Developing a community science research agenda for building community capacity for effective preventive interventions

Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers

Hundreds of millions of dollars are spent each year by U.S. federal agencies for training and technical assistance (TTA) to be delivered by training and technical assistance centers (TTACs) to "delivery system organizations" (e.g., federally qualified health centers, state departments of health, substance abuse treatment centers, schools, and healthcare organizations). TTACs are often requested to help delivery system organizations implement evidence-based interventions. Yet, counterintuitively, TTACs are rarely required to use evidence-based approaches when supporting delivery systems (in the use of evidence-based programs). In fact, evaluations of TTAC activities tend to be minimal; evaluation of technical assistance (if conducted at all) often emphasizes outputs (number of encounters), satisfaction, and self-reports of knowledge gained-more substantive outcomes are not evaluated. The gap between (a) the volume of TTA services being funded and provided and (b) the evaluation of those services is immense and has the potential to be costly. The basic question to be answered is: how effective are TTA services? This article introduces the special issue on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. The special issue promotes 1) knowledge of the state of the art of evaluation of TTACs and 2) advances in what to evaluate in TTA. A major goal of the issue is to improve the science and practice of implementation support, particularly in the areas of TTA.

Continuous Quality Improvement in the Substance Abuse and Mental Health Services Administration's Technology Transfer Center Network: A Process Evaluation

In healthcare and related fields, there is often a gap between research and practice. Scholars have developed frameworks to support dissemination and implementation of best practices, such as the Interactive Systems Framework for Dissemination and Implementation, which shows how scientific innovations are conveyed to practitioners through tools, training, and technical assistance (TA). Underpinning those aspects of the model are evaluation and continuous quality improvement (CQI). However, a recent meta-analysis suggests that the approaches to and outcomes from CQI in healthcare vary considerably, and that more evaluative work is needed. Therefore, this paper describes an assessment of CQI processes within the Substance Abuse and Mental Health Services Administration's (SAMHSA) Technology Transfer Center (TTC) Network, a large TA/TTC system in the United States comprised of 39 distinct centers. We conducted key informant interviews (n = 71 representing 28 centers in the Network) and three surveys (100% center response rates) focused on CQI, time/effort allocation, and Government Performance and Results Act (GPRA) measures. We used data from each of these study components to provide a robust picture of CQI within a TA/TTC system, identifying Network-specific concepts, concerns about conflation of the GPRA data with CQI, and principles that might be studied more generally.

Contextual effects of community capacity as a predictor for adolescent alcohol, tobacco, and illicit drug use: A multi-level analysis

Adolescent substance use is a major public health issue that can result in enduring physical, psychological, and social consequences. This study seeks to examine the relationship between community capacity for prevention and the 4-week prevalence rate of substance use, including tobacco, alcohol, other drugs, and binge-drinking, among students in Germany ranging from grades 5 to 11. This study employed a cross-sectional design and used baseline data from 28 communities participating in the CTC-EFF study. The sample consisted of 7210 students who were surveyed about their substance use behavior. Additionally, 158 local key informants were surveyed on ten capacity domains, which included commitment, knowledge and skills, resources, leadership, inclusiveness, prevention collaboration, sectoral-collaboration, cohesion, problem-solving skills, and needs orientation. Furthermore, a total capacity score was calculated as the mean of the ten capacity domains. To examine the associations between community capacity and substance use behavior, logistic multi-level models were utilized. The analysis shows a negative association between community capacity (total score) and any substance use (OR = 0.28, 95% CI 0.12-0.56). Specifically, higher levels of total community capacity are associated with lower odds of alcohol use (OR = 0.30, 95% CI 0.13-0.80), tobacco use (OR = 0.09, 95% CI 0.01-0.60), and binge-drinking (OR = 0.67, 95% CI (0.46-0.99). Further analyses of distinct community capacity domains indicate that higher levels of sectoral-collaboration (OR = 0.62, 95% CI 0.37-0.97), knowledge and skills (OR = 0.74, 95% CI 0.40-0.79), resources (OR = 0.52, 95% CI 0.36-0.76), and problem-solving skills (OR = 0.71, 95% CI 0.36-0.89) are associated with lower odds of any substance use. The study findings suggest that community capacity is associated with substance use behavior, emphasizing the importance of capacity building in interventions targeting the reduction of substance use among adolescents.

Incorporating multiple data sources to assess changes in organizational capacity in child welfare systems

Three federally funded Child Welfare Capacity Building Centers provide services to build the organizational capacity of public child welfare agencies to help meet federal requirements, improve practice, and improve outcomes for children and families. The aim of this study was to explore capacity outcomes in five dimensions - resources, infrastructure, knowledge and skills, culture and climate, and engagement and partnership - achieved by child welfare jurisdictions who received Center services. Analyses describe the capacities targeted for improvement and the amount and type of services provided by Centers; assess the relationship between services and capacity increase; and explore whether that relationship differs depending on the jurisdiction's level of foundational capacity. Data collected through surveys and a service delivery tracking system reflect the perspectives of service recipients and service providers. Results reveal jurisdictions typically targeted capacity outcomes in the dimensions of knowledge and skills and infrastructure and received an average of 28 hours of direct services to support their capacity-building efforts. Dosage of service was positively associated with achievement of capacity outcomes, though no interaction was found between service dosage and foundational capacity in the effect on outcomes. Methodological lessons learned and implications for future evaluations of organizational capacity building efforts are offered.

A scoping review of the evaluation and effectiveness of technical assistance

Background

Although the benefits of evidence-based practices (EBPs) for advancing community outcomes are well-recognized, challenges with the uptake of EBPs are considerable. Technical assistance (TA) is a core capacity building strategy that has been widely used to support EBP implementation and other community development and improvement efforts. Yet despite growing reliance on TA, no reviews have systematically examined the evaluation of TA across varying implementation contexts and capacity building aims. This study draws on two decades of peer-reviewed publications to summarize the evidence on the evaluation and effectiveness of TA.

