Community-academic partnerships in implementation research

"As a patient I do not belong to the clinic, I belong to the community": co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa

Background

Anticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.

Methods

Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework.

Results

Intervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.

Conclusions

Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44263-024-00084-z.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths

OBJECTIVE

Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not.

METHODS

Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503).

RESULTS

Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01).

CONCLUSIONS

These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.

Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model

Many autistic children require support to meet their learning needs. Given the heterogeneity within the autism spectrum it is plausible that different types of support might be better suited to different children. However, knowledge on what interventions work best for which children is limited. We examined the outcomes of autistic preschool-aged children receiving one of two community early intervention approaches. Our main objective was to understand which baseline child characteristics might be associated with the degree of individual response to intervention-whether prognostically (i.e., irrespective of intervention received) or predictively (i.e., specifically in the context of one or other EI approach). Participants comprised two matched groups of preschool-aged autistic children receiving either Group-based Early Start Denver Model (G-ESDM; n = 42) delivered in a 1:3-4 staff:child ratio or an Early Intensive Behavioural Intervention (EIBI; n = 40) delivered in combination of 1:1 and 1:2 staff:child ratio. Over an approximate one-year follow-up period, children in both groups made significant gains in Developmental Quotient (DQ) scores, and trend-level gains in adaptive behaviour composite scores. Higher attention to a playful adult measured via an eye-tracking task was prognostically indicative of better verbal DQ and adaptive behaviour outcomes for the cohort overall. Moderation analyses indicated a single predictive effect-of pre-program sustained attention for subsequent NVDQ outcomes specific to those children receiving G-ESDM. These findings suggest that fine-grained measures of learning skills offer promise towards the selection and tailoring of intervention approaches to meet individual children's learning needs.

A Statewide Evaluation of the Implementation of Evidence-Based Suicide Prevention Guidelines in Juvenile Detention Centers

This study aimed to explore suicide prevention in juvenile detention centers by conducting a case study of one state. Qualitative data from semistructured interviews were synthesized from 10 juvenile detention centers. Analytical techniques included thematic and content analysis and the integration of quantitative information and qualitative themes to illustrate key differences in suicide prevention practices and center characteristics among facilities with varying frequencies of crisis stabilization calls and critical incidents. Although the use of many suicide prevention practices was reported across the sample, the quality with which those practices were implemented was highly variable. The analysis suggests that facilities with higher-quality implementation of suicide prevention practices may have had leaders who acknowledged that their facility plays a role in suicide prevention. Moreover, preliminary evidence suggests that the quality of suicide prevention implementation may be associated with the number of crisis stabilization calls and critical incidents (i.e., variables related to suicidality) a facility experiences. Clear conceptualization of a juvenile detention center's role in suicide prevention may lead to better outcomes in suicide prevention implementation. High-quality implementation may reduce suicidality exhibited by youths in juvenile detention and save lives.

Building Better Bridges: Outcomes of a Community-Partnered New School Transition Intervention for Students on the Autism Spectrum

New school transitions can be challenging for students on the autism spectrum. No published, evidence-based interventions exist to support families and teachers of students transitioning to elementary and secondary school during this critical period. Using Community Partnered Participatory Research, we developed Building Better Bridges (BBB), a caregiver coaching intervention that includes training on effective school communication, educational rights, advocacy, and child preparation strategies. We compared BBB (n = 83) to a module/resources-only comparison (n = 87) in a four-site randomized controlled trial in racially and ethnically diverse, under-resourced communities. In our intent-to-treat analysis, caregivers and teachers in BBB rated students' transitions to the new classroom as more positive, relative to the comparison group. Results suggest this low-cost intervention can improve the transition process for families and students at high risk of poor transitions.

Family cascade screening for equitable identification of familial hypercholesterolemia: study protocol for a hybrid effectiveness-implementation type III randomized controlled trial

BACKGROUND

Familial hypercholesterolemia (FH) is a heritable disorder affecting 1.3 million individuals in the USA. Eighty percent of people with FH are undiagnosed, particularly minoritized populations including Black or African American people, Asian or Asian American people, and women across racial groups. Family cascade screening is an evidence-based practice that can increase diagnosis and improve health outcomes but is rarely implemented in routine practice, representing an important care gap. In pilot work, we leveraged best practices from behavioral economics and implementation science-including mixed-methods contextual inquiry with clinicians, patients, and health system constituents-to co-design two patient-facing implementation strategies to address this care gap: (a) an automated health system-mediated strategy and (b) a nonprofit foundation-mediated strategy with contact from a foundation-employed care navigator. This trial will test the comparative effectiveness of these strategies on completion of cascade screening for relatives of individuals with FH, centering equitable reach.

METHODS

We will conduct a hybrid effectiveness-implementation type III randomized controlled trial testing the comparative effectiveness of two strategies for implementing cascade screening with 220 individuals with FH (i.e., probands) per arm identified from a large northeastern health system. The primary implementation outcome is reach, or the proportion of probands with at least one first-degree biological relative (parent, sibling, child) in the USA who is screened for FH through the study. Our secondary implementation outcomes include the number of relatives screened and the number of relatives meeting the American Heart Association criteria for FH. Our secondary clinical effectiveness outcome is post-trial proband cholesterol level. We will also use mixed methods to identify implementation strategy mechanisms for implementation strategy effectiveness while centering equity.

