Introduction to Community Psychology Part VI Chapter 18 Dissemination and Implementation

18 . DISSEMINATION AND IMPLEMENTATION Lindsey , Melissa , and Angela Chapter Eighteen By the end of this chapter , you will be able to Know the reasons why validated and effective interventions are often never used Identify effective ways to put research to use in order to improve health Understand advantages of participatory methods that provide more equitable engagement in the creation and use of knowledge RESEARCH FINDING ! Adapted from Photo by ( licensed under the 348

Introduction to Community Psychology 349 What if our research on bringing about change was not used by society to deliver better services to others ?

In other words , if all the programs and interventions that have been reviewed in this book were never used by others , this would be tragic . Well , two major publications from about 20 years ago highlighted this problem of getting the public to use programs that have been validated by research . The report from the Institute of Medicine ( showed that US healthcare was of low quality ( 2001 ) So you might ask , why haven programs that have been shown to work and are effective been widely implemented throughout our healthcare system ?

We need to answers to this question as we all have a stake in getting the most effective and safe healthcare interventions . When this report was released , everyone was shocked to learn how the US healthcare system fell short of national goals for quality programs being used by the public . These healthcare quality concerns were followed There are long delays between by a second report that showed it took an average discovery and use of of 17 years of science before an effective health research in practice program reached patients ( Balas , 2000 ) Even more depressing , at the end of the 17 years , adoption of these practices only occurred among 15 of providers . Imagine , the healthcare you should be getting at age 20 may not reach you until you are 37 years old ! And of course , that only if you are the lucky one out of six patients ( the 15 ) whose healthcare is guided by research . Based on these , researchers began to focus on the gap between research evidence and healthcare practices . Ten years after the original report appeared , Health Affairs , an journal , published new research on the Quality And now , after 20 years , researchers are still that their discoveries are not used ( Proctor , 81 , 2018 ) These high impact led to the development of a new called implementation science . Read more about implementation science . Implementation science began because health practices , programs , and policies were not achieving their expected based on their research evidence . When research shows that a treatment works , or a program addresses a problem , we want to realize those in the broader world . In other words , we need to ways to get effective practices used ( or implemented ) outside of research studies . Dissemination is the process by which this valuable information is made available for our use . But before we come up with solutions to this dissemination problem , let review the different types of evidence , by which programs are evaluated .

350 Leonard Jason , lack , and ( Editors ) WHAT IS KNOWLEDGE AND EVIDENCE ?

233 Truth ! by is licensed under Scientists often differentiate types of evidence . trials ( Type I evidence ) are often a step in program development . These trials establish the cause and effect of a program on its intended outcomes . trials determine whether a program changes a health outcome under controlled conditions . Individuals connected to a university often implement these studies . The next step in developing research evidence is typically known as effectiveness trials . This Type II evidence evaluates cause and effect in community settings , and in these studies the people , such as a teacher in a school , implementing the studies are often right from the community setting . So , what has been learned by researchers from the university is now implemented from people in the to see if positive effects are once again found . practices are through a series of and effectiveness studies published in literature . The third type of evidence ( Type III evidence ) evaluates the implementation context , such as an organization readiness to implement a new practice . One community might be ready and interested to implement a program on birth control , for example , whereas another community might not want to even try to do something in this area due to a number of issues , including the controversies that surround this topic or even lack of leadership to take on such a topic . The readiness of the community is a factor that community psychologists point to as key in whether or not an intervention is successfully implemented ( et , 2015 ) An important skill is being able to work with communities differently so that we take into consideration their readiness to implement an intervention .

