**3. Implementation Challenges**

Implementation of new practices can be exciting but it involves change. We highlight here seven areas that have been the most challenging in international implementation of the RBM. A common implementation challenge, from the perspective of the purveyor, is professionals' claiming they are implementing a model when, in fact, they are not. Their claims are usually based on an honest belief they are doing what they understand to be the practices in the model.

### *3.1. Natural Environments*

In Spain, Marga Cañadas and McWilliam tried for 4 years to persuade early intervention programs to leave their clinics ("centers") and go into homes and communities to implement the RBM. The two main reasons for the attachment to centers were control and money. In their rooms in their centers, professionals are in control of the session. In their centers, they can see eight clients a day, whereas, visiting natural environments, they would be able to see only four or five children and families. When it was clear professionals could not be budged out of their clinics, McWilliam made a huge concession and developed procedures for routines-based clinic visits. By the same means that home visits can be performed in a clinical fashion, clinic visits can be performed in a family-centered fashion, with obvious limitations. Taiwan [40] and Paraguay have also found it difficult to use the model in natural environments. Poland would also find it difficult, but they are focusing on the Engagement Classroom Model rather than the home- and community-based practices in the model.

*What about our "churches"?* In working on international implementation, we came across the phenomenon of the importance of the building [2]. When agencies erect or modify buildings to house their early intervention programs, they are proud of them and want to get the most out of them. You can sense an almost religious devotion to the building. McWilliam first realized this at the Asunción center of Teletón Paraguay-the flagship center. It is a beautiful, modern, spacious building, with a remarkable curved wood-slat ceiling over the therapeutic swimming pool. Why would they not use this lovely space?