DISCUSSION

We will test two patient-facing implementation strategies harnessing insights from behavioral economics that were developed collaboratively with constituents. This trial will improve our understanding of how to implement evidence-based cascade screening for FH, which implementation strategies work, for whom, and why. Learnings from this trial can be used to equitably scale cascade screening programs for FH nationally and inform cascade screening implementation efforts for other genetic disorders.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05750667. Registered 15 February 2023-retrospectively registered, https://clinicaltrials.gov/study/NCT05750667 .

"As a patient I do not belong to the clinic, I belong to the community." Co-developing a multi-level, person-centred tuberculosis stigma intervention in Cape Town, South Africa

Background

Anticipated, internal, and enacted stigma are major barriers to TB care engagement, and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.

Methods

Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n=87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed and then further interpreted using the socio-ecological model.

Results

Intervention components across socio-ecological levels shared common behaviour change strategies, namely education, empowerment, engagement, and innovation. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended. Consideration of how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested to decrease anticipated and enacted stigma. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.

Conclusions

Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-informed intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Using ERIC to Assess Implementation Science in Drowning Prevention Interventions in High-Income Countries: A Systematic Review

This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health approaches to drowning prevention interventions as a case study. International calls for action have identified the need to better understand the implementation of drowning prevention interventions so that intervention design and implementation is improved. In high-income countries (HICs), interventions are sophisticated but still little is known or written about their implementation. The review was registered on PROSPERO (number CRD42022347789) and followed the PRISMA guidelines. Eight databases were searched. Articles were assessed using the Public Health Ontario Meta-tool for quality appraisal of public health evidence. Forty-nine articles were included. Where ERIC strategies were reported, the focus was on evaluative and iterative strategies, developing partnerships and engaging the target group. The review identified few articles that discussed intervention development and implementation sufficiently for strategies to be replicated. Findings will inform further research into the use and measurement of implementation strategies by practitioners and researchers undertaking work in drowning prevention in HICs and supports a call to action for better documentation of implementation in public health interventions.

Partnering with social service staff to implement pragmatic clinical trials: an interim analysis of implementation strategies

BACKGROUND

With recent growth in the conduct of pragmatic clinical trials, the reliance on frontline staff to contribute to trial-related activities has grown as well. Active partnerships with staff members are often critical to pragmatic trial implementation, but rarely do research teams track and evaluate the specific "implementation strategies" used to support staff's involvement in trial procedures (e.g., participant recruitment). Accordingly, we adapted implementation science methodologies and conducted an interim analysis of the strategies deployed with social service staff involved in one multi-site pragmatic clinical trial.

METHODS

We used a naturalistic, observational study design to characterize strategies our research team deployed with staff during monthly, virtual meetings. Data were drawn from meeting notes and recordings from the trial's 4-month Preparation phase and 8-month Implementation phase. Strategies were mapped to the Expert Recommendations for Implementing Change taxonomy and categorized into nine implementation clusters. Survey data were also collected from staff to identify the most useful strategies the research team should deploy when onboarding new staff members in the trial's second year.

RESULTS

A total of 287 strategies were deployed. Strategies in the develop stakeholder interrelationships cluster predominated in both the Preparation (35%) and Implementation (31%) phases, followed by strategies in the use iterative and evaluative approaches cluster, though these were more prevalent during trial Preparation (24%) as compared to trial Implementation (18%). When surveyed on strategy usefulness, strategies in the provide interactive assistance, use financial approaches, and support staff clusters were most useful, per staff responses.

CONCLUSIONS

While strategies to develop stakeholder interrelationships were used most frequently during trial Preparation and Implementation, program staff perceived strategies that provided technical assistance, supported clinicians, and used financial approaches to be most useful and should be deployed when onboarding new staff members. Research teams are encouraged to adapt and apply implementation strategy tracking methods when partnering with social service staff and deploy practical strategies that support pragmatic trial success given staff needs and preferences.

TRIAL REGISTRATION

NCT05357261. May 2, 2022.

Understanding collaborative implementation between community and academic partners in a complex intervention: a qualitative descriptive study

BACKGROUND

Community-academic partnerships (CAPs) can improve the relevance, sustainability, and uptake of new innovations within the community. However, little is known about what topics CAPs focus on and how their discussions and decisions impact implementation at ground level. The objectives of this study were to better understand the activities and learnings from implementation of a complex health intervention by a CAP at the planner/decision-maker level, and how that compared to experiences implementing the program at local sites.

METHODS

The intervention, Health TAPESTRY, was implemented by a nine-partner CAP including academic, charitable organizations, and primary care practices. Meeting minutes were analyzed using qualitative description, latent content analysis, and a member check with key implementors. An open-answer survey about the best and worst elements of the program was completed by clients and health care providers and analyzed using thematic analysis.

RESULTS

In total, 128 meeting minutes were analyzed, 278 providers and clients completed the survey, and six people participated in the member check. Prominent topics of discussion categories from the meeting minutes were: primary care sites, volunteer coordination, volunteer experience, internal and external connections, and sustainability and scalability. Clients liked that they learned new things and gained awareness of community programs, but did not like the volunteer visit length. Clinicians liked the regular interprofessional team meetings but found the program time-consuming.

