outer setting includes the economic, political, and social context within which an organization resides…” (p. 5). Examples of constructs: patient needs and resources, cosmopolitanism
Inner Setting “…the inner setting includes features of structural, political, and cultural contexts through which the implementation process will proceed.” (p. 5). Examples of constructs: networks and communication, structural
Organizational factors
Refers to host agency for intervention and addresses: history of adoption new
interventions, efficiency of agency’s implementation, staff turnover, manner in which issues are resolved, organization of bureaucratic structure, etc.
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characteristics, organizational culture, implementation climate
Characteristics of Individuals
These are individuals who are involved in the implementation of the innovation who are “carriers of cultural, organizational,
professional, and individual mindsets, norms, interests, and affiliations.” (p. 5). Examples of constructs: knowledge and beliefs about the intervention, self-efficacy, individual stage of change
Staff factors Staff refers to people who deliver the intervention and those who supervise them. Characteristics include: staff having access to change agent, staff
understanding the purpose of the interventions, staff has sense of self- efficacy
Implementation Process
“…an active change process aimed to achieve individual and organizational level use of the intervention as designed.” (p. 5)
Examples of constructs: planning, engaging, executing, reflecting and evaluating
Change agent Refers to the person (internal or external) who initiates/implements the intervention and describes the characteristics necessary of the change agent: must have knowledge of agency and staff, must have support of leaders and line staff, must have
credibility, must be persuasive and demonstrate skills in motivational interviewing, problem solving and advocacy
Table B2
Open Coding Results for First Cycle of Coding
Category Description
Population description Description of the challenges probationers with mental illness face in the community.
Impetus Description of the reasons that the SMHP pilot was initiated; descriptions could reflect specific instances or general need for intervention/innovation
Design or activities Description oftasks or components related to the pilot that are part of the SMHP model, either initially intended (e.g., reduced caseload size, ongoing supervision) or developed during the project (e.g., case staffing) that are meant as a long term component or task (i.e., beyond initial implementation). Barriers People, activities, resources or other factors that hindered the
implementation of the intervention. Items coded as actual or anticipated barriers.
Facilitators People, activities, resources or other factors that helped the implementation of the intervention. Items coded as actual or anticipated facilitators.
Outcomes Achievements that are perceived to have resulted from the pilot. Items coded as actual or anticipated.
Strategies Activities (intended or unintended) that stakeholders (e.g., implementation team members, executive committee members, local partners) used to implement different aspects of the intervention (e.g., outreach to officers from local community agencies, building interagency partnerships).
Recommendations Any suggestions about activities of the pilot that should be maintained or any additional activities that can strengthen the pilot (this can include implementation-related activities).
Table B3
CFIR Definitions and Descriptions Adapted to the Local Context
Category CFIR definition Description
Innovation characteristics
Characteristics associated with the core components (“the essential and
indispensable elements of an intervention”) or the
adaptable periphery (“adaptable elements, structures, and systems related to the intervention and organization in to which it is being implemented”; Damschroder et al., 2009, p. 3) .
Characteristics associated with the core components of Specialty Mental Health Probation including: reduced caseload size, problem-solving orientation, ongoing supervision, ongoing training, interfacing with external organizations that could impact the successful
implementation of SMHP. In addition, innovation characteristics refer to the characteristics associated with the ‘adaptable periphery’ (i.e., attributes that can be modified based on setting of the intervention) such as case staffing, service provider contacts, and other consultation with the managed care organization for mental health services. This does not include activities associated with selection and assignment or other activities necessary for carrying out the trial/study (for this coding, see Process).
Outer Setting “…the outer setting includes the economic, political, and social context within which an organization resides…” (Damschroder et al., 2009, p. 5)
Characteristics associated with the environmental context (e.g., economic, political, structural context) of the counties in which SMHP is implemented and the characteristics of the partnering organizations that may impact the successful implementation of SMHP. Outer setting organizations include: mental health agencies, the courts, LMEs/MCOs, NC DHHS, TASC, and other organizations or agencies. Inner Setting “…the inner setting includes
features of structural, political, and cultural contexts through which the implementation process will
Characteristics associated with the local DPS unit (e.g., organizational culture, structural context) and the larger DPS agency in which SMHP is located that impact the successful implementation of SMHP.
proceed.” (Damschroder et al., 2009, p. 5)
Characteristics of Individuals
These are individuals who are involved in the
implementation of the innovation who are “carriers of cultural, organizational, professional, and individual mindsets, norms, interests, and affiliations.”
(Damschroder et al., 2009, p. 5)
Characteristics of individuals
involved in SMHP that could impact successful implementation.
Individuals include the officers who are delivering the intervention as well as internal and external partners associated with the pilot. Individuals on SMHP are not included in this category.
Implementation Process
“…an active change process aimed to achieve individual and organizational level use of the intervention as designed.”
Characteristics associated with strategies and tactics aimed at facilitating the implementation of SMHP but are not necessarily planned to be a feature of the intervention itself.
Semi-structured interview guide
1. How long have you worked for (DPS, DHHS, TASC, MCO, other)?
2. What other positions, if any, have you held at (DPS, DHHS, TASC, MCO, other)? 3. Have you worked at any of the other agencies involved in the pilot (i.e., DPS, DHHS,
TASC)?
4. Thinking back to before the Governor’s Crime Commission grant was funded, based on your perspective, what was the impetus for implementing SMHP and statewide mental health training?
5. During the planning stage (i.e., developing the grant proposal, applying for the grant, developing the plan for implementation), what were the challenges and barriers that the group faced?
6. What were some things (e.g., conditions, people) that may have helped the planning process?
7. During implementation (i.e., developing training modules, hosting training for officers, randomization and probationer assignment), what were/are the challenges and barriers?
8. What were some things (e.g., conditions, people) that may have helped the implementation process?
9. In your opinion, what would a successful SMHP pilot look like? How will we know if this works?
What would be different if SMHP worked?
10.What are the necessary elements or conditions for the success of SMHP? 11.What are potential or likely barriers to the success of SMHP?
12.In your opinion, what would a successful statewide mental health training program look like?
How will we know if it works?
What would be different if the statewide mental health training program worked?
13.What are the necessary elements or conditions for the success of the statewide mental health training program?
14.What are potential or likely barriers to the success of the statewide mental health training program?
15.What are your expected long term outcomes in terms of interagency partnerships with (DPS, DHHS, TASC, MCO/LMEs, etc.)?
16.How does SMHP and the statewide mental health training program fit within existing agency operating principles or structures, such as OMM and TASC?
17.How might SMHP and statewide mental health training program help to reinforce these efforts?
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APPENDIX C: PAPER 3 TABLES