Introduction to Community Psychology 351 Community psychologists often link imbalances in resource allocation to social problems . But even in the creation and distribution of the research knowledge , there might be inequitable practices . For example , some say that we should only rely on knowledge created during randomized clinical trials , as this is the best way to know whether an intervention is effective . Many members of the community , however , do not have access to the resources or skills to implement these types of expensive interventions . And more to the point , there might be many other ways to understand whether an intervention is effective . There is an important role that community members might play in the creation of knowledge . The creation of collaborative teams involving researchers and community members might be one way that allows information to be actually perceived as valuable , and then widely disseminated . We will come back to this important issue , but let see how the of Community Psychology has come up with some strategies to overcome these dissemination problems mentioned at the start of this chapter . SOLUTIONS TO A COMPLEX PROBLEM You Know ?

I Photo by is licensed under the License Many people still believe that research knowledge moves from the research setting ( University ) to the community . But this is not always the case . Community psychologists and Florin ( 2003 ) have examined the gap between research and practice , and they a number of the issues that need to be addressed if we are going to effectively deal with the ongoing challenge of putting research to use . It is unfortunate , but just showing that an intervention can improve health does not mean others in society will use those exciting ideas . In other words , just because there is

352 Leonard , lack , and ( Editors ) evidence that a particular intervention can solve a health problem , there is no guarantee that it will be adopted by community members and groups . For example , many people might never even get a chance to learn about such an innovation , or the intervention could be poorly implemented so its effectiveness is compromised . Clearly , getting effective programs to be used by others is a complex process , and there are often multiple barriers that need to be addressed . Case Study shows a real example of community psychologists addressing these types of implementation issues . The Veterans Health Administration is the largest , integrated US healthcare system . For over 15 years , the Veterans Administration trained thousands of providers to deliver addiction and mental healthcare . The Veterans Administration mandates care and offers incentives for meeting quality measures . Yet , like most US healthcare services , only of the Veterans Administration patient population receives the highest quality care . Understanding this limited reach of practices is critical to the Veterans Administration , providers , Veterans , and their families . To address this problem , Lindsey and her research team of community psychologists used a partnership approach to equitably involve the Veterans Administration stakeholders in implementation research . The program , Modeling to Learn , was designed according to Community Psychology values , methods , principles , and theories . They sought to develop a systems understanding of the Veterans Administration addiction and mental health services . This occurred by empowering frontline providers to improve the limited reach of care with their existing staff and local resources ( et , 2016 ) They prioritized participatory learning , so frontline staff could better meet the needs of their local veteran communities and sustain improvements over time . They also developed and implemented effective methods to address complex problems with care coordination , medication management , psychotherapy , and the overall mix that services teams offer to reduce impairment , relapse , overdose , and suicide . Preliminary research indicate that this innovative program called Modeling to Learn increased the number of patients who received care in the Veterans Administration . One important way to increase the chances that research like in the case study above will be used , is to be involved in Community Psychology participatory methods , as we will illustrate in the next section . These approaches emphasize more equitable engagement by citizens and scientists in the creation and use of knowledge . When this occurs , it is more likely that effective interventions and improvements will be available .

Introduction to Community Psychology 353 COMMUNITY PSYCHOLOGY PARTICIPATORY APPROACHES A Photo by is licensed under the License Community Psychology began when psychologists saw a better way to address some of the most pressing needs and challenges within their communities ( see Chapter , 2019 ) As indicated throughout this book , participatory research methods are a core strategy used by community psychologists ( et , 2004 ) and they can be effectively used to address implementation problems .

354 Leonard , lack , and ( Editors ) nu ' services I launch Figure . Prevention Research Cycle . More and more researchers have learned from the of Community Psychology to bring in community representation in early stages of research . Figure of the National Institute for Drug Abuse Prevention Research Cycle above depicts the need for community input to inform all steps of research development ( Robertson , et , 2012 ) The research cycle allows for opportunities to include community input and address contextual factors ( dashed lines ) earlier in research as opposed to the tendency to use input later ( solid lines ) Researchers should pursue knowledge of how community factors will impact program implementation and success . The approach to implementation is . With a approach , community psychologists can ensure that their efforts in health , education , practice , policy , research are actually used , as is indicated in Case Study .

