Using the Consolidated Framework for Implementation Research to Identify Factors Shared Among Positive Deviants with Respect to Help Me Grow Implementation: A Qualitative Study

The field of implementation science provides a knowledge base to inform the design, delivery, and evaluation of interventions such as Help Me Grow, an early childhood model designed to strengthen developmental promotion, early detection, referral and linkage. This study leveraged the Consolidated Framework for Implementation Research (CFIR) to elucidate factors inherent to the model, characteristics of implementing organizations and individuals, the external context, and the processes used to support implementation among a cohort of Help Me Grow sites. The methodology of positive deviance was used to identify exemplar Help Me Grow sites from across the Help Me Grow National Network. Seven sites participated in the study. Each site completed a survey to measure structural and contextual factors associated with their implementation, and 34 leaders completed semi-structured interviews to provide a qualitative perspective about site approaches to, and perceived factors related to the success of, sustained implementation of Help Me Grow. Interviews clarified critical elements of Help Me Grow implementation that should be addressed to ensure the model is accessible, impactful for, and utilized by a wide range of providers and families. CFIR constructs emerged as relevant for organizations to consider during their exploration and implementation of Help Me Grow; practices that target these themes may increase the likelihood of successful and/or sustained Help Me Grow implementation even across communities that vary in size, demography, and level of funding. Additional research that prospectively assesses the influence of these factors, including through the use of psychometrically valid measures, would increase the precision of estimates of the impact of these factors on successful implementation.