Failure to Launch: The challenges of starting new programs of ASD services and training

Preparing your program for change, identifying relevant research, finding the right person to guide it, and launching it successfully is a lot harder than you think. And achieving true innovation even more so

July 28, 2017

It is an all-too-common tale... A school, university, or hospital embarks on an ambitious plan to create a new center, or program of services or training to address unmet or emerging needs.  Maybe it is inspired by grateful parents, a visionary donor,  enthusiastic legislators, or committed advocates.  Maybe it is a university-based training program, or a hospital-based treatment center.  In any case, a press release to announce a new gift or grant or legislation probably trumpets the organization's aspirations... an inspiring story of local efforts to close gaps in care or lead innovations in training or translate emerging research into treatment breakthroughs.

What is likely to happen next? Sadly, not much. Perhaps the program cannot find a qualified leader, or settles on someone with lots of ambition or ideas but little experience and even less support. Perhaps the program invests in research that vaguely promises to transform treatment, but without any viable plan except to keep kicking that promise down to the road. Perhaps the program invests in a gleaming new facility that they then hesitate to formally dedicate because the promised services cannot yet launch or the research breakthroughs have yet to materialize.

The momentum for true transformation is lost within 1 to 2 years, or maybe even before the launch itself. All the program can realistically hope for is a modest expansion of services or training, or narrowly focused research that might generate publications and another grant to the benefit of the researcher but no one else. And while the program will also hope that no one remembers the promises made when the initiative was launched, the donors, legislators, and advocates who fueled the initiative are no fools.  Attempts to re-kindle enthusiasm for future ASD initiatives are quietly snuffed by whispers of past failures to deliver. Gaps in care are largely untouched, or maybe are even greater than before, spurred ironically by the enthusiasm originally generated when the new initiative was first announced.

This story can be told at countless sites across the country.  Why? It is not for a lack of science: there are many promising practices we have yet to fully exploit.  It is not for a lack of front-line faculty, educators, or clinicians: universities are churning out new professionals with better training every day. In most cases, it is not even for a lack of funding, because of the commitments made by generous donors. And it is certainly not for a lack of need: the gaps in even the most basic care are well-documented on this site and elsewhere.  It occurs because of another kind of gap, the gap between ideas and implementation, between vague aspirations and a detailed plan, between those with the ambition to dream and those with the experience and commitment to deliver.

Why haven't we already heard about the many programs that have already failed on the launchpad? Program improvements and transformation - or the failure to do so - often unfold slowly over a period of several years, and so are more difficult to closely track. Many times, the goals and timeline set for a promised expansion or improvement are vague, making such tracking difficult.  Sadly, we lack examples of successful expansion and improvement.  When examples are found, the peer-reviewed scientific literature pays scant attention to them. And ultimately, there are few mechanisms to truly hold the leader or the parent organization of a failed project accountable.

And we have limited opportunities to learn from our mistakes. Most individuals and programs have one shot at successfully implementing major program expansion related to ASD, because of the long timeline, significant resources, and high stakes involved.  They are much more likely to bury embarrassing mistakes than try again. And funders of these efforts are equally complicit in burying these embarrassments, and will surely think twice before supporting comparable efforts in the future.

In the pieces linked below, I describe three strategies for closing this gap and for successfully launching new programs of services and training.  These all draw on programs I have led, worked directly with, or have closely followed.

• Carefully evaluate the program's true potential for growth. Is the goal to simply grow incrementally by adding new expertise or capacity to existing services or training? Or is the program more ambitious, seeking to create new types of services or dramatically expand capacity and, if so, do they anticipate all of the resources and preparation they will need?
• Identify the kind of research that can guide your programs' growth Research on outcomes and service gaps is clearly relevant; research on ASD's possible causes has proven less so.
• Consider what kind of leader do you need given your goals, and be realistic about who are you really likely to find. How do you build on the expertise or experience candidates are likely to bring?

Taken together, these strategies can help you create a timeline that can ensure rapid gains.  To illustrate, I contrast more incremental expansion and improvement with true program innovation and transformation, using examples of the launch of university-based teacher training and transition programs, and a hospital-based multidisciplinary treatment center.  Together, this information can help funders of new programs to catch problems before the launch, to guide adjustments during the countdown or initial ascent or,  in the case of a failure to launch, de-construct the problems in preparation for a subsequent attempt.