CONCLUSIONS

An important learning was about who had "voice" at the planner/decision-maker level: many of the topics discussed in meeting minutes were not identified as issues or lasting impacts by clients or providers; this may be due to differing roles and needs, but may also identify a gap. Overall, we identified three phases that could serve as a guide for other CAPs: Phase (1) recruitment, financial support, and data ownership; Phase (2) considerations for modifications and adaptations; Phase (3) active input and reflection.

Building a Community-Academic Partnership to Expand Workforce Development in Underserved, High-Need/High-Demand Areas

This case study highlights the partnership development between a large, urban, public, community-based behavioral health system and an academic program. Using principles of partnership building and facilitators that enhance partnership building, we describe the process of initiating, building, and sustaining the partnership. The Health Resources and Services Administration (HRSA) workforce development initiative was the primary catalyst for the partnership development. The public, community-based behavioral health system is located in an urban, medically underserved area and health care professional shortage area. The academic partner is a master in social work (MSW) program in Michigan. We assessed partnership development by using process and outcome measures that captured changes in the partnerships and in implementation of the HRSA workforce development grant. The goals of this partnership were to develop the infrastructure to support the training of MSW students, expand workforce skills in integrated behavioral health, and increase the number of MSW graduates who work with medically underserved populations. During 2018-2020, the partnership trained 70 field instructors, engaged 114 MSW students in HRSA field placements, and developed 35 community-based field sites (including 4 federally qualified health centers). The partnership provided training for field supervisors and for HRSA MSW students and developed new courses/trainings focusing on integrated behavioral health assessment/intervention practices, trauma-informed care, cultural awareness, and telebehavioral health practices. Of 57 HRSA MSW graduates who responded to a postgraduation survey, 38 (66.7%) were employed in medically underserved, high-need/high-demand urban areas. Partnership sustainability was helped by formal agreements, regular communication, and a collaborative decision-making approach.

Climate-Related Natural Disasters: Reflections on an Agenda for Rural Health Research

The increasing frequency and severity of climate-related disasters will exacerbate the health inequities that already exist between people living in rural communities and those living in urban areas. There is a need to improve understanding of the differences in the impacts on and needs of rural communities, in order that policy, adaptation, mitigation, response and recovery efforts meet the needs of those who are most affected by flooding and who have the fewest resources to mitigate the impact and adapt to the increased flood risk. This paper is a reflection by a rural-based academic on the significance and experience of community-based flood-related research, with a discussion of the challenges and opportunities for research on rural health and climate change. From an equity perspective, there is a need for all analyses of national and regional datasets on climate and health to, wherever possible, examine the differential impacts and policy and practice implications for regional, remote and urban communities. At the same time, there is a need to build local capacity in rural communities for community-based participatory action research, and to enhance this capacity through building networks and collaborations between different researchers based in rural areas, and between rural- and urban-based researchers. We should also encourage the documentation, evaluation and sharing of experience and lessons from local and regional efforts to adapt to and mitigate the impacts of climate change on health in rural communities.

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Background: In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. Method: The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. Results: From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Conclusion: Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.

Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals

BACKGROUND

Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed.

OBJECTIVES

to develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process.

METHODS

A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected. Qualitative interviews (n = 14) and focus groups (n = 6) were conducted with healthcare providers on-site. The Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) were applied to collected data and observations in order to identify drivers and barriers to implementation and understand differences in uptake.

RESULTS

One of the three hospitals displayed high intervention uptake. Highly relevant CFIR constructs linked to intervention uptake included tension for change, strong peer intervention champions, champions in influential leadership positions, and the intervention's simplicity (CFIR construct: complexity). Tension for change, a recognized need to improve CDI identification and treatment, at the high uptake hospital was also supported by an academic partnership for antimicrobial stewardship.

CONCLUSIONS

This research provides a straight-forward health systems strengthening intervention for CDI that is both needed and uncomplicated, in an understudied low resource setting. Intervention uptake was highest in the hospital with tension for change, influential champions, and existing academic partnerships. Implementation in settings with fewer academic connections requires further testing of collaborative implementation strategies and proactive adaptations.

Metrics to evaluate implementation scientists in the USA: what matters most?

Background

Implementation science has grown rapidly as a discipline over the past two decades. An examination of how publication patterns and other scholarly activities of implementation scientists are weighted in the tenure and promotion process is needed given the unique and applied focus of the field.

Methods

We surveyed implementation scientists (mostly from the USA) to understand their perspectives on the following matters: (1) factors weighted in tenure and promotion for implementation scientists, (2) how important these factors are for success as an implementation scientist, (3) how impact is defined for implementation scientists, (4) top journals in implementation science, and (5) how these journals are perceived with regard to their prestige. We calculated univariate descriptive statistics for all quantitative data, and we used Wilcoxon signed-rank tests to compare the participants’ ratings of various factors. We analyzed open-ended qualitative responses using content analysis.

