Preparing to Implement or Preparing to Fail? Why the Pre‐Implementation Phase Is Decisive in the Intellectual Disability Context

Vollständiger Abstract

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ABSTRACT Implementation failures in the intellectual disability context are often attributed to poor delivery, yet their roots frequently lie in the pre‐implementation phase. Although highlighted in implementation frameworks, pre‐implementation is commonly treated as administrative preparation rather than a decisive determinant of success. In the intellectual disability context, inadequate preparation is particularly consequential: fragmented governance, limited evidence bases and heterogeneous service‐user needs heighten vulnerability to early‐stage weaknesses. This conceptual debate paper argues that many implementation failures, both within research studies (e.g., randomised controlled trials, RCTs) and in implementing interventions into routine practice, originate in underdeveloped pre‐implementation processes and that structural features of the intellectual disability context further amplify these risks. We propose repositioning pre‐implementation as strategic core work through a pragmatic, co‐designed and multi‐level approach. The perceived tension between urgency and preparation is better understood as a false dichotomy; structured pragmatism allows services to act while learning. We outline a coordinated strategy comprising clarified governance, systematic readiness assessment, concurrent evidence generation, visible leadership engagement and institutionalised co‐design to strengthen conditions for equitable, sustainable and durable implementation.