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. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

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. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Promoting Science-based Approaches to Teen Pregnancy Prevention: Proactively Engaging the Three Systems of the Interactive Systems Framework

In the field of teen pregnancy prevention many efficacious prevention programs are available but adoption of these programs is slow at the community level. In this article, we present a multi-site, capacity-building effort called the Promoting Science-based Approaches to Teen Pregnancy Prevention project (PSBA) as a case example of a proactive application of the Interactive System Framework (ISF) for dissemination and implementation. The ISF is a multi-system model leading to dissemination and implementation of science-based prevention programming through the work of three interactive systems: The "Prevention Delivery," "Prevention Support," and "Prevention Synthesis & Translation" Systems. This article describes the proactive use of the ISF to conceptualize and bolster the PSBA program's goal of assisting local prevention partners in the use of science-based approaches (SBA) to prevent teen pregnancy. PSBA uses all three systems of the ISF to facilitate practice improvements and offers valuable research opportunities to investigate factors related to dissemination and implementation processes across these systems. Describing our application of this framework highlights the feasibility of actively using the ISF to build prevention infrastructure and to guide large-scale prevention promotion strategies in the area of teen pregnancy prevention. The program's ongoing evaluation is presented as an example of early efforts to develop an evidence base around the ISF. Research implications are discussed.     

Researchers, Practitioners, and Funders: Using the Framework to Get Us on the Same Page

The worlds of prevention research and practice are largely disconnected. The growing body of scientific knowledge regarding effects of prevention programs is not often disseminated and translated in a manner that leads to wide scale changes in practice. The Centers for Disease Control and Prevention, in collaboration with a team of academic researchers, has developed the Interactive Systems Framework for Dissemination and Implementation to help us understand the roles and interactions of those associated with developing knowledge, those associated with using the knowledge in practice settings, and those acting in the roles of bridge, support, and broker between the research and practice communities. This special issue on the Framework presents a variety of theoretical, practical and empirical issues related to this framework and its subsystems. This compilation of articles discuss the capacity of the Framework’s subsystems, provide examples of the generally under-developed prevention support system, describe the additional challenges involved in disseminating a change in culture, discuss the delicate balance and interaction of fidelity and adaptation, present a meta-analysis of the relationships between program implementation and program outcomes, and include examples of how the Framework has been used to guide action. The present commentary on this special issue provides a critical examination of the contributions, implications, and challenges raised by each of these articles. It also includes a discussion of how the Framework relates to the basic values and practice of community psychology and concludes with some suggested future directions and challenges for the continued development and use of the Framework.     

Bridging the Gap Between Prevention Research and Practice: The Interactive Systems Framework for Dissemination and Implementation

If we keep on doing what we have been doing, we are going to keep on getting what we have been getting. Concerns about the gap between science and practice are longstanding. There is a need for new approaches to supplement the existing approaches of research to practice models and the evolving community-centered models for bridging this gap. In this article, we present the Interactive Systems Framework for Dissemination and Implementation (ISF) that uses aspects of research to practice models and of community-centered models. The framework presents three systems: the Prevention Synthesis and Translation System (which distills information about innovations and translates it into user-friendly formats); the Prevention Support System (which provides training, technical assistance or other support to users in the field); and the Prevention Delivery System (which implements innovations in the world of practice). The framework is intended to be used by different types of stakeholders (e.g., funders, practitioners, researchers) who can use it to see prevention not only through the lens of their own needs and perspectives, but also as a way to better understand the needs of other stakeholders and systems. It provides a heuristic for understanding the needs, barriers, and resources of the different systems, as well as a structure for summarizing existing research and for illuminating priority areas for new research and action. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Using the Interactive Systems Framework in Understanding the Relation Between General Program Capacity and Implementation in Afterschool Settings

The present study uses the Interactive Systems Framework (ISF) to understand how general capacity influences the implementation of prevention programs in afterschool settings. Eight afterschool sites received the Good Behavior Game (GBG) intervention, a program designed to foster supportive behavioral management and positive youth behavior. In line with the Prevention Support System component of ISF, the intervention afterschool staff were trained and received weekly on-site support from coaches in implementing the GBG. It was found that GBG implementation scores were greatest in afterschool programs that rated high on both organizational- and community-levels of general capacity; high scores on only one level of general capacity resulted in lower implementation scores. Thus, afterschool sites that were more organized, maintained adequate facilities, and developed strong linkages to individuals or organizations in the community scored highest in implementation fidelity and quality. This study highlights the importance of considering interactions among multiple levels of general capacity in efforts to promote evidence-based practices in afterschool settings. Caution should be taken in generalizing findings due to the small sample in this study.     

