The Global Implementation Conference, held in Washington DC, was told that the Norwegian Center for Child Behavioral Development was established in the late 1990s in response to a national concern about increasing levels of youth crime and violence. Despite some calls to increase policing and get “tough on crime” – two of the planks of policy now being promoted in England - the government responded positively to a recommendation from a task force for the implementation and robust evaluation of an empirically supported family and community treatment program. So much so that they committed to the national implementation of two well-regarded programs: Parent Management Training and Multi-systemic therapy.

The center's first challenge was to overcome a natural concern about the suitability of US-developed programs for the Scandinavian country. Ten years later, however, they have found that the programs have required no fundamental changes. Instead they have identified a need for what they call checking for "cultural sensitivity". An obvious example is translation of materials into Norwegian. Less obvious is how to deal with the requirement of a program to use Masters level staff when there is no such qualification as a Masters degree in Norway.

This point tied in with one of the five observations made earlier by Dean Fixsen, a leading light of implementation science. The conference was his brainchild. In his opening address, he said that implementation science appears to be a universal phenomenon that is not dependent on discipline, diagnoses or geography.

The Norwegians conceded that at the outset they were overambitious with the wish to do everything, at once, everywhere. They began by establishing a partnership with the Oregon Social Learning Center, the developers of Parent Management Training, and together agreed appropriate adjustments for cultural sensitivity and crafted a training program for professionals.

Through the efforts of a national and regional team 1,200 professionals have received training. Between them they offer the two programs intensively, as well as other evidence-based strategies for children at risk. They aim to serve in the region of 4,000 families per year.

Successful implementation has been found to require a rigidity regarding the factors that knowingly influence therapist adherence to protocols, client outcomes and sustainability, but flexibility around cultural sensitivity and integration into the system.

The center began with a commitment to evaluate the programs robustly and has so far completed six randomized controlled trials. They are now less interested in the effects of the programs, having established that they work for Norwegian children in the same way that they do for American children. They are now more interested in understanding how the programs work through studying mediators and moderators.

As the team seeks to embed this way of working into the system, they are searching for efficiencies, considering, for example, whether the duration of training can be shortened without reducing effect and whether strategies to reach families can be improved.

The center observe: 'It is a paradox that there is not an evidence-base for the implementation of the evidence based programs.”

The Norwegians were some of the 750 researchers, practitioners, purveyors organisational leaders and policy makers that the conference brought together.

It is part of Fixsen's vision is to establish a global learning community that will shape and develop the “practice and science of bringing science to practice”.

He has worked in implementation science for 40 years and his remarks drew upon the landmark review conducted with colleagues in 2005, Implementation Research: A synthesis of the Literature [See: What Works for a summary], and subsequent experience of applying the models proposed in the review.

Thus, his second observation was that implementation is “in a service to programs”, that is that high quality implementation is nothing if the program is ineffective. The concept of the program, although widely used, is not well developed.

Third, he said that everything interacts with everything else and that while this complexity may be daunting, the interactions can all be treated as hypotheses worthy of study.

His fourth observation was that implementation can be “done on purpose”, that there is a distinction between letting things happen, helping them happen and making them happen. The common approach of publishing information and a manual about a program are good examples of “letting things” happen. Technical assistance centers, online resources and workshops are also a good example of “helping things” to happen. It is only through implementation teams who are accountable for outcomes that things are “made to happen”.

Fixsen said that, fifth, sustainable benefits require organizational and system change. One way of doing this is to create feedback between the senior leaders who have decided to introduce an innovation to the system and practitioners whose job it is to implement it. Through a process of continual feedback the system can be reinvented.

• Tomorrow Prevention Action will share the emerging implementation science research agenda. The following day coverage will outline the over-arching science, policy and practice implementation agenda over the next decade.