Methods

Guided by Arksey and O’Malley’s six-stage methodological framework, we used a scoping review methodology to map research on TA evaluation. We included peer-reviewed articles published in English between 2000 and 2020. Our search involved five databases: Business Source Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycInfo, and PubMed.

Results

A total of 125 evaluation research studies met the study criteria. Findings indicate that publications have increased over the last two decades, signaling a growth in the recognition and reporting of TA. Technical assistance is being implemented across diverse settings, often serving socially vulnerable and under-resourced populations. Most evaluation research studies involved summative evaluations, with TA outcomes mostly reported at the organizational level. Only 5% of the studies examined sustainability of TA outcomes. This review also demonstrates that there is a lack of consistent standards regarding the definition of TA and the level of reporting across relevant TA evaluation categories (e.g., cadence of contact, and directionality).

Conclusions

Advances in the science and practice of TA hinge on understanding what aspects of TA are effective and when, how, and for whom these aspects of TA are effective. Addressing these core questions requires (i) a standard definition for TA; (ii) more robust and rigorous evaluation research designs that involve comparison groups and assessment of direct, indirect, and longitudinal outcomes; (iii) increased use of reliable and objective TA measures; and (iv) development of reporting standards. We view this scoping review as a foundation for improving the state of the science and practice of evaluating TA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-022-00314-1.

Exploring perceptions of implementation practice capacity in community-based behavioral health organizations

Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.

Moving from Implementation Science to Implementation Practice: The Need to Solve Practical Problems to Improve Behavioral Health Services

It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.

Measuring capacity to use evidence-based interventions in community-based organizations: A comprehensive, scoping review

Introduction:

Community-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review.

Methods:

With a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process

Results:

Of the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries.

Conclusions:

Implementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.

Migration in the context: Perspectives, methodologies, and cultural issues

The present article introduces the issue migration in the context: perspectives, methodology, and cultural issues. International migrations and their changing patterns pose new challenges to community social psychologists and new questions to be explored. Community psychologists' attention is necessary to develop a perspective about migration more suitable to effective interventions in global and local communities. Therefore, methods aimed at study migration issues should be implemented at micro-system, community, and national levels. Through this series of papers, we aim to contribute to the debate about how social and community psychologists can engage in community development strategies aimed at improving migrant well-being too. Indeed, they can give relevant contributions to the deepening of migration issues through research, methodologies, and interventions in different contexts and at different levels of analysis.

LiveWell in early childhood: results from a two-year pilot intervention to improve nutrition and physical activity policies, systems and environments among early childhood education programs in South Carolina

BACKGROUND

Early childhood education (ECE) settings are critical intervention targets for obesity prevention. This study evaluated a pilot two-year community-based participatory research (CBPR) project designed to assist ECE center directors and caregivers in policy, systems and environmental (PSE) change for improving healthy eating (HE) and physical activity (PA).

METHODS

A two-year CBPR study was conducted in 10 licensed ECE centers in Greenville, South Carolina. The intervention consisted of five steps: [1] baseline data collection and self-assessment using the Nutrition and Physical Activity Self-Assessment for Child Care (Go-NAP SACC), [2] tailored goal setting and action planning, [3] technical assistance and access to resources, [4] post intervention data collection and re-assessment, and [5] celebration of success. Main outcome measures (HE and PA environments, practices and policies) were assessed using the Environment and Policy Assessment and Observation (EPAO) tool at baseline and 24 months. One classroom of 3-5-year-olds was randomly selected for observation from each center (mean of 12 children per classroom). Means and standard deviations were calculated for total PA, total nutrition and each subscale of PA and nutrition. Paired sample t-tests were calculated to assess changes in EPAO scales from baseline to post intervention.

RESULTS

Ten ECE centers enrolled in the pilot study and eight completed the two-year intervention. Center-based goals were accomplished across all 8 ECE centers over the two-year intervention: 16 child nutrition goals, 6 outdoor play goals, 11 physical activity goals and 8 screen time goals across the entire sample. Nutrition policy and PA policy significantly improved (p < 0.05), with greater improvements in PA (10.0 point increase, p = .048) as compared to nutrition (3.3 point increase, p = 0.02).

CONCLUSIONS

Utilizing a CBPR approach, this two-year nutrition and PA PSE intervention in ECE centers improved ECE center HE and PA policies.

Disentangling social support mobilization via online neighborhood networks

This paper proposes and tests a theoretical model to investigate the mechanism underpinning local social support exchange via online neighborhood networks (ONNs). We drew on community psychology, social support, and social media literature and used a survey conducted in the Dutch-speaking part of Belgium among 561 ONN users (n_females  = 409; 72.9%) between 18 and 82 years old (M_age  = 43.73; SD_age  = 15.37). We found that engaging in online neighboring behaviors was associated to both online and offline neighborhood sense of community. Subsequently, these provide access to perceived local social support and the intention to mobilize local social support online. The latter was predominantly explained via the path along online sense of community. ONNs facilitate local bridging behavior, connecting otherwise distinct local networks and ties. At the same time, online neighboring behaviors provide the normative context that supports the exchange process.

Going the Distance: Technical Assistance to Community Prevention Coalitions and its impact on Prevention Coalitions Over Time

Prevention Coordinators are the linking agents providing technical assistance between universities and communities in the PROSPER model to support the implementation and sustainability of youth and family programs that have reduced substance abuse in prior research. This study examines the outcomes and trajectory of the frequency of contact of technical assistance (i.e. dosage) with community collaborative prevention coalitions across the three stages of coalition development. After communities were randomized, members of PROSPER coalitions (n=12) provided information about the quality of their operations at five time points across four and one-half years; prevention coordinators reported on the frequency of contact with their community coalitions at 14 intervals across the same period of time. This study only utilizes the intervention communities. Results from correlational models show that levels of dosage relate to the quality of internal coalition processes over time, but that the direction of the relationship changes over time: high frequency of contact early on relates to lower coalition-rated functioning initially. In contrast, early frequency of contact relates to higher levels of coalition functioning at later time points. Furthermore, longitudinal mixed models show that levels of dosage were consistent over time. These results provide empirical support of the importance of a proactive technical assistance model and add further evidence that important distinctions exist among different coalition developmental phases.