Results

One hundred thirty-two implementation scientists completed the survey (response rate = 28.9%). Four factors were rated as more important for tenure and promotion decisions: number of publications, quality of publication outlets, success in obtaining external funding, and record of excellence in teaching. Six factors were rated as more important for overall success as an implementation scientist: presentations at professional meetings, involvement in professional service, impact of the implementation scientist’s scholarship on the local community and/or state, impact of the implementation scientist’s scholarship on the research community, the number and quality of the implementation scientist’s community partnerships, and the implementation scientist’s ability to disseminate their work to non-research audiences. Participants most frequently defined and described impact as changing practice and/or policy. This expert cohort identified Implementation Science as the top journal in the field.

Conclusions

Overall, there was a significant mismatch between the factors experts identified as being important to academic success (e.g., tenure and promotion) and the factors needed to be a successful implementation scientist. Findings have important implications for capacity building, although they are largely reflective of the promotion and tenure process in the USA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-022-00323-0.

Promoting sustainable responses to the US opioid epidemic with community-academic partnerships: qualitative outcomes from a statewide program

Background

Drug overdose deaths in the United States have continued to increase at an alarming rate. The Substance Abuse and Mental Health Services Administration (SAMHSA) distributed more than $7 billion between January 2016 and June 2020 to address the drug overdose crisis. The funds support evidence-based responses, including medications for opioid use disorder, and other prevention, treatment and recovery activities. Although the State Opioid Response (SOR) grants finance much-needed community level interventions, many of the services they support may not be sustainable, without ongoing assessment, evaluation and planning for continuation.

Methods

This paper describes a statewide effort to support local entities through SAMHSA’s SOR grants in Virginia. Community agencies across the state participated in detailed needs assessment exercises with VHEOC investigators, and developed requests for proposals (RFPs) to sustain their SOR programs. The RFPs were then distributed to prospective academic partners at the five VHEOC universities, based on the required subject matter expertise identified in the RFP. All responsive proposals were then provided to the local agencies who selected the proposal most likely to meet their needs. VHEOC investigators also conducted an inductive, three-phase content analysis approach to examine the RFPs submitted to the VHEOC to identify nominal categories of support requested of the VHEOC investigators.

Results

VHEOC Investigators received and coded 27 RFPs from ten community agencies representing four of five regions of the state. We identified six nominal categories of academic assistance with high inter-coder agreement. The six categories of support requested of the academic partners were program development and support, literature review and best practices, outreach and education, data analysis and interpretation, program evaluation, and grant writing assistance. Several RFPs requested up to three categories of support in a single project.

Conclusions

Our analysis of the requests received by the consortium identified several categories of academic support for SOR-grantees addressing the drug overdose crisis. The most common requests related to development and maintenance of supportive collaborations, which existing research has demonstrated is necessary for the long-term sustainability of SOR-funded services. In this way, the academic partners reinforced sustainable SOR-funded programs. As the state opioid response program is implemented nationally, we hope that other states will consider similar models in response to the opioid crisis.

Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio

INTRODUCTION

Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally.

METHODS AND ANALYSIS

The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation.

ETHICS AND DISSEMINATION

The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders.

TRIAL REGISTRATION NUMBER

NCT04111939.

Biases, Barriers, and Possible Solutions: Steps Towards Addressing Autism Researchers Under-Engagement with Racially, Ethnically, and Socioeconomically Diverse Communities

Autistic individuals who are also people of color or from lower socioeconomic strata are historically underrepresented in research. Lack of representation in autism research has contributed to health and healthcare disparities. Reducing these disparities will require culturally competent research that is relevant to under-resourced communities as well as collecting large nationally representative samples, or samples in which traditionally disenfranchised groups are over-represented. To achieve these goals, a diverse group of culturally competent researchers must partner with and gain the trust of communities to identify and eliminate barriers to participating in research. We suggest community-academic partnerships as one promising approach that results in high-quality research built on cultural competency, respect, and shared decision making.

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

BACKGROUND

Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers.

MAIN BODY

Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches.

CONCLUSION

We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.

A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework

Research has identified facilitators and barriers to implementation of evidence-based practices (EBPs). Few studies have evaluated which factors persist among healthcare clinicians with extensive education and training on EBP implementation. Therefore, the purpose of this study was to examine facilitators and barriers to EBP implementation across a national sample of specialty-prepared EBP mentors in healthcare settings. Healthcare clinicians participating in an immersive 5-day EBP knowledge and skill building program were invited to complete a follow-up survey 12 months later to report on implementation experiences. The Consolidated Framework for Implementation Research (CFIR) guided content analysis of responses. A force field analysis using Lewin’s change theory was used to assign numerical ‘weights’ to factors. Eighty-four individuals reported facilitators and barriers to implementation. The majority occurred within the inner setting of the CFIR model. Facilitators were strong leadership engagement (n = 15), positive EBP culture (n = 9), and resources (n = 4). Barriers included lack of resources (n = 21), poor leadership engagement (n = 19), implementation climate (n = 17), lack of relative priority (n = 12), and organizational characteristics (n = 9). Respondents also identified simultaneous facilitators and barriers within the process domain of the CFIR model. The construct of stakeholder engagement was a barrier when absent from the implementation process (n = 23), yet was a strong facilitator when present (n = 23). Implementation in healthcare settings appears most effective when conducted by an interprofessional team with strong leadership, resources, stakeholder engagement, and positive EBP culture. When these same factors are absent, they remain persistent barriers to implementation, even among specialty-trained healthcare clinicians.

