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## Breadcrumb

            -  Evidence for Program Improvement 
            -  Externalizing and Effective Implementation 
            -           Ensure Organizational Capacity to Support Complex Service Delivery      

# Ensure Organizational Capacity to Support Complex Service Delivery

## Outcome

### Externalizing Behavior

## Intervention Family

### Effective Implementation

 Effective Implementation              Provider training and supervision              Organizational capacity              Implementation quality      

## Ensure Organizational Capacity to Support Complex Service Delivery

## Evidence

Interventions with **complex service delivery** – those implemented in different setting types, with multiple formats, and/or that used multiple types of providers – tended to have smaller reductions in participants’ externalizing behavior than those with more streamlined operations. However, among **well-implemented interventions**, those with higher complexity tended to have larger impacts than those with less complexity.

Service delivery complexity is a combination of different settings (e.g., classroom, home, community setting), different types of delivery personnel (e.g., teachers, laypeople, program specialists) and different formats (e.g., group, one-on-one, self-directed). The more of these elements a program has, the more complex and challenging it can be to implement with quality and consistency. However, many health and human services programs for youth are intentionally complex, due to factors such as the constellation of needs of populations of interest, community context, and funding requirements. Moreover, many programs for youth are multidimensional, reinforcing content in multiple spheres of a child’s life – home, school, and community – and with multiple people who influence that child – caregivers, teachers, and peers. Because service delivery complexity can be desirable, it is crucial for programs that involve multiple settings, formats, or delivery personnel to have the capacity to ensure they are well implemented.

By organizational capacity, we mean “the range of capabilities, knowledge, and resources that nonprofits need to be effective.”2 There are many different dimensions of organizational capacity – here are four common dimensions, but you may have your own favorite framework for defining organizational capacity:- Leadership  – the active involvement of leadership in providing direction, creating a positive climate, and inspiring others to achieve the organization’s mission.
- Operational  – the people, skills, competencies, space, funding, partnerships, technology, etc. necessary to carry out the organization’s activities.
- Management  – policies, systems, and procedures that provide structure and support the delivery of services. For example, training and supervision, continuous quality improvement (CQI), decision-making structures, and policies that guide service delivery.
- Adaptive  – the ability to respond to changing circumstances within and outside the organization.
**EXAMPLES OF HIGH COMPLEXITY PROGRAMS**- A day treatment program for children exhibiting disruptive behavior provided a daily 2.5 hour block of special education, a 3-hour block of psychotherapy, and weekly family therapy. Though conducted in a single setting, the intervention was delivered by multiple types of providers such as teachers, psychologists, a social worker, and child care workers. In addition, each component of the program required a different format: group special education, one-on-one psychotherapy, and child-parent dyads with a provider for family therapy.
- A program designed to reduce inattention, impulsivity, and improve motivation among 2nd – 4th graders was implemented in a school-based setting and a home setting. At school, classroom teachers used positive reinforcement techniques to reinforce desired behaviors, coupled with parental praise for positive teacher reports. At home, parents consulted with therapists and implemented behavior modification and tutoring, and children received individual counseling from the therapist.
2 Grantmakers for Effective Organizations (2015). Strengthening Nonprofit Capacity. Washington, DC: Author.- Home
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Assess Feasibility- Program design.         Review the number of different setting types, types of delivery personnel, and formats your program uses, and confirm they are necessary elements based on your intervention’s design and implementation context (e.g., your population of interest, your program’s logic model for how behavior change happens, community norms and expectations). Identify any areas where simplification could be practical.
- Organizational capacity. .  	Assess and identify gaps in organizational capacity that may be hindering your ability to implement with quality in a diversity of places and formats. Weaknesses in any part of the organization could affect the staff and resources needed to implement your program as intended.
Take Action
Consider any of the following courses of action depending on the results of your feasibility assessment:
- Build specific capacity  to support complex service delivery, as needed. For example:   - Clear manuals  or written guidance for frontline staff;
  - Ongoing training and professional development  tailored to specific settings and formats;
  - A system to monitor staff’s adherence  to implementation guidance to identify areas in need of improvement.
  - Take steps to improve communication  with key partners who are hosting the intervention.  **If you don’t have the resources to build capacity, think about streamlining service delivery into one type of setting or format to ensure more uniformity and control over implementation quality.** For example, try multiple community center settings that share characteristics, instead of a mix of different community centers, schools, and home settings.                  Subscribe to E-NewsletterLists*youth.gov Share ContentFind opportunities and resources for youth! 
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youth.gov is the U.S. government website that helps you create, maintain, and strengthen effective youth programs. Included are youth facts, funding information, and tools to help you assess community assets, generate maps of local and federal resources, search for evidence-based youth programs, and keep up-to-date on the latest, youth-related news.