Organizing the dissemination and implementation field: who are we, what are we doing, and how should we do it?

Two decades into its tenure as a field, dissemination and implementation (D&I) scientists have begun a process of self-reflection, illuminating a missed opportunity to bridge the gap between research and practice-one of the field's foundational objectives. In this paper, we, the authors, assert the research-to-practice gap has persisted, in part due to an inadequate characterization of roles, functions, and processes within D&I. We aim to address this issue, and the rising tension between D&I researchers and practitioners, by proposing a community-centered path forward that is grounded in equity.We identify key players within the field and characterize their unique roles using the translational science spectrum, a model originally developed in the biomedical sciences to help streamline the research-to-practice process, as a guide. We argue that the full translational science spectrum, from basic science research, or "T0," to translation to community, or "T4," readily applies within D&I and that in using this framework to clarify roles, functions, and processes within the field, we can facilitate greater collaboration and respect across the entire D&I research-to-practice continuum. We also highlight distinct opportunities (e.g., changes to D&I scientific conference structures) to increase regular communication and engagement between individuals whose work sits at different points along the D&I translational science spectrum that can accelerate our efforts to close the research-to-practice gap and achieve the field's foundational objectives.

Multiple Perspectives on Motivating Parents in Pediatric Primary Care to Initiate Participation in Parenting Programs.

OBJECTIVE: To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents. METHODS: We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups. RESULTS: Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy. CONCLUSIONS: Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.

Reducing Abuse and Neglect Recurrence Among Young Foster Children Reunified With Their Families.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a recurrent adverse life event known to cause enduring psychiatric impairment throughout life. For young children in protective custody for a first episode of CM, specialized court-coordinated intervention to optimize reunification has shown promise for preventing CM recidivism, with case series documenting short-term successes. METHODS: We tracked 10-year (Nov 2011-March 2022) court re-entry outcomes in a cohort of 272 young children, birth to six years, reunited with their families following placement in protective custody and court referral to the SYNCHRONY Project, a voluntary clinical service providing Incredible YearsTM parenting education, parental psychiatric care, and serial dyadic clinical evaluation to inform medical recommendations on safety for visitation and reunification. Re-entry was operationalized as rereferral to any Missouri Court and proportions compared with contemporaneous State and national data. RESULTS: SYNCHRONY-enrolled/reunified children experienced frequencies of guardianship (22%) and reunification (46%), in keeping with Missouri averages. In these categories, 3.4% and 7.1% respectively were re-referred to the Court over the 10-year follow-up. In care as usual nationally for this age group, the re-referral proportions are 18% (OR 7.5, P < .0001) and 35% (OR 6.1, P < .0001) respectively. In care as usual in Missouri across all ages, the re-referral proportion is 16% (odds ratio [OR] 3.09, P < .0001). CONCLUSIONS: Judicious implementation of evidence-based parenting education, 2-generation psychiatric care, and clinical consultation were associated with marked reduction in court re-entry versus care-as-usual and warrant consideration in intervention standards for young children in foster care.

Implementing Parenting Programs in Primary Care: A Framework and a Call for Action.

Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being of children. Rigorous evidence has demonstrated the efficacy of these programs. Rising rates of child and youth depression, anxiety, grief, and suicide, both prior to and compounded by the COVID-19 pandemic, provide further reasons to implement parenting programs that support all parents in their essential roles. Parents can act as a buffer to stressors and support for children's well-being when they have the knowledge and skills to do so. Pediatric primary care practices are a natural setting for parenting programs, but challenges, including stigma, technology, workflow issues, and funding, have prevented their broad dissemination, implementation, and sustainability. In this article, we develop a framework for implementing parenting programs in primary care and present key considerations for selecting programs that fit the needs of parents, providers, patients, and the practice. We offer lessons from our experiences in overcoming these challenges, using the updated Consolidated Framework for Implementation Research to structure our discussion. We also provide an initial stepwise process which readers may use to plan their own parenting program implementation. Pediatric clinicians and practices can use this article and associated resources to plan, implement, and evaluate parenting programs in their practices as a strategy to help address the growing youth mental health crisis. Improving parenting behaviors can reduce the need for current or future mental health interventions by supporting optimal child development, emotional regulation, and parent-child relationships.

Associations Between Weight Talk and Biopsychosocial Outcomes in Children from Racially/Ethnically Diverse Households.

