Technical assistance (TA) is a tailored approach to capacity building that has grown in use across diverse settings over the past two decades, particularly in the domains of health improvement, child welfare, youth development, and education. In practice, TA services often include a combination of activities (e.g.
View Article and Find Full Text PDFThere are many ways proposed to achieve better societal outcomes (e.g., in health, education, and well-being) including: (1) bridging research and practice, (2) building the motivation and capacity of service delivery organizations (e.
View Article and Find Full Text PDFEval Health Prof
December 2024
In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the clinical intervention and the implementation science process enhances program success.
View Article and Find Full Text PDFThis article describes (a) key elements of a high-quality technical assistance (TA) system; (b) the operationalization of a high-quality TA system (Getting To Outcomes-Technical Assistance; GTO-TA) being implemented in a training and TA center (TTAC) interested in transforming its support services to include an evidence-informed approach to TA; and (c) key lessons learned in successfully transitioning from "TA-as-usual" to an evidence-informed TA system. GTO-TA is one operationalization of a systematic, proactive, evidence-informed approach to TA. GTO-TA includes best practices and core elements for a comprehensive TA system; it aims to increase the readiness (reduce barriers and increase facilitators) of an organization to deliver an innovation (program, policy, practice, and process new to an organization) with quality.
View Article and Find Full Text PDFWe introduce the second of two special issues that examine the science and practice of implementation support with takeaways for training and technical centers (TTACs). Major goals of both issues were to provide: rationale, concepts, and tools for evaluating training and technical assistance (TTA); an evidence-base for TTACs; and greater understanding of what is required to close the research-practice gap. To achieve these ambitious goals, we encouraged submissions from a broad array of individuals and groups involved in TTA.
View Article and Find Full Text PDFHundreds 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.
View Article and Find Full Text PDFWhile the Department of Defense (DoD) has given increased attention and priority to preventing sexual assault and sexual harassment (SA/SH), it remains a problem. To build its prevention capacity, DoD piloted Getting To Outcomes (GTO) from 2019 to 2022 at 10 military installations. GTO is an evidence-based planning and implementation support that has been used in many civilian contexts but has only recently been adapted for military SA/SH.
View Article and Find Full Text PDFImplementing evidence-based interventions remains slow in federally qualified health centers (FQHCs). The purpose of this study is to qualitatively examine the R = MC (Readiness = motivation × innovation specific capacity × general capacity) heuristic subcomponents in the context of implementing general and colorectal cancer screening (CRCS)-related practice changes in FQHCs. We conducted 17 interviews with FQHC employees to examine (1) experiences with successful or unsuccessful practice change efforts, (2) using approaches to promote CRCS, and (3) opinions about R = MC subcomponents.
View Article and Find Full Text PDFBackground: Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.
View Article and Find Full Text PDFWhile the literature strongly supports the need for sustainability of evidence-based interventions (EBIs), we present a review of the literature that indicates only three articles discuss a health-focused sustainability strategy. The aims of our sustainability readiness strategy (SRS) are to increase infrastructure capacity and EBI advocacy to impact the level of sustainability readiness. In this article, we describe the development of an evidence-informed promising practice sustainability readiness strategy (SRS) with three evidence-based components.
View Article and Find Full Text PDFImproving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients.
View Article and Find Full Text PDFBackground: 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.
View Article and Find Full Text PDFOrganizational readiness is essential for high-quality implementation of innovations (programs, policies, practices, or processes). The = MC heuristic describes three readiness components necessary for implementation-the general functioning of the organization (general capacities), the ability to deliver a particular innovation (innovation-specific capacities), and the motivation to implement the innovation. In this article, we describe how we used the for assessing, prioritizing, and improving readiness and , a systematic process for planning implementation strategies, to build organizational readiness for implementation of sexual assault prevention evidence-based interventions (EBIs).
View Article and Find Full Text PDFTechnical assistance (TA) is a major capacity building strategy used by the government sector to promote health outcomes in the United States. However, there is minimal literature about how to develop TA provider capacities. This article describes a systematic and proactive approach for developing TA provider capacity, referred to as Technical Assistance for Technical Assistance Providers (TAFTAP), which draws on three implementation science frameworks (Interactive Systems Framework for Dissemination and Implementation, Getting To Outcomes, and R = MC).