Introduction to Community Psychology 355 The Test and Treat Rapid Access Model is designed to start someone who is diagnosed with HIV on medications immediately . Angela and her team from Behavioral Science Research Institute partnered with the Infectious Disease Elimination Act Needle Exchange in County , Florida , to implement this model for their clients in collaboration with community partners ( HIV treatment providers ) The needle exchange clientele were active injection drug users who received support to reduce the harm associated with drug use . Although Test and Treat was effectively practiced in Miami with multiple community based organizations , the Infectious Disease Elimination Act Needle Exchange staff had concerns about their ability to use Test and Treat to link their clientele to HIV care . Although the Test and Treat model was a best practice , effective use required addressing barriers to implementation so that it could the needle exchange clientele . So , what did the Infectious Disease Elimination Act Needle Exchange staff do to put Test and Treat into practice ?

They used centered values and participatory methods to develop their implementation plan . A consumer , Doe , helped with planning from the meeting and key barriers that could have gone unnoticed and impacted the program success . lane pointed out that given the timeframe , individuals who are active injection drug users would experience a come down during the Test and Treat process . Even with a care navigator , this would make them more likely to leave rather than complete enrollment . This would minimize the program effectiveness linking vulnerable individuals to treatment . Read more about the Infectious Disease Elimination Act Needle Exchange program . By engaging consumer voices and valuing the expertise of their community , the needle exchange staff prevented a failed implementation and they continue the process with ongoing feedback . As a result , the Infectious Disease Elimination Act Needle Exchange staff have found ways to make services more accessible . This includes Medication Assisted Treatment for individuals willing to begin treatment for opioid use , and the provision of services so consumers can enroll directly in Test and Treat from the Infectious Disease Elimination Act Needle Exchange hub . lane Doe voice and expertise were highly valued , and this again shows how community psychologists can partner with community members from the very beginning of their work to have programs more effectively implemented . Program Adaptation Successful implementation means that programs often need to be adapted to meet the special needs of the local community , whether they are care managers , foster parents , nurses , teachers , therapists , or physicians . One key question is how much a program needs to be adapted to with the local context ( adaptation ) versus how much it needs to be implemented as intended by developers ( Fidelity often declines when a program or practice developed under tightly controlled research conditions is then translated to a new community setting . There is some evidence that the closer the

356 Leonard , lack , and ( Editors ) community members can implement the programs in ways similar to those of the researchers , the more positive are the health . However , and adaptation need not be at odds . For example , Anyon and colleagues ( 2019 ) argue that when adaptations follow some key guiding principles , successful and adaptation can be achieved ( et , 2013 ) If there is a core effective method in an innovation , and it is culturally tailored to a particular community , there is no reason it might , not be as effective or even more effective than the a , original intervention . The key issue is whether the i intervention continues to have those basic components that are effective and whether it is implemented in a way to which the community members are receptive . Participatory bridge the research and practice gap through a mutual of knowledge among researchers and communities . This bidirectional knowledge sharing goes on throughout the implementation and evaluation phases of the project . CAPACITY BUILDING LEARNING LEARNING I LEARNING LEARNING Photo by is licensed under the License However , there is another problem that often arises even when a new program is adopted and used in a setting , it is not sustained . This sometimes occurs because the community has not been provided the means and training to take over the intervention . Here we can rely on another Community Psychology principle which involves building capacities for local communities to sustain their efforts over time . In Chapter , Wolfe ( 2019 ) reviewed practice that are used by community psychologists . Community capacity building is one of the key practice to sustain the of research and practice efforts . Capacity building describes activities that build tangible