Effective leaders(hip) in community-academic health partnership projects: An inductive, qualitative study

To deepen our understanding of how project leaders can lead effectively in different community-academic health partnerships (CAHPs), we conducted an inductive, qualitative study through semi-structured interviews (N = 32) and analyzed the data with Grounded Theory approaches. By presenting a process model illustrating the cycle of effective leaders(hip) in CAHP projects, we contribute to the literature on CAHP, leadership development, and complexity leadership theory in three ways. Firstly, the model depicts the strategies enabling leaders to navigate typical project challenges and perform leadership tasks effectively. Secondly, we distill four beneficial qualities (i.e., adopting a proactive attitude, having an open and adaptive mindset, relying on peer learning and support, and emphasizing self-growth and reflexivity) which CAHP project leaders require to develop themselves into effective leaders. Thirdly, we illustrate leaders' dynamic developmental logics and processes of effective leadership and their contributions to better project functioning in diverse CAHPs.

When Higher Education Meets Sustainable Development of Rural Areas: Lessons Learned from a Community–University Partnership

Sustainable development in mountain areas faces numerous socioenvironmental and economic challenges that public institutions have sought to address for decades. The EU is increasingly demanding Higher Education Institutions be more socially relevant and responsible in addressing the needs of these often-underserved communities. To this end, one central principle of the Erasmus+ Project 2014–2020, also consolidated by the Programme 2021–2027, has been to enhance the development, transfer, and implementation of innovative practices fostering social engagement at the local and international levels. The paper describes a case study developed in the “Socially Engaged Universities—(SEU)” project, co-funded by the Erasmus+ Programme 2014–2020, which aimed to strengthen the cooperation between universities and local communities. A local foundation and the University of Parma co-piloted a project to strengthen the short supply chains of a group of farmers in the Italian Appennines. The partnership identified factors that fostered and hampered the effectiveness of community–university partnerships. We propose some final recommendations to ensure that sustainable rural development fully leverages university resources. This includes higher education teaching and research programmes tailored toward the needs of the local community.

Leveraging academic initiatives to advance implementation practice: a scoping review of capacity building interventions

BACKGROUND

Academic institutions building capacity for implementation scholarship are also well positioned to build capacity in real world health and human service settings. How practitioners and policy makers are included and trained in implementation capacity-building initiatives, and their impact on building implementation practice capacity is unclear. This scoping review identified and examined features of interventions that build implementation practice capacity across researchers and practitioners or practitioners-in-training.

METHODS

Five bibliographic databases were searched. Eligible studies (a) described an implementation capacity building intervention with a connection to an academic institution, (b) targeted researchers and practitioners (including practitioners-in-training, students, or educators), and (c) reported intervention or participant outcomes. Articles that only described capacity building interventions without reporting outcomes were excluded. Consistent with Arksey and O'Malley's framework, key study characteristics were extracted (target participants, core components, and outcomes) and analyzed using open coding and numerical analysis.

RESULTS

Of 1349 studies identified, 64 met eligibility for full-text review, and 14 were included in the final analysis. Half of the studies described implementation capacity building interventions that targeted health or behavioral health researchers, practitioners, and practitioners-in-training together, and half targeted practitioners or practitioners-in-training only. The most common components included structured didactic activities offered in person or online, mentorship and expert consultation to support implementation, and practical application activities (e.g., field placements, case studies). Knowledge sharing activities and technical assistance were less common. All studies reported favorable outcomes related to knowledge attainment, increased ability to implement evidence, productivity, and satisfaction.

CONCLUSIONS

Building implementation capacity among practitioners is critical for integrating insights from implementation science into the field and preventing the "secondary" implementation research-to-practice gap. This scoping review identified several promising implementation practice capacity building interventions that tend to build practitioner capacity via expert led activities which may be relevant for academic institutions seeking to build implementation practice capacity. To avoid widening the implementation research-to-practice gap, implementation capacity building interventions are needed that target policy makers, expand beyond multiple practice settings, and leverage university/community partnerships or on-site academic medical centers. Future studies will also be needed to test the impact on service quality and public health outcomes.

STRIVE PNG: using a partnership-based approach in implementation research to strengthen surveillance and health systems in Papua New Guinea

Successful implementation research requires effective and equitable relationships between policy-makers, researchers and implementers to effect evidence-based systems change. However, mainstream research grant models between Global North and Global South institutions often (unintentionally) reinforce power imbalances between partners, which result in missed opportunities for knowledge and learning exchange between policy-makers, researchers and implementers.

This case study, centred on the STRIVE PNG project, describes how a partnership-based approach has been used to establish, maintain and review effective and equitable relationships between 13 partner organizations (independent research institutes, government health agencies and public health laboratories) to strengthen surveillance and health systems in Papua New Guinea (PNG). We provide an overview of key terms (with supporting conceptual frameworks), describe selected partnership processes and tools used within the project, and share observations regarding early outcomes achieved through this approach.

