Implementation and Sustainment Decision Tree
Implementing and Sustaining Change to Advance Early Detection of Dementia for Communities
This tool was developed to guide you through key phases, action steps, community considerations, and capacity building steps to successfully adopt, implement, evaluate, improve, and sustain comprehensive early detection of dementia programs for communities.
There are many creative opportunities to leverage this new tool. Please get in touch with us at [email protected] to let us know how you are using the decision tree to inform and guide efforts to advance early detection of dementia for your communities! Our Center is happy to provide technical assistance and additional guidance regarding any of the steps.
The PDF version is available to download at the bottom of the page.
Click “Start Here” to navigate through the decision tree.
capacity building step
action step
Community consideration
EXPLORE
PREPARE
IMPLEMENT
SUSTAIN
HERE
EXPLORATION Phase
Have you chosen an early detection approach (program, process, policy, practice, guideline) to implement and sustain in your setting?
Community consideration
Please ensure that your approach reaches those most impacted in your setting.
Capacity building step
Review our sector-specific resource guides on Early Detection of Dementia to learn about different early detection approaches and key considerations
Community consideration
Please consider engaging key community partners and local champions to ensure the appropriateness and acceptability of your approach.
ACTION STEP
Choose a promising approach that fits your setting and goals
Preparation Phase
Do you have the capacity, champions, buy-in, resources, and leadership support to successfully implement your selected early detection approach?
Capacity building step
Leverage organizational and patient/community needs and assets assessments to ensure a comprehensive understanding of baseline capacity in your setting + what additional capacity may be required to optimize implementation success and sustainability (use an implementation readiness tool or the Organizational Readiness for Implementing Change measure)
Community consideration
Consider engaging key community partners and local champions to ensure their perspectives and priorities are aligned with the assessment.
ACTION STEP
Based on needs and assets identified, build necessary capacity e.g., engage additional champions + key stakeholders, secure additional leadership buy-in Watch our webinar on “Becoming a Prepared Leader”
Initial / Early Implementation
Are you confident in your approach to evaluating the success of your early implementation efforts?
Capacity building step
Do you need to modify/adapt your approach? If so, make necessary modifications/adaptations to optimize the approach and carefully document what you did. Then, carefully document what you modify/adapt – e.g., use the Framework for Reporting Adaptation and Modifications-Expanded (FRAME) to guide + track your efforts
Community consideration
Is the approach working for some segments of your population but not others?Adapt your efforts to improve engagement of those not being effectively reached.
ACTION STEP
Make necessary modifications/adaptations to improve the approach and its initial implementation.
Mid- to Later-Term Implementation
Has your early detection approach been fully implemented? Can it be sustained to meet dynamic needs + priorities over time?
Community consideration
Ensure that your approach, if sustained, can meaningfully close gaps in early detection for all communities.
Capacity building step
Do you need to further modify/adapt the early detection approach for sustained success? (also using the Framework for Reporting Adaptation and Modifications-Expanded (FRAME))
ACTION STEP
Make and document necessary modifications/adaptations to optimize the approach now that it has reached full implementation.
Sustainability Phase
Do you have a plan for longer-term implementation and sustainability of your early detection approach? How will you identify any potential emerging or widening gaps?
Community consideration
Please consider how your early detection program will continue to reach and impact all communities.
Capacity building step
Conduct a sustainability capacity assessment using the Program Sustainability Assessment Tool (PSAT) / Clinical Sustainability Assessment Tool (CSAT)
ACTION STEP
Define your measures of community reach and impact.
Ongoing Sustainment and Continuous Quality Improvement (CQI)
Opportunities to improve the implementation and sustainment of your early detection approach should now be prioritized. Do you have ongoing monitoring, evaluation, and sustained partner engagement to continue meeting dynamic priorities and needs with your comprehensive early detection approach? Consider using established quality improvement tools to drive continuous improvement. For more information on aligning quality improvement and implementation, read these case examples.
Acknowledgement: Phases for this decision tree follow those of the EPIS Implementation Framework
- Khan, S. (2025, January 23). Readiness thinking tool: Why organizational readiness for change matters. The Center for Implementation. https://thecenterforimplementation.com/toolbox/readiness-thinking-tool
- Shea, C.M., Jacobs, S.R., Esserman, D.A. et al. Organizational readiness for implementing change: a psychometric assessment of a new measure. Implementation Sci 9, 7 (2014). https://doi.org/10.1186/1748-5908-9-7
- Wiltsey Stirman, S., Baumann, A.A. & Miller, C.J. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Sci 14, 58 (2019). https://doi.org/10.1186/s13012-019-0898-y
- Washington University in St Louis. PSAT/CSAT Program Assessment Sustainability Tool. https://www.sustaintool.org/
- Institute for Healthcare Improvement (IHI). Quality Improvement Essentials Toolkit https://www.ihi.org/resources/tools/quality-improvement-essentials-toolkit
- Leeman, J., Rohweder, C., Lee, M. et al. Aligning implementation science with improvement practice: a call to action. Implement Sci Commun 2, 99 (2021). https://doi.org/10.1186/s43058-021-00201-1