title: Developmental milestones across the programmatic life cycle: implementing the CDC's Colorectal Cancer Screening Demonstration Program.
abstract: BACKGROUND
  In 2005 through 2009, the Centers for Disease Control and Prevention (CDC) funded 5 sites to implement a colorectal cancer screening program for uninsured, low-income populations. These 5 sites composed a demonstration project intended to explore the feasibility of establishing a national colorectal cancer screening program through various service delivery models.
  
  
  METHODS
  A longitudinal, multiple case study was conducted to understand and document program implementation processes. Using metaphor as a qualitative analytic technique, evaluators identified stages of maturation across the programmatic life cycle.
  
  
  RESULTS
  Analysis rendered a working theory of program development during screening implementation. In early stages, program staff built relationships with CDC and local partners around screening readiness, faced real-world challenges putting program policies into practice, revised initial program designs, and developed new professional skills. Midterm implementation was defined by establishing program cohesiveness and expanding programmatic reach. In later stages of implementation, staff focused on sustainability and formal program closeout, which prompted reflection about personal and programmatic accomplishments.
  
  
  CONCLUSIONS
  Demonstration sites evolved through common developmental stages during screening implementation. Findings elucidate ways to target technical assistance to more efficiently move programs along their maturation trajectory. In practical terms, the time and cost associated with guiding a program to maturity may be potentially shortened to maximize return on investment for both organizations and clients receiving service benefits.
authors.affiliation: University Health Center, University of Georgia, Athens, Georgia, USA. RGloverKudon@cdc.gov
authors.forename: Rebecca
authors.initials: R
authors.lastname: Glover-Kudon
authors.forename: Amy
authors.initials: A
authors.lastname: DeGroff
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Rohan
authors.forename: Judith
authors.initials: J
authors.lastname: Preissle
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Boehm
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D011203:Poverty; D016730:Program Development; D015397:Program Evaluation; D014481:United States
keywords: colorectal cancer screening; multiple case study; program development; program evaluation; program implementation; qualitative methods; technical assistance