Chapter 7.

Implementing Injury Prevention Strategies at the Community Level (continued)

By Janice Yuwiler, MPH


Step Four: Develop an Implementation Plan


So far, we've talked about using data to set priorities and identify your intervention strategies. What's next? You've got your strategy identified, but how do you go about and plan your implementation? Developing an implementation plan can be a tremendous boon for you.

Developing a plan will help you
guide and focus your efforts, gather resources, and evaluate what you do. One of the things that we've found is that by putting together an implementation plan, you get an idea of where you are going and what you want to do. This does two things: 1) it helps you to do what you are setting out to do, and 2) it helps you not to do the things that you didn't plan on doing. There are lots of injury problems out there but if you have in your plan that you're going to address just a couple of them it helps you to stay focused so that you do not divide all your resources.

Developing an implementation plan also helps you gather resources. If you are looking for funding and you can tell somebody, "This is what I want to do, this is why I want to do it, this is how I'm going to do it, and this is who will work with me to get it done." you are much more likely to get funding than if you say, "You know I had a brilliant idea last night." So having a plan can be very useful in terms of being able to get access to funding resources.

Last, a plan can help you evaluate what you do. Bottom line -- if you do not know what you are going to do, not only are you not going to do it, but also you are not going to be able to evaluate it.

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What should your implementation plan include? Basically, you should have goals and objectives so you have a sense of what you're ultimately trying to do and how you are going to go about doing that; activities -- who is going to do what and how it's going to be done; evaluation measures -- how are you going to track what you're doing to see if you're really doing what you set out to do, and is it making a difference; resources assessment --what kind of resources are you going to need; and a timeline.

There are a couple of things to point out:

1) Planning your evaluation up front can make a tremendous difference. If you figure out what you're going to do and start looking at your evaluation plan right now you can collect data that will give you a sense of where you are before you do the intervention. So that later, when you want to see whether or not you made a difference, you will know where you were before you started your activity as compared to where you are further down the road. It also helps you keep track of what you're doing and how you're doing it. This can be really important in terms of modifying your program to be more successful. Furthermore, as you decide how you're going to track your activities and their impact, you are forced to rethink what you're doing, what your activities are, and what your goals and objectives are in order to tighten them and carry them out in a manner that can be tracked and measured. In the end, if you design your evaluation early, your plan will be much tighter and you'll have a better chance of success. Not only will you be able to evaluate if you were successful but you will have a better chance of success overall.

2) A timeline is really important. It gives you a sense of progress, and some success along the way. You can say, "We've done this and now we're moving on to this." It gives you both a sense of flow and accomplishment.

Step Five: Identify, Select and Commit Community Agencies to Implement and Support the Plan

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Next you want to implement your plan. As you start to go forward, you want to identify, select, and commit community agencies to help implement and support the plan.

Now remember, this whole systems approach is an
iterative process. You probably will not come to your partners with a finished plan. In fact, if you did, you'd be rather foolish because your partners are going to have wonderful ideas, have a better sense of what resources are out there, and be able to help you put together a better prevention plan.

As you start your plan, think about who needs to be involved and how you might pull those people together. Go out and see who can work with you. As you do that you're going to look for
partners who are credible, who have a parallel mission, and who have the organizational structure to carry out the implementation plan. In terms of credibility, you want folks who are credible to the people that you will be working with so that they will pay attention to the message you're carrying and the work you're trying to do. That may mean, for instance using young people to work with young people.

Choose people who have a parallel mission -- are they interested in the same population you're going to be working with? Are they interested in the same injury? It's going to be much easier to do a poison prevention effort with a pharmacist than with your Fire Department. Last, choose partners who have the resources, the staff, the time and the energy to go forth with the implementation plan.

choosing partners, remember to look beyond the obvious and include the broader community. You also want to look within your own agencies and programs. By 'beyond the obvious' I mean look to the faith community -- we often don't look enough at what our religious organizations are doing and how we can bring them in as partners. Look at what young people are doing -- if you're doing an intervention for young people bring young people on board. Bring in your city planners and your traffic safety engineers. Look beyond the folks that you might obviously think would be interested in injury prevention to the folks that are working with the population you are trying to reach.