Weight talk in the home-parents talking to their children about their weight, shape or size-has been associated with many negative health outcomes in children and adolescents, although the majority of research has been with adolescents. This study explored associations between weight talk in the home and a broad range of child biopsychosocial outcomes (e.g., weight status, diet quality, psychological well-being, peer problems), in addition to child sex and race/ethnicity. Parents of 5-7 year old children from six racial/ethnic groups (White, African American, Hmong, Latino, Native American, Somali) (n=150) completed an online survey and completed 24-hour dietary recalls on the child. Additionally, anthropometric measurements were taken on the 5-7 year old child and parent. Over one-third of parents reported engaging in weight talk with their child. Overall, weight talk was associated with child weight status, but not with child diet quality. The presence of weight talk differed by race/ethnicity and child weight status. Most psychological (e.g., emotional problems) and social (e.g., peer problems) outcomes differed significantly by race/ethnicity with the following pattern: (1) no significant associations between weight talk and biopsychosocial outcomes were found for Hmong and Latino children; (2) a negative association (e.g., less healthy functioning) was found for African American and Somali children; (3) a positive association (e.g., healthier functioning) was found for Native American children. Future research should investigate why psychological and social outcomes differ by race/ethnicity in children experiencing weight talk. This study confirms the need to develop best practices for helping parents concerned about their child's weight to talk to children in a healthful way.

Potential Points of Intervention to Minimize the Impact of Parents' Adverse Childhood Experiences on Child Mental Health.

OBJECTIVE: Children of parents who experienced adverse childhood experiences (ACEs) are at elevated risk for mental health (MH) issues. The goal of this study was to explore the relationships between parent ACEs and child MH and to identify potential mediators and points of psychosocial intervention. METHODS: Participants were 1307 children aged 5 to 9 years from diverse backgrounds and their primary caregivers. Using cross-sectional questionnaire data, we used structural equation modeling to examine the research questions. RESULTS: Parent ACEs were directly related to child MH issues (ß = 0.189, p < 0.001). This relationship was fully mediated by parent MH (ß = 0.374, p < 0.001; ß = 0.246, p < 0.001) and positive parenting behaviors (ß = -0.237, p < 0.001; ß = -0.556, p < 0.001). High parent ACEs were negatively associated with parent MH (ß = 0.374, p < 0.001), which was then negatively associated with parenting behaviors (ß = -0.500, p < 0.001), which was then negatively associated with child MH (ß = -0.600, p < 0.001). Parent MH maintained a significant, though attenuated, direct relationship with child MH (ß = 0.102, p < 0.05). CONCLUSION: Parents with high ACEs but who have good mental health and positive parenting behaviors demonstrated no impact of their ACEs on their children's mental health. Providing MH care to parents and parenting programs may be strategies for improving children's MH. Parenting behavior assessment is recommended for clinicians when pediatric patients present with MH concerns.

The mechanics of implementation strategies and measures: advancing the study of implementation mechanisms.

BACKGROUND: There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Until this gap is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will remain elusive. This research project aims to identify plausible strategy-mechanism linkages, develop causal models for mechanism evaluation, produce measures needed to evaluate such linkages, and make these models, methods, and measures available in a user-friendly website. The specific aims are as follows: (1) build a database of strategy-mechanism linkages and associated causal pathway diagrams, (2) develop psychometrically strong, pragmatic measures of mechanisms, and (3) develop and disseminate a website of implementation mechanisms knowledge for use by diverse stakeholders. METHODS: For the first aim, a combination of qualitative inquiry, expert panel methods, and causal pathway diagramming will be used to identify and confirm plausible strategy-mechanism linkages and articulate moderators, preconditions, and proximal and distal outcomes associated with those linkages. For the second aim, rapid-cycle measure development and testing methods will be employed to create reliable, valid, pragmatic measures of six mechanisms of common strategies for which no high-quality measures exist. For the third aim, we will develop a user-friendly website and searchable database that incorporates user-centered design, disseminating the final product using social marketing principles. DISCUSSION: Once strategy-mechanism linkages are identified using this multi-method approach, implementation scientists can use the searchable database to develop tailored implementation strategies and generate more robust evidence about which strategies work best in which contexts. Moreover, practitioners will be better able to select implementation strategies to address their specific implementation problems. New horizons in implementation strategy development, optimization, evaluation, and deployment are expected to be more attainable as a result of this research, which will lead to enhanced implementation of evidence-based interventions for cancer control, and ultimately improvements in patient outcomes.

Immigrant Family Financial and Relationship Stress From the COVID-19 Pandemic.