View Article and Find Full Text PDFSexual violence affects millions of Americans, and approximately one out of every three women and one out of every four men have experienced sexual violence during their lifetime. While prevention efforts have focused on implementing specific programmatic approaches, there has been relatively little focus on developing comprehensive and effective approaches to reduce sexual assault prevention across an organization. This study describes the development of the Prevention Evaluation Framework, an assessment targeting organizational best practices for comprehensive sexual assault prevention across multiple domains including human resources, collaborative relationships and infrastructure, use of evidence-informed approaches, quality implementation and continuous evaluation of programs/policies.
View Article and Find Full Text PDFSchools and research partners are increasingly implementing complex, multicomponent interventions and school-wide frameworks to better meet students' social, emotional, behavioral, and academic needs; however, in the research and real-world contexts, implementation is often fraught with many challenges and barriers to success. This study explores implementation barriers encountered during a randomized controlled trial testing effects of one complex intervention strategy-the Interconnected Systems Framework-from the lens of a practical model for conceptualizing organizational readiness-the Interactive Systems Framework for Dissemination and Implementation. Implementation of the Interconnected Systems Framework was explored via focus group and key informant interviews with school and mental health professionals, and research team members responsible for implementing the intervention in randomly assigned study schools.
View Article and Find Full Text PDFBMC Psychol
February 2022
Background: The school is a key setting for the provision of mental health services to children, particularly those underserved through traditional service delivery systems. School-wide Positive Behavioral Interventions and Supports (PBIS) is a tiered approach to service delivery based on the public health model that schools use to implement universal (Tier 1) supports to improve school climate and safety. As our prior research has demonstrated, PBIS is a useful vehicle for implementing mental and behavioral health evidence-based practices (EBPs) at Tier 2 for children with, or at risk for, mental health disorders.
View Article and Find Full Text PDFUnlabelled: Disruptions of varying severity often occur in the course of an organization's work to implement new programs or projects. These disruptions may slow their progress or even derail the work altogether. Resilient organizations must be prepared to respond in a thoughtful and timely way to disruptions.
View Article and Find Full Text PDFTransforming communities to be healthier and more equitable prosents a systemic challenge best addressed by those with native knowledge of the system. Community coalitions are a promising structure for tackling local health inequities, if they approach the change process with multiple local stakeholders and with systemic change in mind. Maturity models offer a framework for system assessment by defining sequential stages toward ideal development.
View Article and Find Full Text PDFBackground: Thailand has a rapidly aging population yet lacks evidence for effective and scalable evidence-based psychosocial interventions to support persons living with dementia and their family caregivers. In this study of a culturally adapted and evidence-based clinical program (Reducing Disabilities in Alzheimer's Disease [RDAD]), designed to reduce behavioral and psychological symptoms of dementia in older adults, the authors test the hypothesis that an implementation support strategy, Getting To Outcomes (GTO), would produce better implementation and clinical outcomes compared with usual implementation of RDAD in Thailand.
Methods: The study uses a hybrid type III cluster-randomized design to compare eight geographical districts that receive training on both implementing the RDAD clinical intervention and on GTO implementation support strategies (intervention arm) with eight other districts that receive the same RDAD training but without training in GTO implementation support strategies (control arm).
Effective implementation of evidence-based interventions is a persistent challenge across community settings. Organizational readiness - or, the motivation and collective capacity of an entity to adopt and sustain an innovation - is important to facilitate implementation. Drawing on the R = MC readiness framework, we developed a readiness building process to tailor support for implementation.
View Article and Find Full Text PDFBackground: Organizational readiness is important for the implementation of evidence-based interventions. Currently, there is a critical need for a comprehensive, valid, reliable, and pragmatic measure of organizational readiness that can be used throughout the implementation process. This study aims to develop a readiness measure that can be used to support implementation in two critical public health settings: federally qualified health centers (FQHCs) and schools.
View Article and Find Full Text PDFLimited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy.
View Article and Find Full Text PDFOrganizational readiness for an innovation (a program, policy, or practice new to a setting) is important for successful implementation. The R = MC heuristic focuses on capacity and motivation as a framework for readiness; it comprises 3 components and 18 subcomponents. A Delphi study with community coalition leaders was undertaken to assess when each subcomponent is most significant in the life cycle of implementing an innovation in a coalition.
View Article and Find Full Text PDFThe gap between implementers and researchers of quality improvement (QI) has hampered the degree and speed of change needed to reduce avoidable suffering and harm in health care. Underlying causes of this gap include differences in goals and incentives, preferred methodologies, level and types of evidence prioritized and targeted audiences. The Salzburg Global Seminar on 'Better Health Care: How do we learn about improvement?' brought together researchers, policy makers, funders, implementers, evaluators from low-, middle- and high-income countries to explore how to increase the impact of QI.
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