Using a Training-of-Trainers Approach and Proactive Technical Assistance to Bring Evidence Based Programs to Scale: An Operationalization of the Interactive Systems Framework’s Support System

Bringing evidence based programs to scale was a major initial impetus for the development of the Interactive Systems Framework for Dissemination and Implementation (ISF). The ISF demonstrates the importance of the Support System in facilitating the uptake of innovations in the community (the Delivery System). Two strategies that members of the Support System commonly use are training‐of‐trainers (TOT) models and technical assistance (TA). In this article, we focus on the role of the Support System in bringing evidence‐based programs (EBPs) to scale in the Delivery System using a case example, with special attention on two strategies employed by Support Systems—training‐of‐trainers (TOT) and proactive technical assistance. We then report on findings from a case example from the Promoting Science Based Approaches to Teen Pregnancy Prevention project that furthers our conceptualization of these strategies and the evidence base for them. We also report on the limitations in the literature regarding research on TOTs and proactive TA and provide suggestions for future research on TOTs and proactive TA that will enhance the science and practice of support in the ISF. 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 Role of a State‐Level Prevention Support System in Promoting High‐Quality Implementation and Sustainability of Evidence‐Based Programs

Although numerous evidence‐based programs (EBPs) have been proven effective in research trials and are being widely promoted through federal, state, and philanthropic dollars, few have been “scaled up” in a manner likely to have a measurable impact on today's critical social problems. The Interactive Systems Framework for Dissemination and Implementation (ISF) explicates three systems that are critical in addressing the barriers that prevent these programs from having their intended public health impact. In this article we describe the relevance of these systems in a real‐world context with a specific focus on the Prevention Support System (PSS). We expand on the ISF model by presenting funders and policy‐makers as active and engaged stakeholders, and demonstrate how a state‐level PSS has used empirical evidence to inform general and program‐specific capacity‐building and support interactions among researchers, funders, and practitioners in Pennsylvania. By embracing this expanded ISF framework as a conceptual model for the wide‐scale dissemination and support of EBPs, and recognizing the need for a distinct state‐level PSS, Pennsylvania has created an infrastructure to effectively address the primary barriers to moving from lists of EBPs to achieving population‐level public health 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     

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     

Developing a Prevention Synthesis and Translation System to Promote Science‐Based Approaches to Teen Pregnancy,HIV and STI Prevention

The Interactive Systems Framework for Dissemination and Implementation (ISF) is a multi‐system framework that can guide research‐to‐practice efforts by building and supporting the work of three interacting systems: the Prevention Delivery, Support, and Synthesis and Translation Systems. The Synthesis and Translation system is vital to bridging science and practice, yet how to develop it and train support system partners to use it is under‐researched. This article bridges this gap by offering a case example of the planning, development, and use of a synthesis and translation product called Promoting Science‐based Approaches to Teen Pregnancy Prevention using Getting To Outcomes. The case presented documents the process used for developing the synthesis and translation product, reports on efforts to engage the Prevention Support system to use the product, and how we approached building interaction between the Synthesis and Translation System and the Support System partners. Practice‐oriented evaluation data are also presented. Implications for practice, policy and research 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     

The Quality Implementation Framework: A Synthesis of Critical Steps in the Implementation Process

Implementation science is growing in importance among funders, researchers, and practitioners as an approach to bridging the gap between science and practice. We addressed three goals to contribute to the understanding of the complex and dynamic nature of implementation. Our first goal was to provide a conceptual overview of the process of implementation by synthesizing information from 25 implementation frameworks. The synthesis extends prior work by focusing on specific actions (i.e., the “how to”) that can be employed to foster high quality implementation. The synthesis identified 14 critical steps that were used to construct the Quality Implementation Framework (QIF). These steps comprise four QIF phases: Initial Considerations Regarding the Host Setting, Creating a Structure for Implementation, Ongoing Structure Once Implementation Begins, and Improving Future Applications. Our second goal was to summarize research support for each of the 14 QIF steps and to offer suggestions to direct future research efforts. Our third goal was to outline practical implications of our findings for improving future implementation efforts in the world of practice. The QIF's critical steps can serve as a useful blueprint for future research and practice. Applying the collective guidance synthesized by the QIF to the Interactive Systems Framework for Dissemination and Implementation (ISF) emphasizes that accountability for quality implementation does not rest with the practitioner Delivery System alone. Instead, all three ISF systems are mutually accountable for quality implementation. 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     

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     

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     

A Comparison of the Interactive Systems Framework (ISF) for Dissemination and Implementation and the CDC Division of HIV/AIDS Prevention’s Research-to-Practice Model for Behavioral Interventions

Translating evidence-based HIV/STD prevention interventions and research findings into applicable HIV prevention practice has become an important challenge for the fields of community psychology and public health due to evidence-based interventions and evidence-based practice being given higher priority and endorsement by federal, state, and local health department funders. The Interactive Systems Framework (ISF) for Dissemination and Implementation and the Division of HIV/AIDS Prevention (DHAP) Research-to-Practice model both address this challenge. The DHAP model and the ISF are each presented with a brief history and an introduction of their features from synthesis of research findings through translation into intervention materials to implementation by prevention providers. This paper describes why the ISF and the DHAP model were developed and the similarities and differences between them. Specific examples of the use of the models to translate research to practice and the subsequent implications for support of each model are provided. The paper concludes that the ISF and the DHAP model are truly complementary with some unique differences, while both contribute substantially to addressing the gap between identifying effective programs and ensuring their widespread adoption in the field.     

