In this View From the Field column from the implementation science series, highlighting how the field enhances the implementation and scale-up of EBPs in schools and districts (Kittelman et al., 2020), we discuss the importance of implementation teams and their roles in directing support for students and supporting educators to implement EBPs. We focus largely on the work from researchers and technical assistance providers from the National Technical Assistance Center on the State Implementation and Scale-Up of Evidence-Based Practices (https://sisep.fpg.unc.edu) and the National Center on Intensive Intervention (https://intensiveintervention.org).

his “View From the Field” column is the first in a series discussing aspects of implementation science important for scaling up and sustaining evidence-based practices in schools and districts. Recent research suggests there are important approaches to instruction, behavior support, and mental health that have been empirically documented but are not being implemented widely across local schools and school districts (Ginns et al., 2020; Mazzotti & Plotner, 2016; Powell et al., 2020).

This article is a demonstration of how an implementation-science (IS) framework can be coupled with the measurement of implementation outcomes to effectively integrate evidence-based family interventions in primary care. The primary care environment presents a number of challenges for successfully integrating such interventions. However, IS methods can improve the prospect of successfully implementing a new intervention while simultaneously and rigorously evaluating the impact on salient outcomes. We used our experiences across 2 pilot trials in which the family check-up (Smith, Montaño, Mauricio, Berkel, & Dishion, 2016), an evidence-based family intervention, was integrated into primary care. In these pilot trials, the exploration, preparation, implementation, and sustainment (EPIS) framework and the Proctor et al. taxonomy of implementation outcomes were used to guide the implementation and evaluate its success. Grounding our presentation in our pilot work offers an illustration of applying the EPIS framework and outcomes measurement to real-world problems and contexts. When embarking on new efforts to integrate behavioral interventions into health-care settings, the application of IS frameworks and measurement strategies can create generalizable knowledge that substantively contributes to a sparse literature. Today, those “in the trenches” who are translating evidence-based interventions to their setting can contribute to the corpus of research in integrated care by using IS methods to plan a new program and evaluate its feasibility, adoption, and reach.

Introduction: Health service organizations and their partners are increasingly under pressure to collaborate to deliver integrated patient care. The Collective Impact framework aligns well with respectful engagement and decision making between an organization and its partners, ensuring long-term change at the systems level. Shared vision, mutually reinforcing activities, and continuous communication are key components of a collective impact effort. Communication, in particular, plays an important role in all aspects of an organization, both internally and externally. Thoughtful feedback from partners and collaborative efforts can achieve collective impact and improved patient and population outcomes. Choose Well (CW), a statewide contraceptive access initiative in South Carolina, was developed using Collective Impact principles. CW launched in 2017 and continued through 2022. CW aimed to implement best practices for contraceptive access and provision. This study examined the perceptions of CW staff towards shared vision for contraceptive access, mutually reinforced activities, and communication strategies between CW and its partners. Methods: Data were collected in 2022 via exit key-informant interviews with CW staff to reflect across-all-years of their involvement with the initiative. A semi-structured interview guide was used, and the interviews were recorded, transcribed, and coded. A codebook was developed based on the interview guide. Data from questions related to 1) shared vision, 2) communication, and 3) mutually reinforcing activities between CW staff and partners were analyzed for this study. Coding was conducted with NVivo software version 1.7. Results: A total of eight CW staff participated in the interviews. Findings indicate that participants were very satisfied with the shared vision for contraceptive access between CW and its partners. The most prevalent facilitators for shared vision were constant and ongoing communication, collaboration with partners, and CW changes in framing for the initiative. Regarding communication, most participants perceived that the level of communication and coordination among various CW partners was consistent and streamlined. Integration of communication into daily processes, open communication with partners, and use of an online communication tool were mentioned as strategies that facilitated communication. Lack of administrative and partner buy-in among some partners, staff turnover, and pandemic-related challenges were commonly mentioned by participants as barriers to communication. Most participants perceived mutually reinforcing activities to be adaptability to partner needs, funding for the full range of contraceptive methods, collaboration efforts, and feedback from the partners. Conclusion: While lack of buy-in among some partners and the pandemic posed challenges, most participants perceived that constant and consistent communication facilitated a shared vision among the CW partners. Through adaptability, collaboration, and open communication with partners, CW adjusted its work to align with their partners’ goals. The findings of this study indicate that CW has coordinated their efforts around a common goal that aligns with their partners. CW maintained effective and consistent communication and integrated partner feedback as a Collective Impact approach towards improving contraceptive access and provision in SC. Shared vision and understanding of the health issue between the organization and partners can lead to a collective impact towards solving community health problems such as contraceptive access.