Storytelling and Arts to Facilitate Community Capacity Building for Urban Planning and Social Work

Creating social connections and fostering engagement in communities is a growing challenge for community work. Planners, social workers, and community activists are starting to look towards the arts and storytelling as a way to promote community capacity. A community in Lopez Island, Washington, facing sustainable housing and agricultural issues brought in a two-day storytelling and theatre program to build capacity for their ecosocial work. This research describes facilitator engagement methodology and pilots a community capacity survey to evaluate the experience of workshop participants. Preliminary results show that the storytelling program makes strides in deepening connections to others and generating authentic dialogue. Participants reported both positive experiences of building trust and negative feelings of vulnerability. As funding can be a major barrier for community groups to incorporate arts programs, this research introduces a preliminary survey that communities can adapt and improve upon to help them start gathering evidence-based data for assessing measures of community capacity. Though the facilitators brought unique theatrical and choreographic skills to the programming, planners and social workers can take away for practice a simple storytelling exercise that participants enthusiastically expressed fostered listening, trust, and connection.

Critical Reflexivity of Communities on Their Experience to Improve Population Health

Although community capacity has been prominent in the public health literature for nearly 20 years, the field has only operationalized a few dimensions. An intriguing dimension of capacity is a community's ability to critically reflect. On the basis of previous research as well as theoretical and practical insights from management and organizational learning literature, we offer a process framework for critical reflexivity practice in community. The framework draws on ideas regarding cognition and agency, praxis, as well as the transformative learning model to conceptualize how reflexivity happens as an emergent community process. The implication is that reflexivity is a community-level process of making meaning of experiences that drive a common narrative. Inclusivity and establishing consensus are paramount, and can be difficult in light of power dynamics and consideration of dissenting voices and different experiences; enlightened self-interest and creating conducive spaces for dialogue are key in this process. Strengthening communities' ability to gain and employ collective wisdom from their experience will also build their overall capacity for population health improvement.

Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science

Over a decade ago, the Society for Prevention Research endorsed the first standards of evidence for research in preventive interventions. The growing recognition of the need to use limited resources to make sound investments in prevention led the Board of Directors to charge a new task force to set standards for research in analysis of the economic impact of preventive interventions. This article reports the findings of this group's deliberations, proposes standards for economic analyses, and identifies opportunities for future prevention science. Through examples, policymakers' need and use of economic analysis are described. Standards are proposed for framing economic analysis, estimating costs of prevention programs, estimating benefits of prevention programs, implementing summary metrics, handling uncertainty in estimates, and reporting findings. Topics for research in economic analysis are identified. The SPR Board of Directors endorses the "Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science."

Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach

Evidence-based interventions (EBIs) to promote cancer control among Latinos have proliferated in recent years, though adoption and implementation of these interventions by faith-based organizations (FBOs) is limited. Capacity building may be one strategy to promote implementation. In this qualitative study, 18 community key informants were interviewed to (a) understand existing capacity for health programming among Catholic parishes, (b) characterize parishes' resource gaps and capacity-building needs implementing cancer control EBIs, and (c) elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs. Semi-structured qualitative interviews were conducted. Key informants concurred about the capacity of Catholic parishes to deliver health programs, and described attributes of parishes that make them strong partners in health promotion initiatives, including a mission to address physical and mental health, outreach to marginalized groups, altruism among members, and existing engagement in health programming. However, resource gaps and capacity building needs were also identified. Specific recommendations participants made about how existing resources might be leveraged to address challenges include to: establish parish wellness committees; provide "hands-on" learning opportunities for parishioners to gain program planning skills; offer continuous, tailored, on-site technical assistance; facilitate relationships between parishes and community resources; and provide financial support for parishes. Leveraging parishes' existing resources and addressing their implementation needs may improve adoption of cancer control EBIs.

Valuing Our Communities: Ethical Considerations for Economic Evaluation of Community-Based Prevention

Restricted public budgets and increasing efforts to link the impact of community interventions to public savings have increased the use of economic evaluation. While this type of evaluation can be important for program planning, it also raises important ethical issues about how we value the time of local stakeholders who support community interventions. In particular, researchers navigate issues of scientific accuracy, institutional inequality, and research utility in their pursuit of even basic cost estimates. We provide an example of how we confronted these issues when estimating the costs of a large-scale community-based intervention. Principles for valuing community members' time and conducting economic evaluations of community programs are discussed.

Technical Assistance to Enhance Prevention Capacity: a Research Synthesis of the Evidence Base

Despite the availability of many evidence-based prevention interventions (EBIs), gaps exist in bringing these programs into widespread practice. Technical assistance (TA) is a strategy for enhancing the readiness of practitioners to implement EBIs. Although many millions of dollars are spent on TA each year, there is little consensus about what the essential features of TA are and how to provide TA with quality. A broad-based research synthesis methodology was used for analyzing the current evidence base for TA using three frames: (1) applying the Getting To Outcomes (GTO) model for categorizing evidence on TA that specifies tasks for planning, implementing, and evaluating TA; (2) understanding the relevance of a successful relationship between the TA provider and TA recipient; and (3) considering the extent to which TA fits the life cycle needs of the preventive intervention. Results indicated that an explicit model or organizing framework is rarely used to plan, implement, and/or evaluate TA; specific TA tasks performed vary widely across studies; TA is rarely delivered to recipients who are seeking to sustain innovations subsequent to adoption and implementation; however, there is systematic attention to relationships and relationship-building. Overall, this synthesis indicates that the extent to which TA is being delivered systematically is limited. We suggest that funders and other stakeholders develop and implement standards for TA quality in order to ensure that many of these limitations are addressed.

Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes®

BACKGROUND

Research is needed to evaluate the impact of implementation support interventions over and above typical efforts by community settings to deploy evidence-based prevention programs.