Making Progress Monitoring Easier and More Motivating: Developing a Client Data Collection App Incorporating User-Centered Design and Behavioral Economics Insights

Data collection is an important component of evidence-based behavioral interventions for children with autism, but many one-to-one aides (i.e., behavioral support staff) do not systemically collect quantitative data that are necessary for best-practice client progress monitoring. Data collection of clients' behaviors often involves labor-intensive pen-and-paper practices. In addition, the solitary nature of one-to-one work limits opportunities for timely supervisor feedback, potentially reducing motivation to collect data. We incorporated principles from behavioral economics and user-centered design to develop a phone-based application, Footsteps, to address these challenges. We interviewed nine one-to-one aides working with children with autism and seven supervisors to ask for their app development ideas. We then developed the Footsteps app prototype and tested the prototype with 10 one-to-one aides and supervisors through three testing cycles. At each cycle, one-to-one aides rated app usability. Participants provided 76 discrete suggestions for improvement, including 29 new app features (e.g., behavior timer), 20 feature modifications (e.g., numeric type-in option for behavior frequency), four flow modifications (e.g., deleting a redundant form), and 23 out-of-scope suggestions. Of the participants that tested the app, 90% rated usability as good or excellent. Results support continuing to develop Footsteps and testing its impact in a clinical trial.

Aiming High: Monitoring Population Level Indicators of Child Wellbeing as a Goal of Community-Academic Partnerships

INTRODUCTION

Community-academic partnerships (CAPs) aim to improve neighborhood population health. Though measuring the impact of partnership activities at a population level can be difficult, evaluating indicators of wellbeing may increase understanding of how communities benefit from CAPs. This study examined child health indicators over time in two low-income, predominantly Black/African American and Hispanic communities where partnerships between an academic child development center and community coalitions were formed with the intention of improving child well-being.

METHODS

Trends in three child wellbeing indicators (graduation rates, kindergarten readiness, and proportion of youth in school and/or employed) were compared between two CAP communities and several neighboring comparison communities. Data between 2011 and 2017 were analyzed to calculate percent change from baseline and mapped using ArcGIS to visualize trends by zip code. Proportions of youth meeting benchmarks were also determined.

RESULTS

Kindergarten readiness and high-school graduation rates improved in CAP communities but not in geographically proximal and socioeconomically similar comparison communities. No improvements were found in the proportion of youth in school or employed.

DISCUSSION

This study revealed population-level indicators improved over time in CAP communities. Because community-level child health and wellbeing are influenced by many factors, this correlation is not proof of a causal relationship. Assessing population level indicators can nonetheless provide insight into the benefit of CAPs, and the commitment to monitoring such outcomes can itself advance how academic and community partners plan activities and set long-term goals.

A community-based partnership collaborative practice agreement project to disseminate and implement evidence-based practices in community pharmacy

BACKGROUND AND PURPOSE

The objective of this study is to explore the impact of an educational intervention including (1) collaborative practice agreement (CPA)-focused lecture and (2) a student project in partnership with a community-based pharmacy on dissemination and implementation of CPAs in community pharmacy practice.

EDUCATIONAL ACTIVITY AND SETTING

A CPA-focused classroom lecture and related project were given to five sequential years of second-year pharmacy students enrolled in a community pharmacy elective course. Community pharmacist feedback provided at the completion of the project was compared to present-day data collected via telephone survey. Responses for each survey question were summarized using frequencies, and chi-square analysis was conducted to assess the association between pharmacist perceptions at the time of the project vs. the present day.

FINDINGS

Forty-seven projects representing 47 unique CPAs were completed over five sequential years of the course. The most commonly targeted disease states by CPAs were influenza/streptococcus pharyngitis (25.5%), therapeutic interchange (6.4%), oral contraceptives (6.4%), and tobacco cessation (6.4%). Pharmacists noted that students facilitated their progress toward CPA implementation by serving as a means for CPA law education (23.4%) and by saving time in CPA development (12.8%).

SUMMARY

This study demonstrated that a student project partnering with a local community pharmacy improved knowledge dissemination but did not have any direct impact on implementation of CPAs in a community pharmacy. However, students may have a role in dissemination and implementation of evidence-based practices, such as CPAs, when appropriately matched to setting-specific implementation barriers.

Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps

PURPOSE OF REVIEW

This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population.

RECENT FINDINGS

Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.

Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health

Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.

Challenges and enablers of the embedded researcher model

PURPOSE

The embedded researcher is a healthcare-academic partnership model in which the researcher is engaged as a core member of the healthcare organisation. While this model has potential to support evidence translation, there is a paucity of evidence in relation to the specific challenges and strengths of the model. The aim of this study was to map the barriers and enablers of the model from the perspective of embedded researchers in Australian healthcare settings, and compare the responses of embedded researchers with a primary healthcare versus a primary academic affiliation.

DESIGN/METHODOLOGY/APPROACH

104 embedded researchers from Australian healthcare organisations completed an online survey. Both purposive and snowball sampling strategies were used to identify current and former embedded researchers. This paper reports on responses to the open-ended questions in relation to barriers and enablers of the role, the available support, and recommendations for change. Thematic analysis was used to describe and interpret the breadth and depth of responses and common themes.