In terms of looking within your own agencies and programs, you want to do as much as you can within your own agency. You've got a little bit more control over what's going on within your own agency. For example, we talked about everybody wearing their seatbelt when they were on company business or buying cars with air bags. You might also do something where you can provide your employees with help if they are depressed or experiencing interpersonal relationship problems, domestic violence, or child abuse. Build injury prevention into your own agencies and your own programs. By doing this you're going to build your own credibility. If you're going to go out and ask other partners to do something with you it's nice to know that you're doing what you can within your own house.

You also want to Think Institutionalization! Let me explain the concept - you must build on what's already out there. Pediatricians are already doing developmental assessments during Well Child visits -- have them do some injury prevention counseling. WIC programs are already doing an educational session every month -- have them include injury prevention for a minute or two within that educational session. Home nurses are already doing home visits -- have them look at the environment that the child is in for safety hazard or smoke detectors or have them assess potential domestic violence and child abuse situations.

Build injury prevention activities into what people are already doing. By doing that you create the opportunity for something to continue over a long period of time -- you could leave and the program might still continue. Now, be careful and be sure that you evaluate the program. -- You don't want the intervention going on forever if it's not effective. So first take a look at a pilot and see if it works. If it's working and effective then you can expand and work to institutionalize the program. Help the organizations involved maintain the program, by helping them become able to orient new employees. Institutionalization helps to insure that effective interventions don't stop and start. Otherwise you might get a grant to do a bicycle helmet program, and when the grant is over -- no more bicycle helmet program.

This is really important because sometimes you can chop down a tree so you can see the stop sign and you've solved your problem, but other problems aren't so simple and take a longer sustained effort at multiple levels. As much as you can, build on what is already there and incorporate your program into existing structures so you can keep your effort going and have more success.

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A lot of folks have also found that it's really helpful to establish a task force or coalition. Bringing a group together helps in terms of conceptualization, planning, and implementation. We found that a task force or coalition can help to identify barriers and how to address them so you can see what is coming before it becomes a problem.

Task forces and coalitions can help fine tune goals and objectives so that you are building on what's already out there and using the best expertise.
Task forces and coalitions can also help develop and carry out implementation; identify and solicit resources (because members may be linked into political, technological, and financial resources that you might never have known existed); and solve problems that arise along the way.

What you want to do is
bring together people with the time, commitment, technical experience, political linkages and access to resources -- that is what you're looking for in terms of your coalition. Don't bring people together unless you've got something for them to do -- They don't have the time to waste sitting around a table. Think of what you're going to use this group for and then look for people who have the necessary qualities.

The other thing to remember is that you don't necessarily have to start a brand new injury prevention coalition -- you might be able to build on an existing coalition. For small communities this is sometimes very important -- you may have the same five volunteers for every community activity. You don't need to establish something new. You can build on what's already there. For example, if you have a children's initiative maybe injury prevention can be a subcommittee of the children's initiative. Think smart as you're putting together your coalition.

Once your folks are together, whether it's a subcommittee or a coalition standing on it's own, make sure that you
orient members. You want to make sure that everyone has a sense of what the mission is, that they are all walking in the same direction, and that they understand what the goals and objectives are. You need to allow time for trust and understanding to develop. For example, I'm in public health so I go out and talk about injury prevention and surveillance -- fancy words for data collection -- all the time. But to our public safety partners, surveillance is something illegal that you don't do that without a warrant!

Coalition members need time to understand each other's terminology and where people are coming from, and to allow trust and understanding to develop. Also, if you provide an initial focus you're more likely to be successful, because you're building something along the way, and giving people a chance to know each other as they work towards a common goal. Shared successes and the development of trust can break down some of the turf issues and help people work together to really maximize the injury prevention effort.

Step Six: Develop Protocols and Materials

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Before you implement your program, you want to develop protocols that define the roles and responsibilities of each agency or person and the activities that each will be doing. This is really important because you want people to understand what they are going to be doing. For example, you can create a flow chart for a clinic with who the contact person is in the reception area, the waiting room, and the prep room, what activities will be conducted and who's going to be responsible for each activity. A protocol lets people know what they will be doing and what you're expecting of them. It also makes it easier for them to follow through with the tasks that they've been assigned.

The next thing you need to think about is
developing materials. Make sure you use simple targeted messages, include what action should be taken, and make the materials easy to read and reproduce. You don't want to produce materials that just talk about a problem. You want to let people know what it is that you want them to do -- and this is as true for parents as it is for policy makers. You want to make the materials easy to read -- not only for low literacy populations, but also for professionals who don't have time to read through a 20 page dissertation.