METHODS

Enhancing Quality Interventions Promoting Healthy Sexuality is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 16 Boys and Girls Club sites implementing Making Proud Choices (MPC, control group), a structured teen pregnancy prevention evidence-based program with 16 similar sites implementing MPC augmented with GTO (intervention group). All sites received training and manuals typical for MPC. GTO has its own manuals, training, and onsite technical assistance (TA) to help practitioners complete key programming practices specified by GTO. During the first year, TA providers helped the intervention group adopt, plan, and deliver MPC. This group then received training on the evaluation and quality improvement steps of GTO, including feedback reports summarizing their data, which were used in a TA-facilitated quality improvement process that yielded revised plans for the second MPC implementation. This paper presents results regarding GTO's impact on performance of the sites (i.e., how well key programming practices were carried out), fidelity of MPC implementation, and the relationship between amount of TA support, performance, and fidelity. Performance was measured using ratings made from a standardized, structured interview conducted with participating staff at all 32 Boys and Girls Clubs sites after the first and second years of MPC implementation. Multiple elements of fidelity (adherence, classroom delivery, dosage) were assessed at all sites by observer ratings and attendance logs.

RESULTS

After 2 years, the intervention sites had higher ratings of performance, adherence, and classroom delivery (dosage remained similar). Higher performance predicted greater adherence in both years.

CONCLUSIONS

These findings suggest that in typical community-based settings, manuals and training common to structured EBPs may be sufficient to yield low levels of performance and moderate levels of fidelity but that systematic implementation support is needed to achieve high levels of performance and fidelity.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01818791.

Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: results from the CRUZA randomized trial

BACKGROUND

The CRUZA randomized trial tested the efficacy of an organizational-level intervention to increase the capacity of Catholic faith-based organizations (FBOs) serving Latinos to implement evidence-based strategies (EBS) for cancer control.

METHODS

Thirty-one Catholic parishes were enrolled. Twenty were randomized to a "capacity enhancement" (CE) intervention and 11 to a "standard dissemination" (SD) condition. Each received a Program Implementation Manual and Toolkit of materials culturally adapted for FBOs with Latino audiences for five types of EBS recommended by the US Preventive Services Community Guide. CE parishes were offered a menu of capacity-building activities over a 3-month period, while SD parishes were provided a one-time consultation by an Intervention Specialist. Baseline and follow-up surveys compared the number and types of EBS offered.

RESULTS

At baseline, only one parish had offered any cancer-related program in the prior year, yet a third (36 %) had offered some other type of health program or service. At post-intervention follow-up, all parishes offered a greater number of EBS. The only statistically significant difference between CE and SD groups was the number of parishes offering small media interventions (90 % in CE, 64 % in SD; p < 0.05).

CONCLUSIONS

All parishes increased the number of cancer control activities offered to their members. These findings suggest that Catholic parishes may already have capacity to implement EBS if they are appropriately adapted and packaged and may only require low levels of support to carry out programming. Further research is needed to examine the extent to which program offerings continued after the period of grant funding.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01740219 .

The power of a collaborative relationship between technical assistance providers and community prevention teams: A correlational and longitudinal study

BACKGROUND

Historically, effectiveness of community collaborative prevention efforts has been mixed. Consequently, research has been undertaken to better understand the factors that support their effectiveness; theory and some related empirical research suggests that the provision of technical assistance is one important supporting factor. The current study examines one aspect of technical assistance that may be important in supporting coalition effectiveness, the collaborative relationship between the technical assistance provider and site lead implementer.

METHODS

Four and one-half years of data were collected from technical assistance providers and prevention team members from the 14 community prevention teams involved in the PROSPER project.

RESULTS

Spearman correlation analyses with longitudinal data show that the levels of the collaborative relationship during one phase of collaborative team functioning associated with characteristics of internal team functioning in future phases.

CONCLUSIONS

Results suggest that community collaborative prevention work should consider the collaborative nature of the technical assistance provider - prevention community team relationship when designing and conducting technical assistance activities, and it may be important to continually assess these dynamics to support high quality implementation.

Designs for Evaluating the Community-Level Impact of Comprehensive Prevention Programs: Examples from the CDC Centers of Excellence in Youth Violence Prevention

This article discusses the opportunities and challenges of developing research designs to evaluate the impact of community-level prevention efforts. To illustrate examples of evaluation designs, we describe six projects funded by the Centers for Disease Control and Prevention to evaluate multifaceted approaches to reduce youth violence in high-risk communities. Each of these projects was designed to evaluate the community-level impact of multiple intervention strategies to address individual and contextual factors that place youth at risk for violent behavior. Communities differed across projects in their setting, size, and how their boundaries were defined. Each project is using multiple approaches to compare outcomes in one or more intervention communities to those in comparison communities. Five of the projects are using comparative interrupted time-series designs to compare outcomes in an intervention community to matched comparison communities. A sixth project is using a multiple baseline design in which the order and timing of intervention activities is randomized across three communities. All six projects are also using regression point displacement designs to compare outcomes within intervention communities to those within broader sets of similar communities. Projects are using a variety of approaches to assess outcomes including archival records, surveys, and direct observations. We discuss the strengths and weaknesses of the designs of these projects and illustrate the challenges of designing high-quality evaluations of comprehensive prevention approaches implemented at the community level.

A "Community Fit" Community-Based Participatory Research Program for Family Health, Happiness, and Harmony: Design and Implementation

BACKGROUND

A principal factor in maintaining positive family functioning and well-being, family communication time is decreasing in modern societies such as Hong Kong, where long working hours and indulgent use of information technology are typical.

OBJECTIVE

The objective of this paper is to describe an innovative study protocol, "Happy Family Kitchen," under the project, "FAMILY: A Jockey Club Initiative for a Harmonious Society," aimed at improving family health, happiness, and harmony (3Hs) through enhancement of family communication.

METHODS

This study employed the community-based participatory research (CBPR) approach, and adopted 5 principles of positive psychology and the traditional Chinese concepts of cooking and dining, as a means to connect family members to promote family health, happiness, and harmony (3Hs).