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. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Navigating the Road Ahead: Public Health Challenges and the Interactive Systems Framework for Dissemination and Implementation

Public health is currently faced with an array of critical challenges and disconnects. Research and evaluation have identified a number of evidence‐based strategies for effecting behavior change at individual, group, organizational, and environmental levels, all of which hold promise for leading to substantial reductions in morbidity and mortality, and increased quality of life. Unfortunately, there is huge variability across the public health system in awareness of the value of using evidence to inform decision making, let alone in capacity to locate, assess, compare, select, justify, adapt, implement, and evaluate evidence‐based strategies, or to participate in building the evidence base for practice‐based innovations. As a result, many communities may not be benefitting from research‐tested and practice‐based strategies that could help them to meet their public health goals more efficiently and effectively. CDC's Interactive Systems Framework for Dissemination and Implementation (ISF), released in 2008, was designed to help close this gap between research and practice. This commentary identifies the ways in which the ISF framework is useful in addressing the research practice gap; revisits the elements of the framework that have continued to guide research and practice in fruitful ways; and highlights areas that need further development to meet current public health challenges. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

The Interactive Systems Framework for Dissemination and Implementation: Enhancing the Opportunity for Implementation Science

This article reflects on the progress made in the development of the Interactive Systems Framework (ISF) for Dissemination and Implementation in recent years. Considering the ISF in the context of the broader field of dissemination and implementation research, the author offers commentary on the strengths of the framework and opportunities for further expansion and refinement.     

Moving Knowledge into Action: Developing the Rapid Synthesis and Translation Process Within the Interactive Systems Framework

The Interactive Systems Framework (ISF) for Dissemination and Implementation presents an overall framework for translating knowledge into action. Each of its three systems requires further clarification and explanation to truly understand how to conduct this work. This article describes the development and initial application of the Rapid Synthesis and Translation Process (RSTP) using the exchange model of knowledge transfer in the context of one of the ISF systems: the Prevention Synthesis and Translation System (see [special issue “introduction” article] for a translation of the Wandersman et al. (Am J Community Psychol 41:3–4, 2008) article using the RSTP). This six‐step process, which was developed by and for the Division of Violence Prevention at the Centers for Disease Control and Prevention in collaboration with partners, serves as an example of how a federal agency can expedite the transfer of research knowledge to practitioners to prevent violence. While the RSTP itself represents one of the possible functions in the Prevention Synthesis and Translation System, the resulting products affect both prevention support and prevention delivery as well. Examples of how practitioner and researcher feedback were incorporated into the Rapid Synthesis and Translation Process are discussed. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation

The first purpose of this review was to assess the impact of implementation on program outcomes, and the second purpose was to identify factors affecting the implementation process. Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs. Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation. The implementation process is affected by variables related to communities, providers and innovations, and aspects of the prevention delivery system (i.e., organizational functioning) and the prevention support system (i.e., training and technical assistance). The collection of implementation data is an essential feature of program evaluations, and more information is needed on which and how various factors influence implementation in different community settings.     

Blending Theory with Practice: Implementing Kindergarten Transition Using the Interactive Systems Framework

The Interactive Systems Framework (ISF; Wandersman et al. in Am J Commu Psychol 41(3–4):171–181, 2008) was used to implement a kindergarten transition demonstration project collaboratively developed by elementary and early education providers, community‐based family and housing services, parents, and a University intermediary and technical assistance group. First person accounts from stakeholders at all levels provide a complementary and broad perspective on the project's implementation. The practice model blended existing research on kindergarten transition and parent involvement with feedback from stakeholders to create a community‐specific program designed to help all children make a smooth entry into kindergarten. During implementation, evidence‐based approaches needed to be adjusted to fit the specific needs of each community. Using the ISF as a guide, next steps and lessons learned include increasing leadership through a district‐wide plan that is still flexible within each school community, increasing information and supports to individual schools, and improving data collection for continuous program improvement. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

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 ystem has been under-researched and under-developed. This 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.     