FINDINGS

Key barriers to being an embedded researcher in a public hospital included a lack of research infrastructure and funding in the healthcare organisation, a culture that does not value research, a lack of leadership and support to undertake research, limited access to mentoring and career progression and issues associated with having a dual affiliation. Key enablers included supportive colleagues and executive leaders, personal commitment to research and research collaboration including formal health-academic partnerships.

RESEARCH LIMITATIONS/IMPLICATIONS

To support the embedded researcher model, broader system changes are required, including greater investment in research infrastructure and healthcare-academic partnerships with formal agreements. Significant changes are required, so that healthcare organisations appreciate the value of research and support both clinicians and researchers to engage in research that is important to their local population.

ORIGINALITY/VALUE

This is the first study to systematically investigate the enablers and challenges of the embedded researcher model.

Partners in School: An Implementation Strategy to Promote Alignment of Evidence-Based Practices Across Home and School for Children with Autism Spectrum Disorder

When parents and teachers align their practices across home and school, it may optimize services for children with autism spectrum disorder (ASD). Partners in School is a multi-faceted implementation strategy designed to improve ASD services in schools. The goal is to increase parents' and teachers' use of evidence-based practices (EBPs) and to align those EBPs across settings. We piloted Partners in School with 49 parent-teacher dyads to assess administration and the factors associated with reported fidelity to the model. Specifically, we measured the number of intervention steps both parents and teachers completed (reported alignment) and the characteristics associated with intervention alignment. Partners in School involves parent-teacher participation in a pre-consultation interview, an in-person consultation meeting, active implementation of the same EBPs in their respective settings, and a post-consultation interview. Parents and teachers also completed surveys pre- and post-consultation. On average, parents and teachers completed approximately five EBP steps on their own in their respective settings (i.e., at home or at school). Of these five steps, parents and teachers both completed three of the same EBPs steps, on average. Different factors were related to reported alignment for parents versus teachers; however, a similarity noted for both parents and teachers was that communication variables were associated with reported alignment. Our findings indicate the important role of communication in aligning stakeholders for ASD service delivery models.

Parent empowerment and coaching in early intervention: study protocol for a feasibility study

Background

Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children’s cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-mediated early interventions for ASD is clinician use of parent coaching and occurs when a clinician actively teaches the parent techniques to improve their child’s functioning. Available evidence suggests that community-based EI clinicians rarely coach parents when working with families of these children, although specific barriers to coaching are unknown. This consistent finding points to the need to develop strategies to improve the use of parent coaching in community EI programs. The purpose of this community-partnered study is to iteratively develop and pilot test a toolkit of implementation strategies designed to increase EI clinicians’ use of parent coaching.

Methods

This study has four related phases. Phase 1: examine how EI clinicians trained in Project ImPACT, an evidence-based parent-mediated intervention, coach parents of children with ASD. Phase 2: identify barriers and facilitators to clinician implementation of parent coaching by administering validated questionnaires to, and conducting semi-structured interviews with, clinicians, parents, and agency leaders. Phase 3: partner with a community advisory board to iteratively develop a toolkit of implementation strategies that addresses identified barriers and capitalizes on facilitators to improve clinician implementation of evidence-based parent coaching. Phase 4: pilot test the feasibility and effectiveness of the implementation strategy toolkit in improving EI clinicians’ use of parent coaching with nine EI clinicians and parent-child dyads using a multiple-baseline-across-participants single-case design.

Discussion

Completion of these activities will lead to an in-depth understanding of EI clinicians’ implementation of parent coaching in usual practice following training in an evidence-based parent-mediated intervention, barriers to their implementation of parent coaching, a toolkit of implementation strategies developed through an iterative community-partnered process, and preliminary evidence regarding the potential for this toolkit to improve EI clinicians’ implementation of parent coaching. These pilot data will offer important direction for a larger evaluation of strategies to improve the use of parent coaching for young children with ASD.

Stop Calling Them Laggards: Strategies for Encouraging Nonadopters to Incorporate Evidence-Based Practices

Diffusion theory has deeply influenced implementation science and, specifically, language and thinking around practitioners and organizations that do not adopt evidence-based practices. In this Open Forum, the authors address the use of the term "laggard" to characterize this late or nonadopting group and argue for new nomenclature and modernized attitudes and approaches toward this group.

Rationale and methods for a cross-sectional study of mental health and wellbeing following river flooding in rural Australia, using a community-academic partnership approach

BACKGROUND

Climate change is associated with greater frequency, duration, intensity and unpredictability of certain weather-related events, including floods. Floods harm mental health. There is limited understanding of the mental health and well-being effects from river flooding, particularly over the longer term and in rural contexts. This paper describes the rationale, aims, objectives, study design and socio-demographic characteristics of the sample for a study measuring associations between flood experience and mental health and wellbeing of residents (particularly those most likely to be negatively impacted and hard to reach) in rural NSW Australia 6 months following a devastating flood in 2017. To our knowledge, the study is the first of its kind within Australia in a rural community and is an important initiative given the likelihood of an increasing frequency of severe flooding in Australia given climate change.