RESULTS

In-depth collaboration took place between an academic institution and a large nongovernmental community organization association (NGO association) with 400 social service agency members. Both groups were deeply involved in the project design, implementation, and evaluation of 23 community-based interventions. From 612 families with 1419 individuals' findings, significant increases in mean communication time per week (from 153.44 to 170.31 minutes, P=.002) at 6 weeks after the intervention and mean communication scores (from 67.18 to 69.56 out of 100, P<.001) at 12 weeks after the intervention were shown. Significant enhancements were also found for mean happiness scores 12 weeks after the intervention (from 7.80 to 7.82 out of 10, P<.001), and mean health scores (from 7.70 to 7.73 out of 10, P<.001) and mean harmony scores (from 7.70 to 8.07 out of 10, P<.001) 6 weeks after the intervention.

CONCLUSIONS

This was the first CBPR study in a Hong Kong Chinese community. The results should be useful in informing collaborative intervention programs and engaging public health researchers and community social service providers, major stakeholders, and community participants in the promotion of family well-being. Furthermore, this study has generated an effective practice model for the improvement of family communication and well-being. Challenges in maintaining research rigor during data collection and program implementation were observed, and should be considered during future program planning.

Prevention system mediation of communities that care effects on youth outcomes

This study examined whether the significant intervention effects of the Communities That Care (CTC) prevention system on youth problem behaviors observed in a panel of eighth-grade students (Hawkins et al. Archives of Pediatrics and Adolescent Medicine 163:789-798 2009) were mediated by community-level prevention system constructs posited in the CTC theory of change. Potential prevention system constructs included the community's degree of (a) adoption of a science-based approach to prevention, (b) collaboration on prevention activities, (c) support for prevention, and (d) norms against adolescent drug use as reported by key community leaders in 24 communities. Higher levels of community adoption of a science-based approach to prevention and support for prevention in 2004 predicted significantly lower levels of youth problem behaviors in 2007, and higher levels of community norms against adolescent drug use predicted lower levels of youth drug use in 2007. Effects of the CTC intervention on youth problem behaviors by the end of eighth grade were mediated fully by community adoption of a science-based approach to prevention. No other significant mediated effects were found. Results support CTC's theory of change that encourages communities to adopt a science-based approach to prevention as a primary mechanism for improving youth outcomes.

Mixed picture of readiness for adoption of evidence-based prevention programs in communities: exploratory surveys of state program delivery systems

An emerging literature highlights the potential for broader dissemination of evidence-based prevention programs in communities through existing state systems, such as the land grant university Extension outreach system and departments of public education and health (DOE-DPH). This exploratory study entailed surveying representatives of the national Extension system and DOE-DPH, to evaluate dissemination readiness factors, as part of a larger project on an evidence-based program delivery model called PROSPER. In addition to assessing systems' readiness factors, differences among US regions and comparative levels of readiness between state systems were evaluated. The Extension web-based survey sample N was 958 and the DOE-DPH telephone survey N was 338, with response rates of 23 and 79 %, respectively. Extension survey results suggested only a moderate level of overall readiness nationally, with relatively higher perceived need for collaborative efforts and relatively lower perceived resource availability. There were significant regional differences on all factors, generally favoring the Northeast. Results from DOE-DPH surveys showed significantly higher levels for all readiness factors, compared with Extension systems. Overall, the findings present a mixed picture. Although there were clear challenges related to measuring readiness in complex systems, addressing currently limited dissemination resources, and devising strategies for optimizing readiness, all systems showed some readiness-related strengths.

Using the exhibited generalization approach to evaluate a carbon monoxide alarm ordinance

Current interests in enhancing the focus of external validity or transferability call for developing practical evaluation approaches and illustrating their applications in this area for meeting the need. This study takes the challenge by introducing an innovative evaluation approach, named the exhibited generalization approach, and applying it in evaluating the carbon monoxide (CO) alarm ordinance passed by Mecklenburg County, North Carolina. The stakeholders specifically asked evaluators to determine the answers to the following two questions: (1) Does the alarm ordinance work? (2) What generalizable information can the Mecklenburg experience provide to other jurisdictions trying to decide if the alarm ordinance's planning, implementation, adoption, and outcomes are transferable to their communities? This study illustrates how to apply the exhibited generalization approach to provide the stakeholders with answers to these questions. Our results indicate that the alarm ordinance was effective in increasing CO alarm ownerships and reducing CO poisoning cases. The evaluation provides potential users and other interested parties with the necessary information on contextual factors and the causal mechanism underlying the CO alarm ordinance, so that these parties and users could decide whether the Mecklenburg alarm ordinance would be transferable to their own communities. Discussions include implications of this study for contributing in further advancing evaluation theory in addressing transferability or external validity issues.

Environmental Research Translation: enhancing interactions with communities at contaminated sites

The characterization and remediation of contaminated sites are complex endeavors fraught with numerous challenges. One particular challenge that is receiving increased attention is the development and encouragement of full participation by communities and community members affected by a given site in all facets of decision-making. Many disciplines have been grappling with the challenges associated with environmental and risk communication, public participation in environmental data generation, and decision-making and increasing community capacity. The concepts and methods developed by these disciplines are reviewed, with a focus on their relevance to the specific dynamics associated with environmental contamination sites. The contributions of these disciplines are then synthesized and integrated to help develop Environmental Research Translation (ERT), a proposed framework for environmental scientists to promote interaction and communication among involved parties at contaminated sites. This holistic approach is rooted in public participation approaches to science, which includes: a transdisciplinary team, effective collaboration, information transfer, public participation in environmental projects, and a cultural model of risk communication. Although there are challenges associated with the implementation of ERT, it is anticipated that application of this proposed translational science method could promote more robust community participation at contaminated sites.

Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial

Background

Much is to be learned about what implementation strategies are the most beneficial to communities attempting to adopt evidence-based practices. This paper presents outcomes from a randomized implementation trial of Multidimensional Treatment Foster Care (MTFC) in child public service systems in California and Ohio, including child welfare, juvenile justice, and mental health.