Problem: A major gap in adolescent mental health services exists in the United States. Nearly 80% of children and adolescents who are defined as needing mental health services are not receiving mental health care. School-based services have demonstrated promise as a strategy to address this gap. The purpose of this dissertation is to determine how a large urban school system implemented and sustained an innovative service of care model in response to financial, human resource, and community constraints and opportunities. Methods: A case study of the San Diego Unified School District’s (SDUSD) Mental Health Resource Center (MHRC) was completed using Pettigrew and Whipp's Content, Context, and Process Model of Strategic Change (PWM) as the theoretical framework that guided the research. Three primary sources of evidence were collected covering a fifteen-year period of implementation (1999–2014): 1) documents; 2) archival records; and, 3) interviews. The interviews were conducted with local and state stakeholders (n=20) and with students who received MHRC services and their parents (n= 15). A chronological reconstruction was completed and all data underwent a content analysis to organize and identify emergent themes based on the PWM framework. Results: Eight factors were identified as critical to the implementation and sustainability of the MHRC: establishing the legitimacy of school as environment for the delivery of mental health services; aligning education and mental health policies; implementing cross systems collaboration; utilizing data to improve performance and prioritize services; strengthening parent and student involvement; commitment to lead; institutionalization of mental health training; and, investment in staff. Further analysis assessed potential system improvements and opportunities for new collaborations and produced sustainability recommendations for SDUSD and MHRC administration, staff, and stakeholders. Conclusion: The MHRC provides a unique systems model that can inform best practices and policy decisions regarding the implementation and sustainability of school-based mental health services. Lessons learned from the sustainability of the MHRC support schools as a legitimate environment for the delivery of mental health services and the integration of mental health services in schools as a feasible strategy to improve student academic and mental health outcomes.

Trauma is a substantial threat to public health. As such, significant effort has been exerted into developing interventions which mitigate the consequences of trauma. Trauma-informed practice (TIP) aims to alleviate the effects of trauma by building policies and practices focused on safety, trust, transparency, support, collaboration, and empowerment. This study investigated how individual-level factors, including readiness for organizational change, perceived benefit of TIP training, and personal trauma history affect one’s ability to apply a TIP lens in a sample (n =100) of members of a graduate-level college. Further, it explored if one’s perceptions of and response to trauma-informed practice training predict changes in well-being, stress, and burnout. Results indicated that perceived benefit and readiness for organizational change are important predictors of post-training outcomes. Participants with a history of trauma performed more poorly on post-training trauma-informed knowledge questions. Results provided initial utility for use of objective measurement of trauma-informed application abilities.

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In many academic disciplines, there are promising discoveries and valuable information, which have the potential to improve lives but have not been transferred to or taken up in ‘real world’ practice. There are multiple, complex reasons for this divide between theory and practice—sometimes referred to as the ‘know-do’ gap—and there are a number of disciplines and research fields that have grown out of the perceived need to close these gaps. In the field of health, Knowledge Translation (KT) and its related research field, Implementation Science (IS) aim to shorten the time between discovery and implementation to save and improve lives. In the field of humanitarian development, the discipline of Communication for Development (ComDev) arose from a belief that communication methods could help close the perceived gap in development between high- and low-income societies. While Implementation Science and Communication for Development share some historical roots and key characteristics and IS is being increasingly applied in development contexts, there has been limited knowledge exchange between these fields. The aim of this paper is to provide an overview of the characteristics of IS and ComDev, analyze some key similarities and differences between them and discuss how knowledge from each could help inform the other to more effectively achieve their common goals.

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This study assessed the feasibility of a music therapy intervention protocol for adolescents in an Emergency Department Extended Care Unit (EDECU) of the Children’s Hospital of Philadelphia. This theory-based protocol was designed using the theories of resilience and hope. The study (N=14) was implemented in two phases (Phase 1 n=4; Phase 2 n=10). Data was collected using semi-structured interviews with participants, review of EMR notes, descriptive statistics and statistical analyses for stress, Heart Rate Variability. The intervention protocol demonstrated a high degree of feasibility and acceptability. Participants found it engaging, helpful, with minimal burden, and in alignment with their values. Additionally, the protocol was deemed ethical, and participants understood its value. Limited efficacy results revealed statistically significant reductions in stress and improvements in hope. While resilience did not achieve a statistically significant effect, elements such as competence, connection, character, contribution, coping, and control were highlighted in participants' experiences as plausible mediating pathways for its effect. The emphasis of the protocol was on dignity and autonomy as constructs aligned with person-centered approaches to healthcare. The protocol was found to be implementable, with high participant responsiveness and study completion rates. Preliminary evidence indicated that stress reduction and increased hope could be achieved in two sessions. The findings also emphasized choice control and witnessing as essential components for meaningful therapeutic engagement. Additional constructs to explain the feasibility of the protocol included the concept of self-worth promoted by nurturing the participant’s life drive and safely closing the cycle between emotional awareness and self-expression for adolescents experiencing psychiatric emergencies. / Music Therapy