METHODS

A conceptual framework (The Flood Impact Framework) drawing on social ecological approaches was developed by the research team. It was based on the literature and feedback from the community. The Framework describes putative relationships between flood exposure and mental health and wellbeing outcomes. Within a community-academic partnership approach, a cross-sectional survey was then undertaken to quantify and further explore these relationships.

RESULTS

The cross-sectional survey was conducted online (including on mobile phone) and on paper between September and November 2017 and recruited 2530 respondents. Of those, 2180 provided complete demographic data, among whom 69% were women, 91% were aged 25-74, 4% identified as Aboriginal and/or Torres Strait Islander, 9% were farmers and 33% were business owners.

CONCLUSIONS

The study recruited a wide range of respondents and the partnership facilitated the community's engagement with the design and implementation of the study. The study will provide a basis for a follow-up study, that will aim to improve the understanding of mental health and wellbeing effects over the longer term. It will provide an important and original contribution to understanding river flooding and mental health in rural Australia, a topic that will grow in importance in the context of human-induced climate change, and identify critical opportunities to strengthen services, emergency planning and resilience to future flooding.

Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study

The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.

Collaboration with Urban Community Stakeholders: Refining Paraprofessional-led Services to Promote Positive Parenting

This paper describes the process of a community-academic partnership to navigate implementation challenges for a school-based service model led by paraprofessionals to promote positive parenting in high poverty urban communities. We describe the process by which we (a) identified implementation challenges, (b) sustained a university-community collaboration to redesign the paraprofessional service model, and (c) assessed the feasibility of the new model involving four social service agencies in 16 schools with over 600 families. The structure and process of the collaboration and refinement are described with attention to who was best positioned to engage in the collaboration and how the partnership worked to balance scientific rigor with responsiveness to paraprofessional workforce strengths. Feasibility data indicated that the revised model was successfully implemented by paraprofessional staff; 92.2% of possible staff monthly reports were completed and discussion of key goals was incorporated into 94.2% of interactions. Continual monitoring provided critical feedback from stakeholders as we drew on and interpreted these various sources of information to build and refine the service model. We suggest that these processes are critical steps to bridge the research-to-practice gap, by promoting practices that are aligned with the needs of children and families, and the staff who serve them.

A Cluster-Randomized Clinical Trial Testing the Effectiveness of the Addressing Tobacco Through Organizational Change Model for Improving the Treatment of Tobacco Use in Community Mental Health Care: Preliminary Study Feasibility and Baseline Findings

INTRODUCTION

People with mental illness are more likely to smoke and less likely to receive tobacco treatment than the general population. The Addressing Tobacco Through Organizational Change (ATTOC) approach supports organizational change to increase tobacco treatment in this population. We describe preliminary study feasibility and baseline behaviors and attitudes among clients and staff regarding tobacco treatment, and assesse correlates of treatment of smoking.

METHODS

Preliminary accrual, engagement, and baseline data are reported from a cluster-randomized trial comparing ATTOC to usual care. Feasibility, thus far, was the rate of site and participant accrual and engagement (eg, participants remaining in the trial). Correlates of assessing smoking, advising cessation, and providing treatment were assessed.

RESULTS

Site and participant accrual is 80% (8/10) and 86% (456/533), and engagement is 100% and 82%. "Staff asking about smoking" was reported by 63% of clients and 38% of staff; "staff advising cessation" was reported by 57% of clients and 46% of staff; staff report "assisting clients with any medication" at most 22% of the time, whereas at most 18% of clients report receiving a cessation medication; 59% of clients want tobacco treatment, but 36% of staff think that it is part of their job. "Staff assisting with medications" is related to more training, believing treating smoking is part of their job, and believing patients are concerned about smoking (ps < .05).

CONCLUSIONS

This trial of training in tobacco treatment within mental health care is feasible thus far; self-reported rates of tobacco treatment are low and associated with clinician attitudes and barriers.

IMPLICATIONS

Evaluation of ways to help address tobacco use treatment in community mental health care is feasible and needed, including the use of technical assistance and training guided by an organizational change approach.

Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects

BACKGROUND

Efficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings.

OBJECTIVE

The goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span.

METHODS

Project 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches.

RESULTS

Enrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted.

CONCLUSIONS

This research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/12121.

Social Work's Role in Collaborative Community-Academic Partnerships: How Our Past Informs Our Future

In recent years, community-academic partnerships (CAPs) have gained traction in academia as a method for bridging the research-to-practice gap and reducing health disparities for marginalized populations. The field of social work may be well poised to enhance its ability to engage in partnerships and research around partnerships given its emphasis on conducting practice research and its historical roots in boundary spanning. In this article, the author begins by defining collaborative partnerships between academics and community stakeholders and then states specific advantages and challenges to collaborative partnerships in the field of social work. Throughout, the author explains how the historical foundations of the field (for example, acting as boundary spanners, advocating for marginalized individuals) place social workers in an ideal position to become leaders in the development, sustainment, and strengthening of CAPs. The author details the ways in which social work researchers can use the field's unique history to enhance the development and sustainment of CAPs. The article concludes by encouraging the field to use standardized terminology, methodology, and evaluation procedures when conducting CAPs and providing strategies for social work researchers who wish to increase their ability to develop and sustain CAPs within their own institutions.