We tend to overlook immigrant families in policy and program discussions related to the COVID-19 pandemic, yet they are some of the most vulnerable to the effects of this continuing crisis. This study examined the impact of the COVID-19 pandemic on immigrant families in an upper Midwest state. We interviewed 19 human and social service providers from agencies serving Somali, Latinx, and Karen (refugees from Burma/Myanmar) immigrant families between June and August 2020. Results analyzed for this paper focused on responses to questions asked about COVID-19-related financial and familial stress, and coping resources and constraints that providers were observing with their immigrant clients. Guided by the Family Adjustment and Adaptation Response Model (Patterson, 1988), we identified a pile-up of financial and relationship stressors including employment, housing, and family relationship strains, and resource access constraints. We found that job loss in already financially vulnerable immigrant families was particularly impactful. Housing insecurity soon followed. Immigrant families also faced significant constraints to resource access including lack of documentation, fear of making a mistake, language barriers, and lack of technology skills. We identified family and community resources that families used to meet demands, coping strategies, and glimmers of resilience. As we near the end of the pandemic, we urge family researchers to monitor long-term effects of the crisis on immigrant families. Findings can inform the creation of programs and policies that address immigrant family needs for resources and culturally relevant services to support their financial recovery post-COVID.

Integrated Behavioral Health Implementation Patterns in Primary Care Using the Cross-Model Framework: A Latent Class Analysis.

Primary care has increasingly adopted integrated behavioral health (IBH) practices to enhance overall care. The IBH Cross-Model Framework clarifies the core processes and structures of IBH, but little is known about how practices vary in the implementation of these processes and structures. This study aimed to describe clusters of clinics using the IBH Cross-Model Framework for a large sample of primary care clinics, as well as contextual variables associated with differences in implementation. Primary care clinics (N = 102) in Minnesota reported their level of implementation across 18 different components of IBH via the site self-assessment (SSA). The components were mapped to all five principles and four of the nine structures of the IBH Cross-Model Framework. latent class analysis was used to identify unique clusters of IBH components from the SSA across the IBH Cross-Model Framework's processes and structures. Latent classes were then regressed onto context variables. A four-class model was determined to be the best fit: Low IBH (39.6%), Structural IBH (7.9%), Partial IBH (29.4%), and Strong IBH (23.1%). Partial IBH clinics were more urban than the other three classes, lower in SES risk than Structural IBH clinics, and located in smaller organizations than Strong IBH clinics. There were no differences between classes in race/ethnicity of the clinic area or practice size. Four groups of IBH implementation were identified representing unique profiles of integration. These clusters may represent patterns of community-based implementation of IBH that indicate easier and more challenging aspects of IBH implementation.

Inhibitory Control Moderates the Intervention Effects of a Preventive Parenting Program on Posttraumatic Stress Disorder Symptoms Among Male Service Members.

Military servicemembers face substantial challenges due to war-related trauma exposure, including posttraumatic stress disorder (PTSD). Individuals with deficits in inhibitory control (IC) may have an increased risk of developing PTSD due to a reduced ability to regulate their cognitive responses to and disengage from trauma-related stimuli. After Deployment, Adaptive Parenting Tools (ADAPT) is a mindfulness-infused parenting program for military families that has also been found to have crossover effects on parental mental health. The present study examined whether fathers' IC at baseline affected their response to this emotional skills-focused intervention and further influenced their PTSD symptoms 1 year later. The sample included 282 male National Guard and Reserve (NG/R) service members who had recently been deployed to Iraq or Afghanistan. Fathers were randomly assigned to either the ADAPT program or a control condition, with IC measured at baseline and PTSD symptoms measured at baseline and 1-year follow-up. Intent-to-treat analyses revealed no significant main effect of the intervention on fathers' PTSD symptoms. However, fathers' IC moderated intervention effects on PTSD symptoms, f2 = 0.03. The intervention had more beneficial effects on reducing fathers' PTSD symptoms for participants with low IC at baseline. These findings are consistent with compensatory effects in the risk moderation hypothesis, which suggests that prevention or intervention programs are more effective for high-risk subgroups.

Feasibility of a novel, brief parenting intervention in primary care clinics.

INTRODUCTION: Primary care provides a nonstigmatizing service setting in which parents routinely seek care and advice related to their children's behavior. To make care truly accessible for all families, multiple methods and approaches should be available, including brief interventions. The objective of this project was to evaluate the feasibility and acceptability of a novel brief program called Behavior Checker. METHOD: This feasibility evaluation is based on in-depth interviews with personnel (N = 19) from two safety-net clinics in which Behavior Checker was tested. RESULTS: Clinic personnel found the program useful and acceptable, citing ease of use and reporting it addressed an existing need. Providers indicated that the program led to more behavioral health conversations with parents and that these were more efficient than without the program. CONCLUSION: Behavior Checker appeals to providers and clinics as a first-line approach to address parenting and children's behavioral needs. The program's effectiveness should be examined. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resilience in the system: COVID-19 and immigrant- and refugee-serving health and human service providers.