This safety tip is an example of something that was done for the
WIC program. It tells you what you should do. There's a short graphic to catch your eye and then there is a little explanation about why it is important that you do these activities. Very easy to reproduce, very simple, it tells people what they need to do and why. Remember, you want to keep those materials simple.

Step Seven: Orient and Train Agencies/Individuals Implementing the Intervention Plan

Once you've got your materials and your protocols, what you need to do is go ahead and
train the people who are going to be conducting the intervention. They need to have some practice with using the materials, following the protocols, and knowing what is expected of them.

Step Eight: Monitor and Support Implementation of the Plan

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Then go out and implement your program t. Have fun. Injury prevention really is fun to do. But as you are working, remember to monitor and support your implementation. Don't leave your people out there out in the cold. You want to meet frequently; deal with problems as they arise; remain flexible -- because there will be changes that you will need to make; and make your partners famous. The more famous you make your partners -- the more success and visibility they get for participating in this effort -- the more likely they are going to want to continue.

Step Nine: Evaluate and Revise

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So we are coming around full circle. We are back to evaluate and revise.

Evaluation really helps you to
revise your program to make it more effective and to convince funding agencies and the community of the value of your program. For example, there was a program a while back that wanted to prevent falls among the elderly by installing skid strips in bathtubs. They got incredible community participation and got skid strips, out everywhere. But they were a smart program. They went back to look at how many of the skid strips were actually installed in the bathtubs. You know what? Not too many. So they went back and revised their program. Instead of just distributing skid strips they went out and physically installed those skid strips in the bathroom. And when they did -- they realized why the skid strips weren't installed to begin with -- there was a ton of soap scum that had to be scraped off before they could put those skid strips on.

When they went back to evaluate their revised program, they discovered they had had much better success in terms of getting the skid strips in the bathtubs, but you know what? They found that people were not falling in the bathtub -- they were falling while getting in and out of the bathtubs. What they really needed to have done was install grab bars. Because this program evaluated their efforts, they were able to modify their intervention to be more successful.

You, hopefully, would have taken a real good look at what the scenario was and understood your problem so that you would have set out to install the grab bars to begin with. But this program's evaluation really helped them to look at what they were doing, determine whether they had been effective, and make the changes needed.

The other reason to evaluate is to be able to convince your funders and your community about the value of your program. In Jackie Moore's case study they were able to go back and say, "Hey folks, we had a 21% reduction in house fire calls because of the work we did." That is a success that you, your partners, and the community can all feel good about. Since most people and funders like to be a part of something successful, this can help you bring in new partners and funders.

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The other thing to note is that Jackie Moore's group didn't show a 21% decrease in all burns, but in house fires which is what their program targeted. Remember, make sure your evaluation matches your intervention. That's one of the reasons your evaluation design really must be done before you begin your intervention. And, it needs to be a part of your program -- it's going to strengthen your program and allow you to collect data along the way so you understand what you're doing and whether what you're doing is what you think you're doing. It's not always the same -- remember, lots of skid strips were distributed, but they were not being installed.

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Basically there are three key questions you're trying to answer in your evaluation. What is the program designed to do? Are you doing it? And is it making a difference? You don't need to have fancy data, but you do need to try to answer those three questions.

Having the answers to those questions will help you to report to
agencies and stakeholders the results of your program -- not just the results of your program but how those results were reached so that maybe somebody else can repeat what you did.

Step Ten: Disseminate Lessons Learned

You need to share what lessons you learned - what worked, what didn't work, what needs to be changed next time around, and the cost-benefits of your efforts. (Cost-benefit ratios depend on what you can find out about the impact of your program -- you know how much your program costs, but if you can get a sense of how many injuries you have actually prevented, you can get a sense of how much they would have cost society. Then you can put together a cost-benefit ratio, which can be really helpful in terms of moving your program forward.)

Once you have results, be sure to share them with your funding agency and with your community. They need to know -- they've been working with you -- and they should know the
results of your evaluation. Again, there's a lot out there in injury prevention, but we've got to share what we do with others, so that we can build on that and continue to create our successes.

Last, I want to leave you with a thought -- I am not letting you off the hook.
You can make a difference -- I want you to take back what we've discussed throughout the course and think about what you can do within your home, agency, and community to prevent injuries.

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Next: Chapter 8: Bringing it all together


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