Introduction to Community Psychology 357 resources , such as a prevention program , and enable the community to sustain it . Capacity building helps to maintain staff , facilities , and other resources to deliver effective programs over time , especially when research funding ends ( et , 2018 ) Capacity building activities include developing a communications strategy , establishing a plan , improving data collection and measurement systems , training , and strategic planning . Community psychologists are trained for community leadership and mentoring , facilitating small and large group processes , consultation , and resource and organizational development ( Dalton Wolfe , 2012 ) All of these support community and organizational capacity building . By using processes to build community capacities , community psychologists help community members gain access to important resources . Learn more about an example of processes by visiting the Power Through Partnerships Community Based Participatory Research toolkit for domestic violence researchers . These types of empowering processes lay the groundwork for achieving desired outcomes and sustainability , as is indicated in Case Study . Children Trust of South Carolina ( Children Trust ) is a statewide organization focused on the prevention of abuse and neglect . The vision of Children Trust is a South Carolina free from child abuse and neglect . The mission of Children Trust is to build strong families and empower communities to prevent child abuse by supporting and delivering programs , building , providing resources , and leading prevention training . Children Trust is considered an intermediary organization , which means that it does not provide direct services , but partners with community based organizations across the state , who do provide community services . As an intermediary , Children Trust performs core functions partnership engagement and communications , implementation support , research and evaluation , workforce development , and policy and . These functions form the foundation of the Children Trust Partnership Assessment , a tool by which Children Trust measures their success at building capacities of partner organizations to provide services within the community . The Partnership Assessment examines whether capacities have been built and if not , what supports are needed to achieve those capacities . In this way , Children Trust demonstrates its impact as a partner with organizations to build their capacities for successful and sustained service implementation . Learn more about Children Trust . Puma by IS licensed under the License

358 Leonard , lack , and ( Editors ) ECOLOGICAL PERSPECTIVES Photo by is licensed under Lhe License In Chapter , the ecological model was described , and it involved multiple layers involving individuals , groups , organizations , communities , and the larger society . As is evident from the many case studies in this textbook , individuals can communities and communities can societies . In return , societies can communities and communities can individuals . This ecological model provides a useful framework to better understand the complex relationships among factors that contribute to social and community problems . Program developers and need to be aware of this ecological model , as it provides a strong rationale to target our work toward multiple levels of . By considering ecological issues , we are better able to avoid and reduce biases ( attribution effect , racial prejudice ) that can contribute to and perpetuate injustice . This can be particularly important for program who support practitioners working in and settings . Case Study applies the ecological model to the risk and protective factors involving child abuse and neglect . Children Trust , led by Melissa , a Community Psychologist , and an team of researchers , practitioners , and community members developed The Empower Action as a blueprint for communities to prevent child abuse and neglect and build and resilience .

Introduction to Community Psychology 359 Public Policy Organization Interpersonal ( Individual ( cram ) Early Childhood Adulthood Figure Empower Action courtesy of Melissa The Empower Action Model uses an expanded version of the ecological model to ensure that levels of are and protective factors are promoted among children , families , organizations , communities , and public policies ( Daniels , For example , parents and caregivers can protect their children by focusing on child resilience . Organizations can emphasize policies and practices that promote employee health and . Communities can build protective environments for children , including parks , schools , settings , social services , and health facilities . can also prioritize programs and initiatives that support child health and ( Daniels , Adapting the ecological model to the mission of Children Trust is helping communities all over South Carolina address the very challenging problem of abuse and neglect . Figure below is useful in addressing some of the implementation problems discussed in this chapter .

360 Leonard Jason , lack , and ( Editors ) Implementation Science Problems and Community Psychology Solutions Practice . Follow . Use Prioritize . Solution participatory capacity ?

research . methods theories . Figure . Implementation Science and Community Psychology Solutions by . and Moos GIVING IT AWAY ii . i . Photo by is licensed under the License We conclude this chapter with another barrier that confronts so many people critical knowledge about the effectiveness of programs remains in privileged settings , such as among academic and audiences , behind and professional dues . lust as researchers who use participatory methods value knowledge , participatory methods increase the utility and ownership of research in communities . Participatory methods aim to support community partners who need to have ongoing access to information and resources . Community psychologists work to share information to reduce the access imbalance between scientists and communities . As one example , this textbook is an book designed to provide