Methods

Fifty-one counties were assigned randomly to one of two different implementation strategies (Community Development Teams (CDT) or independent county implementation strategy (IND)) across four cohorts after being matched on county characteristics. We compared these two strategies on implementation process, quality, and milestone achievements using the Stages of Implementation Completion (SIC) (Implement Sci 6(1):1–8, 2011).

Results

A composite score for each county, combining the final implementation stage attained, the number of families served, and quality of implementation, was used as the primary outcome. No significant difference between CDT and IND was found for the composite measure. Additional analyses showed that there was no evidence that CDT increased the proportion of counties that started-up programs (i.e., placed at least one family in MTFC). For counties that did implement MTFC, those in the CDT condition served over twice as many youth during the study period as did IND. Of the counties that successfully achieved program start-up, those in the CDT condition completed the implementation process more thoroughly, as measured by the SIC. We found no significant differences by implementation condition on the time it took for first placement, achieving competency, or number of stages completed.

Conclusions

This trial did not lead to higher rates of implementation or faster implementation but did provide evidence for more robust implementation in the CDT condition compared to IND implementation once the first family received MTFC services. This trial was successful from a design perspective in that no counties dropped out, even though this study took place during an economic recession. We believe that this methodologic approach of measurement utilizing the SIC, which is comprised of the three dimensions of quality, quantity, and timing, is appropriate for a wide range of implementation and translational studies.

Trial registration

Trial ID: NCT00880126 (ClinicalTrials.gov).

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-014-0134-8) contains supplementary material, which is available to authorized users.

Developing and validating a measure of community capacity: Why volunteers make the best neighbours

Social support and community connectedness are key determinants of both mental and physical wellbeing. While social capital has been used to indicate the instrumental value of these social relationships, its broad and often competing definitions have hindered practical applications of the concept. Within the health promotion field, the related concept of community capacity, the ability of a group to identify and act on problems, has gained prominence (Labonte and Laverack, 2001). The goal of this study was to develop and validate a scale measuring community capacity including exploring its associations with socio-demographic and civic behaviour variables among the residents of four small (populations 1500-2000) high-deprivation towns in southern New Zealand. The full (41-item) scale was found to have strong internal consistency (Cronbach's alpha = 0.89) but a process of reducing the scale resulted in a shorter 26-item instrument with similar internal consistency (alpha 0.88). Subscales of the reduced instrument displayed at least marginally acceptable levels of internal consistency (0.62-0.77). Using linear regression models, differences in community capacity scores were found for selected criterion, namely time spent living in the location, local voting, and volunteering behaviour, although the first of these was no longer statistically significant in an adjusted model with potential confounders including age, sex, ethnicity, education, marital status, employment, household income, and religious beliefs. This provides support for the scale's concurrent validity. Differences were present between the four towns in unadjusted models and remained statistically significant in adjusted models (including variables mentioned above) suggesting, crucially, that even when such factors are accounted for, perceptions of one's community may still depend on place.

The implementation road: engaging community partnerships in evidence-based cancer control interventions

Southern rural and underserved counties have high proportions of individuals with increased mortality for cervical and breast cancers. To improve the integration of behavioral research into practice, the dissemination and implementation of efficacious interventions to encourage the use of screening have increased in recent years. This study addressed gaps in the dissemination and implementation of evidence-based interventions with a pilot called Team Up. Qualitative interviews with 24 key individuals in six state-level partnerships explored partnership characteristics that influenced selection and use of evidence-based interventions among low-income, rarely or never screened women. Guided by diffusion of innovations theory and the Lasker and Weiss partnership functioning model, interviews about the intervention centered on (a) knowledge surrounding evidence base; (b) identification, selection, and adoption; (c) planning and adaptation; (d) implementation; and (e) partnership reflections and impact. Using grounded theory and content analysis, data revealed that lack of communication and high partner turnover hindered adoption and adaptation, whereas failure of partnership leaders to engage local stakeholders and lack of sufficient funds hampered implementation. Delivery of evidence-based interventions was more effective when partnerships included local partners in early decision making and when coaches were introduced to facilitate strategic thinking about translating evidence-based interventions into practice. A challenge for public health partnerships was the translation of interventions into successful programs, such that underserved communities benefited from early detection intervention research.

The role of the public health analyst in the delivery of technical assistance to state health departments for healthcare-associated infection prevention

INTRODUCTION

Aligned with the goals of the DHHS Action Plan to Prevent Healthcare Associated Infections (HAIs), in 2009 the Centers for Disease Control and Prevention (CDC) awarded cooperative agreements to 51 state and territorial health departments for purposes of developing and implementing strategies to reduce HAIs. These cooperative agreements through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) were supported by the American Recovery and Reinvestment Act (ARRA).

OBJECTIVES

To systematically describe the perceptions of CDC public health analysts who delivered technical assistance (TA) to state health departments as part of the ELC cooperative agreement supported by ARRA to develop, implement, and/or expand HAI prevention programs.

RESEARCH DESIGN

Eight semistructured interviews using a standardized script were administered. Interviews were audio recorded; responses were transcribed, thematically coded, and analyzed using a qualitative immersion approach.

SUBJECTS

This study included CDC staff who provided TA to grantees of the ELC cooperative agreement supported by ARRA from September 2009 to December 2011.

RESULTS

Four convergent themes were identified, creating a framework of activities for the delivery of TA: acting as a liaison, facilitating training, providing administrative and program management support, and sharing/disseminating information to states. Having a liaison and providing informational resources to states were perceived as critical components of TA for HAI program sustainability.

CONCLUSIONS

Findings provide a framework of core TA activities required to build and sustain capacity in state HAI prevention programs through the cooperative agreement structure. This categorization of themes can be used to assist other agencies and entities in planning for and provision of TA when utilizing cooperative agreements.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

BACKGROUND

Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program.

METHODS

This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points.

RESULTS

We found no significant differences between AGTO and control group's prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement.

CONCLUSIONS

This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. CLINICALTRIALS.GOV IDENTIFIER: NCT00780338.