Applying the Interactive Systems Framework to the Dissemination and Adoption of National and State Recommendations for Hypertension

The Centers for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention (DHDSP), commissioned an Institute of Medicine (IOM) report to identify the highest priority action areas for CDC, state health departments, and other public health partners in their efforts to reduce and control hypertension. To assess the dissemination and adoption of the IOM report recommendations, DHDSP developed an evaluation based on the Interactive Systems Framework for Dissemination and Implementation (ISF). The evaluation incorporates data collection at critical points across 3 years. In this article, we focus on the ISF systems to describe the role of funded state partners and their relationship with CDC in implementing public health recommendations. We describe baseline results for three data collection activities: (1) key informant interviews, (2) a Web‐based survey, and (3) content analysis of state workplans to determine the degree of alignment with IOM recommendations. For example, currently 30 % of surveyed programs are implementing most (or all) of the recommendations in the IOM report, however 76 % intend to change hypertension program priorities based on the recommendations of the IOM report. Qualitative data suggest that there are several facilitators and barriers in implementing public health policy recommendations. DHDSP will use these baseline results to provide additional technical assistance and support to state health departments in their efforts to implement the IOM report's recommendations. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

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. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Preliminary Efficacy of an Intervention to Reduce Psychosocial Stress and Improve Coping in Low-Income Families

This article reports pre-post intervention results from a randomized controlled trial evaluating the initial efficacy of a couples-based intervention aimed at teaching skills for coping with stress and improving relationship skills in a sample of 173 ethnically diverse low-income co-resident mothers and fathers who were raising at least one child together. Couples were randomly assigned to one of three interventions or to an assessment-only control condition. The Fatherhood, Relationship, and Marriage Education (FRAME) intervention is a 14-h psychoeducation intervention developed specifically to strengthen the ability of low-income mothers and fathers to reduce conflict, cope with stress, and co-parent effectively. Three versions of FRAME were assessed: a men-only group, a women-only group, and a couple's group. The pre-post intervention analyses revealed reductions in financial stress, disengagement coping, and involuntary disengagement responses, as well as improvements in problem solving. These pre-post changes on stress and coping variables were both statistically significant and reliable as assessed by the Reliable Change Index (Jacobson and Truax 1991). Results were particularly strong for the couples' and women's groups. In addition, positive pre-post changes on stress and coping variables were associated with pre-post reductions on symptoms of depression for participants assigned to an intervention. The results demonstrate that participants in FRAME acquire some of the key skills taught in the intervention, and skills acquisition appears to translate into symptom reduction. In addition, this study highlights the value of an intervention aiming to improve the capacity of parents with economic hardship to cope effectively with stress.     

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. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Using Mental Imagery to Enhance the Effectiveness of Implementation Intentions

Past research shows that forming implementation intentions increases the probability of carrying out goals. The present research proposes that mental imagery can strengthen the effects of implementation intentions on goal achievement. Participants were assigned a mundane goal and were randomly assigned to one of two conditions: implementation intentions only or implementation intentions plus mental imagery. Results support the hypothesis that using mental imagery when forming implementation intentions leads to higher rates of goal achievement.     

Using performance feedback to enhance implementation fidelity of the problem-solving team process

Implementation integrity is a potentially critical issue for problem-solving teams (PST) and most response-to-intervention models. The current study hypothesized that providing performance feedback, which has consistently been shown to increase implementation integrity, to PSTs would enhance the procedural integrity of the process. The PSTs for three elementary schools were provided performance feedback with a 20-item checklist created from the literature. A multiple-baseline design across schools revealed an immediate change in level after providing performance feedback. The resulting percentages of non-overlapping data were 90.9%, 90.0%, and 100%. However, PSTs still did not monitor student progress, assess the effectiveness of the intervention, or measure the integrity with which the intervention was implemented even after receiving feedback. Thus, providing performance feedback could be a method to increase the fidelity with which critical components of data-based problem-solving are implemented, but these data suggest the need for additional research.