Introduction to Community Psychology 361 an accessible , free introduction to Community Psychology . Undergraduates can now freely join the Society for Community Research and Action as an Associate member , something that the editors of this textbook successfully advocated for with the leadership of this organization . The Community Psychologist and Global Journal of Community Psychology Practice are also online and open access . Throughout this book , consistent with values and principles , you can learn about free and open blogs , podcasts , and based on collaborations between community psychologists and communities , putting new research knowledge to greater use . UP Photo by is licensed under the License In this chapter , we have shown that the research conducted by psychologists does not often have an impact on the social and community problems that need our attention . One reason this information is not widely spread is that many programs , practices , and policies continue to be developed with minimal input from community members . More and more , we are recognizing the problems with this unidirectional transfer of knowledge . But the of Community Psychology does offer a solution to this problem , and by following its values , there is a higher likelihood that the research will be used by community members and those in a position of policy . This chapter has shown the advantages of using participatory research methods , which emphasize more equitable engagement in the creation and use of knowledge . When using such methods , there is a higher chance that the research will actually translate into programs and be used by members of the community even when the researchers have their work . A key to this approach is building capacities for local communities to sustain and grow their efforts . Often problems that we face are complicated , and the of Community Psychology offers an ecological approach to target contributors to problems so that useful and effective approaches are widely implemented .

362 Leonard , lack , and ( Editors ) Critical Thought Questions . Where have you seen a new policy or practice implemented that was not effective ?

What Community Psychology approaches would have helped in this situation ?

What are the advantages of partnering with those closest to community problems to improve implementation ?

In the case studies , what types of organizations are the community psychologists working in or partnering with to address implementation problems ?

After reading this chapter , which implementation problems do you believe are hardest to address ?

Take the Chapter 18 View the Chapter 18 Lecture Slides REFERENCES Anyon , Roscoe , Bender , Kennedy , Begun , 2019 ) Reconciling adaptation and Implications for scaling up high quality youth programs . The Journal of Primary Prevention , 40 , Balas , A . 2000 ) Managing clinical knowledge for health care improvement . Yearbook , Proctor , 2018 ) Dissemination and implementation research in health Translating science to practice ( edition . New York , NY Oxford University Press . Dalton , Wolfe , 2012 ) column Education connection and the community practitioner . The Community Psychologist , 45 , Institute of Medicine ( 2001 ) Crossing the quality chasm A new health system for the century . Washington , National Academy Press . Retrieved from Reports 2001 , 2019 ) Introduction to the of Community Psychology . In , Introduction to Community Psychology Becoming an agent of change . Retrieved from chapter , Keys , Taylor , Davis , 2004 ) Participatory community research Theories and methods in action . Washington , American Psychological Association . Robertson , Sims , 2012 ) Partnerships in drug abuse prevention services research Perspectives from the National Institute on Drug Abuse . Administration and Policy in Mental Health and Mental Health Services Research , 39 ,

Introduction to Community Psychology 363 , Cook , 2015 ) A practical implementation science heuristic for organizational readiness . Journal of Community Psychology , 43 ( Leaf , Brown , Hawkins , 2013 ) Addressing core challenges for the next generation of type translation research and systems The translation science to population impact ( Impact ) framework . Prevention Science , 14 , 81 Daniels , The Empower Action Mobilizing prevention to promote and resilience . Retrieved from , Daniels , 201 ) The Empower Action A framework for promoting equity , health , and . Health Promotion Practice . Florin , 2003 ) Community interventions and effective prevention . American Psychologist , 58 , Wolfe , 2019 ) Practice . In , 81 ( Introduction to Community Psychology Becoming an agent of change . Retrieved from chapter , Rosen , I . 2016 ) Participatory system dynamics modeling Increasing stakeholder engagement and precision to improve implementation planning in systems . Administration and Policy in Mental Health and Mental Health Services Research , by is licensed under the License