Exploring the Use of the Interactive Systems Framework to Guide School Mental Health Services in Post‐disaster Contexts: Building Community Capacity for Trauma‐Focused Interventions

Over the past two decades schools have been identified as the de facto mental health system for youth. Therefore, improving and expanding school mental health (SMH) has become a pressing agenda item for researchers, practitioners, policy makers, and funders. Advancing this agenda includes not only translating intervention research into practice within schools, but building capacities for these interventions to occur. The interactive systems framework (ISF) of Wandersman and colleagues, and the focus of this special issue, provides guidance in bridging the gap between research and practice through multisystem capacity building. There is some evidence that application of the ISF has helped to build capacity for SMH in states, but this evidence is preliminary. In addition, application of the ISF has not occurred in SMH at the community level or in relation to the specific stresses a community undergoes in relation to a disaster. The purpose of this article was to conduct a preliminary attempt to connect these three areas—the ISF, SMH and strengthening SMH through the ISF to better address impacts of a community level disaster; in this case, we explore the impacts of Hurricane Katrina on New Orleans schools, their students and families, and SMH programming within them. 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     

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 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     

Bridging Science and Practice in Violence Prevention: Addressing Ten Key Challenges

This article illustrates ideas for bridging science and practice generated during the Division of Violence Prevention's (DVP) dissemination/implementation planning process. The difficulty of moving what is known about what works into broader use is near universal, and this planning process pushed us to look beyond the common explanations (e.g., providers were resistant/unwilling to change practice) and think about the multiple layers and systems involved. As part of this planning process, the Interactive Systems Framework for Dissemination and Implementation (ISF) was developed and then applied to the fields of child maltreatment and youth violence prevention. Challenges for each of the three systems in the ISF are discussed as well as and action and research ideas to address the challenges. Also described are actions taken by DVP in response to the planning process to illustrate how a funder can use the ISF to bridge science and practice.     

New Directions in Capacity Building: Incorporating Cultural Competence into the Interactive Systems Framework

The UMBC Psychology Department's Center for Community Collaboration (CCC) provides training and support for capacity building to promote substance abuse and mental health treatment as well as adherence improvement in community agencies funded through the Ryan White Act serving persons living with HIV/AIDS. This article describes an approach to dissemination of Evidence Based Practices (EBPs) for these services that uses the Interactive Systems Framework (ISF) and incorporates a collaborative process involving trainer cultural competence, along with a comprehensive assessment of organizational needs, culture, and climate that culminates in tailored training and ongoing collaboration. This article provides: (1) an overview of the CCC's expanded ISF for the effective dissemination of two EBPs—motivational interviewing and the stages of change perspective; (2) an examination of the role of trainer cultural competence within the ISF framework, particularly attending to organizational culture and climate; and (3) case examples to demonstrate this approach for both general and innovation‐specific capacity building in two community based organizations. 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     

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     

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     

The Development and Evaluation of a Statewide Training Center for Home Visitors and Supervisors

This paper informs practice in community‐based home visiting workforce development by describing the development and evaluation of a university‐based training certificate program for home visitors and supervisors. The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008) guides our conceptualization and paper organization. The ISF describes the components involved in translating research findings into effective implementation of prevention programs. We describe implementation and lessons learned from seven development activities: (a) review of the literature, (b) survey of other training initiatives across the country, (c) focus groups with home visitors and supervisors, (d) consultation with individual home visitors, (e) creation of a state advisory board of home visiting providers and stakeholders, (f) evaluation of two pilot trainings, and (g) video development. We then present evaluation data from 49 home visitors and 23 supervisors who completed the training certificate program after the pilot trainings. Both home visitors and supervisors rated training satisfaction highly, reported significant increases in self‐efficacy related to the training topics, and reported extensive use of motivational communication techniques, which are the foundational skills of the training content. These and other favorable results reflect the benefits of building on advances in theory and science‐based practice and of involving providers and stakeholders repeatedly throughout the development process.     

The Diffusion of Youth-Led Participatory Research in Urban Schools: The Role of the Prevention Support System in Implementation and Sustainability

This article discusses the dissemination of a process of youth-led participatory research in urban secondary schools within the Interactive Systems Framework for Dissemination and Implementation (ISF) developed in collaboration with the CDC and its university partners (Wandersman et al. American Journal of Community Psychology, 41(3-4) 2008). The focus here is on the development of the Prevention Support System with respect to general and innovation-specific capacity building. The specific process under study involves youth-led needs assessment and research to inform the planning of prevention programs and policies to address students' health and developmental needs. The article first briefly describes the youth-led research process, its potential benefits, and a case example in two urban secondary schools. It then describes challenges and responses in providing support for the diffusion of this model in 6 secondary schools. The settings are urban public schools with a majority of students of color from diverse ethnic groups: Asian-American, Latino, and African-American. This project constitutes a collaborative partnership with a university school of public health and community-based organizations (CBOs) to build capacity for long-term, sustainable implementation of this innovative process within the local school system. The perspectives of the university-based researcher and the CBO partners on the development and effectiveness of the Prevention Support System are presented.     

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. 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