Component analysis of adherence in a family intervention

PURPOSE

Most studies of adherence use a single global measure to examine the relation of adherence to outcomes. These studies inform us about effects of overall implementation but not about importance of specific program elements. Previous research on the Strengthening Families Program 10-14 has shown that outcomes were unrelated to global adherence. The purpose of the present study was to determine whether adherence to specific components of SFP was related to outcomes, even though global adherence was not.

DESIGN/METHODOLOGY/APPROACH

The authors micro-coded data from an observational study of 11 instances of SFP (N = 47 facilitators, 151 participants) into specific process and content components. Using multilevel analysis, they examined the relation of each component to program outcomes, accounting for individual- and program-level variables.

FINDINGS

Most associations of adherence with outcome were negligible for European-Americans but significant for minority participants.

RESEARCH LIMITATIONS/IMPLICATIONS

Global assessments of implementation are insufficient for complex, multi-component prevention programs and may obscure relations of implementation to outcomes. Additionally, program components may function differently based on participant characteristics.

PRACTICAL IMPLICATIONS

Facilitators would benefit from understanding the function of individual program components, particularly when programs are delivered to diverse audiences. Program developers should provide detailed logic models of program theory to guide facilitators' decisions about adaptation.

ORIGINALITY/VALUE

This is one of only a few studies to examine the relation of adherence to specific intervention components to outcomes in a real-world setting. Results show the utility of component analysis and the importance of considering individual characteristics for implementation assessment.

Intervening with practitioners to improve the quality of prevention: one-year findings from a randomized trial of assets-getting to outcomes

There continues to be a gap in prevention outcomes achieved in research trials versus those achieved in "real-world" practice. This article reports interim findings from a randomized controlled trial evaluating Assets-Getting To Outcomes (AGTO), a two-year intervention designed to build prevention practitioners' capacity to implement positive youth development-oriented practices in 12 community coalitions in Maine. A survey of coalition members was used to assess change on individual practitioners' prevention capacity between baseline and one year later. Structured interviews with 32 program directors (16 in the intervention group and 16 in the control group) were used to assess changes in programs' prevention practices during the same time period. Change in prevention capacity over time did not differ significantly between the intervention and control groups. However, in secondary analyses of only those assigned to the AGTO intervention, users showed greater improvement in their self-efficacy to conduct Assets-based programming and increases in the frequency with which they engaged in AGTO behaviors, whereas among non-users, self-efficacy to conduct Assets-based programming declined. Interview ratings showed improvement in several key areas of performance among intervention programs. Improvement was associated with the number of technical assistance hours received. These results suggest that, after one year, AGTO is beginning to improve the capacity of community practitioners who make use of it.

Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies

Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist-practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP.

An organizational capacity-building program to enhance adolescent sexual and reproductive health

OBJECTIVES

To present a new practice for promoting sexual health among youth, and a pilot evaluation. The Afterschool Health and Sexuality Education Project is a capacity-building program that provides staff training, technical assistance, resource materials, and policy recommendations to create organizational change that facilitates staff members' abilities to promote sexual and reproductive health for adolescents.

METHOD

The evaluation included assessment of (a) sexual health educational materials, resources, and referral lists; (b) organizational policies that guide provision of sexual information and referrals; and (c) communication about sexual health. Data were collected prior to intervention, 7 months later, and 1 year later using anonymous surveys of staff and adolescents, and researcher observations.

RESULTS

Results indicate that organizational support for addressing youth sexual health increased as did communication between staff and youth, with decreased barriers. Most, but not all, improvements were maintained at the 1-year follow-up. Organizational policies that support youth sexual health and the availability of educational materials, resources such as condoms, and referral lists also increased and were maintained at follow-up.

CONCLUSIONS

Organizational systems change may create a broader, more sustainable environment for increasing communication between youth and adults and increasing resources to promote sexual health.

Establishing and evaluating the key functions of an interactive systems framework using an assets-getting to outcomes intervention

Community practitioners can face difficulty in achieving outcomes demonstrated by prevention science. Building a community practitioner's prevention capacity-the knowledge and skills needed to conduct critical prevention practices-could improve the quality of prevention and its outcomes. The purpose of this article is to: (1) describe how an intervention called Assets-Getting To Outcomes (AGTO) was used to establish the key functions of the ISF and present early lessons learned from that intervention's first 6 months and (2) examine whether there is an empirical relationship between practitioner capacity at the individual level and the performance of prevention at the program level-a relationship predicted by the ISF but untested. The article describes an operationalization of the ISF in the context of a five-year randomized controlled efficacy trial that combines two complementary models designed to build capacity: Getting To Outcomes (GTO) and Developmental Assets. The trial compares programs and individual practitioners from six community-based coalitions using AGTO with programs and practitioners from six similar coalitions that are not. In this article, we primarily focus on what the ISF calls innovation specific capacity and discuss how the combined AGTO innovation structures and uses feedback about its capacity-building activities, which can serve as a model for implementing the ISF. Focus group discussions used to gather lessons learned from the first 6 months of the AGTO intervention suggest that while the ISF may have been conceptualized as three distinct systems, in practice they are less distinct. Findings from the baseline wave of data collection of individual capacity and program performance suggest that practitioner capacity predicts, in part, performance of prevention programs. Empirically linking practitioner capacity and performance of prevention provides empirical support for both the ISF and AGTO.

Enhancing teen pregnancy prevention in local communities: capacity building using the interactive systems framework

Getting To Outcomes (GTO), an innovative framework for planning, implementing, evaluating, and sustaining interventions has been shown to be effective in helping community-based organizations (CBOs) introduce science-based approaches into their prevention work. However, the Interactive Systems Framework (ISF) suggests that adopting innovations like GTO requires a significant amount of capacity building through training and technical assistance (T/TA). In this study, 11 CBOs and three schools in South Carolina entered into a 3 year program of intense and proactive T/TA based on the ISF to learn how to apply an adaptation of GTO (Promoting Science-Based Approaches-Getting To Outcomes, PSBA-GTO) to their teen pregnancy prevention programs. Using semi-structured interviews, the partnering organizations were assessed at three points in time, pre-T/TA, 12 months, and post T/TA (30 months) for their performance of the steps of GTO in their work. The seven organizations which participated in T/TA until the end of the project received an average of 76 h of TA and 112 h of training per organization. Interview results showed increased performance of all 10 steps of PSBA-GTO by these organizations when conducting their teen pregnancy programs. These results suggest targeted and proactive T/TA can successfully bridge the gap between research and practice by using a three part delivery system, as prescribed in the ISF, which relies on an intermediary prevention support system to ensure accurate and effective translation of research to the everyday work of community-based practitioners.

Community-based prevention support: using the interactive systems framework to facilitate grassroots evidenced-based substance abuse prevention

The community plays an important role in the success of substance abuse prevention efforts. However, current funding structures and a focus on limited approaches to prevention delivery have created a large gap between what substance abuse prevention professionals practice and what the community at large knows about prevention. The concept of "community" has not always been well-defined in the field of prevention, and there are few mechanisms to engage grassroots community members in evidence-based substance abuse prevention. This article explains how Wandersman et al.'s (Am J Community Psychol 41:171-181, 2008) Interactive Systems Framework can be applied to grassroots prevention efforts. The authors describe a Community Prevention Support System that collaborates with the Professional Prevention Support System to promote the adoption of evidence-based substance abuse prevention practices at the grassroots, community level.

Using the interactive systems framework to support a quality improvement approach to dissemination of evidence-based strategies to promote early detection of breast cancer: planning a comprehensive dynamic trial

Dissemination efforts must optimize interventions for new settings and populations. As such, dissemination research should incorporate principles of quality improvement. Comprehensive Dynamic Trial (CDT) designs examine how information gained during dissemination may be used to modify interventions and improve performance. Although CDT may offer distinct advantages over static designs, organizing the many necessary roles and activities is a significant challenge. In this article, we discuss use of the Interactive Systems Framework for Dissemination and Implementation to systematically implement a CDT. Specifically, we describe "Bronx ACCESS", a program designed to disseminate evidence-based strategies to promote adherence to mammography guidelines. In Bronx ACCESS, the Intervention Delivery System will elicit information needed to adapt strategies to specific settings and circumstances. The Intervention Synthesis and Translation System will use this information to test changes to strategies through "embedded experiments". The Intervention Support System will build local capacities found to be necessary for intervention institutionalization. Simulation modeling will be used to integrate findings across systems. Results will inform on-going policy debate about interventions needed to promote population-level screening. More generally, this project is intended to advance understanding of research paradigms necessary to study dissemination.

Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

The interactive systems framework applied to the strategic prevention framework: the Rhode Island experience

The Interactive Systems Framework for Dissemination and Implementation (ISF) was introduced as a heuristic systems level model to help bridge the gap between research and practice (Wandersman et al., in Am J Commun Psychol 41:171-181, 2008). This model describes three interacting systems with distinct functions that (1) distill knowledge to develop innovations; (2) provide supportive training and technical assistance for dissemination to; (3) a prevention delivery system responsible for implementation in the field. The Strategic Prevention Framework (SPF) is a major prevention innovation launched by the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Administration (SAMHSA). The SPF offers a structured, sequential, data-driven approach that explicitly targets environmental conditions in the community and aims for change in substance use and problems at the population level. This paper describes how the ISF was applied to the challenges of implementing the SPF in 14 Rhode Island communities, with a focus on the development of a new Training and Technical Assistance Resources Center to support SPF efforts. More specifically, we (1) describe each of the three ISF interacting systems as they evolved in Rhode Island; (2) articulate the lines of communication between the three systems; and (3) examine selected evaluation data to understand relationships between training and technical assistance and SPF implementation and outcomes.

Ready, willing, and able: developing a support system to promote implementation of school-based prevention programs

While the number and scope of evidence-based health, education, and mental health services continues to grow, the movement of these practices into schools and other practice settings remains a complex and haphazard process. The purpose of this paper is to describe and present initial support for a prevention support system designed to promote high-quality implementation of whole school prevention initiatives in elementary and middle schools. The function and strategies of a school-based prevention support system are discussed, including key structures and activities undertaken to identify, select, and provide technical assistance to school personnel. Data collected over a 5 year period are presented, including evidence of successful implementation support for 5 different evidence-based programs implemented with fidelity at 12 schools and preliminary evidence of goal attainment. Findings suggest the ongoing collection of information related to organizational readiness assists in the adoption and implementation of effective practices and initiatives and provide valuable insight into the development of results-oriented approaches to prevention service delivery. Problems, progress, and lessons learned through this process are discussed to frame future research and action steps for this school-based prevention support system.

Dimensions of community and organizational readiness for change

BACKGROUND

Readiness can influence whether health interventions are implemented in, and ultimately integrated into, communities. Although there is significant research interest in readiness and capacity for change, the measurement of these constructs is still in its infancy.

OBJECTIVE

The purpose of this review was to integrate existing assessment models of community and organizational readiness.

DATA SOURCES

The database PubMed was searched for articles; articles, book chapters, and practitioner guides identified as references cited in the list of core articles.

REVIEW METHODS

Studies were included if they met the following criteria: (1) Empirical research, (2) identified community or organizational readiness for innovative health programming in the study's title, purpose, research questions, or hypotheses, and (3) identified methods to measure these constructs. Duplicate articles were deleted and measures published before 1995 were excluded. The search yielded 150 studies; 13 met all criteria.

RESULTS

This article presents the results of a critical review of 13 community and organizational readiness assessment models, stemming from articles, chapters, and practitioner's guides focusing on assessing, developing, and sustaining community and organizational readiness for innovative public health programs.

CONCLUSIONS

Readiness is multidimensional and different models place emphasis on different components of readiness, such as (1) community and organizational climate that facilitates change, (2) attitudes and current efforts toward prevention, (3) commitment to change, and (4) capacity to implement change. When initiating the program planning process, it is essential to assess these four domains of readiness to determine how they apply to the nuances across different communities. Thus, community-based participatory research (CBPR) partnerships, in efforts to focus on public health problems, may consider using readiness assessments as a tool for tailoring intervention efforts to the needs of the community.