INTRODUCTION: Immigrant and refugee families in the U.S. have been particularly hard hit by the COVID-19 pandemic. Health and human service providers who serve these communities have been essential in supporting them during this crisis, yet have also had to adapt the way they provide services. The current study aims to describe the challenges these service providers have faced and the adaptations they have made. METHOD: Our research team conducted semistructured interviews with 19 service providers at 10 organizations identified as serving one or more immigrant and/or refugee communities in the state of Minnesota. We analyzed the interviews for themes and used normalization process theory (May & Finch, 2009) to understand how service providers have shown resilience and where gaps in capacity emerged. RESULTS: Mechanisms of adaptation to the COVID-19 crisis included staff taking on larger workloads, utilizing existing service frameworks in new ways, shifting their services remotely and/or substantively, and utilizing the trust they had built with communities and individuals over time. Challenges that had not been fully overcome included insufficient funding for community need and restrictions on methods of interaction. DISCUSSION: Key implications include allocating funding for immigrant and refugee families, developing and evaluating new service formats in collaboration with clients, providing direct support for staff in times of crisis, and using practice-based evidence to speed implementation science research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parent-adolescent emotion-related behavior during conflict in a clinical sample.

INTRODUCTION: Parents and adolescents often have conflict. Previous research has been inconsistent regarding the association between some parent behaviors during this conflict and adolescent symptoms. This study examines parents' behaviors during a conflict resolution discussion in a clinical sample, and the relationship between parents' behaviors and adolescents' depression and anxiety symptoms. METHODS: Depression and anxiety symptoms were self-reported by 22 adolescents of ages 13-17 who were diagnosed with depression. They also participated in an observed conflict resolution task with one parent. Using observationally coded data, we utilized two linear multiple regressions to assess how parent and adolescent emotion-related behaviors related to adolescents' depression and anxiety symptoms. RESULTS: Adolescents' conflict behaviors were not associated with their psychopathology symptoms. Parent conflict behaviors of support and withdrawal were both negatively associated with adolescent depression and anxiety, with parent contempt marginally associated with adolescent depression. CONCLUSIONS: In this clinical sample, parents of adolescents with low mood or anxiety demonstrated some reduced negative parenting behaviors (i.e., contempt and withdrawal), but also reduced positive parenting behavior (i.e., support). The results suggest that when some negative parenting behaviors are reduced, this may inadvertently reinforce depressive behaviors. The results also indicate the importance of increasing supportive parent behaviors.

CHAOS in the Home Environment and Child Weight-Related Outcomes.

INTRODUCTION: Biopsychosocial approaches to health care are critical to addressing childhood obesity. This study aimed to examine how multiple indicators of the home environment related to child weight-related outcomes. We hypothesized that families with home environments of higher chaos and stress, and lower quality parent-child interactions, would have children with a higher body mass index (BMI), less healthy dietary intake, and less healthy eating behaviors. METHODS: Data were drawn from the cross-sectional Phase I of the Family Matters study. Participants were 150 racially/ethnically diverse families with a child between 5 to 7 (mean, 6.4) years old. We used a latent profile analysis approach. A 4-class solution fit the data well, and we used predicted class posterior probabilities to assign families to classes. We then regressed the results onto the distal outcomes of child BMI, healthy dietary intake, and healthy eating behaviors. RESULTS: Families were classified as Collaborative-Chill (n = 38), Busy Bees (n = 37), Engaged (n = 61), and Inconsistent-Distant (n = 14). Collaborative-Chill was used as the reference class. Inconsistent-Distant families had children with higher BMI (P < .001) that were more food responsive (P < .001). Busy Bees families had children who were more food responsive (P = .04) and more satiety responsive (P = .02). Engaged families had children who were marginally more food responsive (P = .06). CONCLUSION: Household chaos, parent stress, and parent-child interactions are important components of the home environment implicated in children's weight-related outcomes. Health care providers should consider these indicators with child patients who struggle with obesity.

Defining and measuring core processes and structures in integrated behavioral health in primary care: a cross-model framework.

A movement towards integrated behavioral health (IBH) in primary care continues to grow, among an accumulating evidence base for its effectiveness for improving care. However, healthcare organizations struggle to navigate where to target their limited resources for improving integration. We evaluated a cross-model framework of IBH core processes and structures. We used a mixed-methods approach for evaluation of the framework, which included (a) an evaluation survey of national experts and stakeholders, (b) crosswalks with common IBH measures, and (c) a real-world usability test. Five core IBH principles, mapping to 25 processes, and nine clinic structures were defined. Survey responses from 29 IBH domain and policy experts and stakeholders resulted in uniformly high ratings of importance and variable levels of feasibility for measurement, particularly with respect to electronic health record (EHR) systems. A real-world usability test resulted in good uptake and use of the framework across a state-wide effort. An IBH Cross-Model Framework of core principles, processes, and structures generated good acceptability and showed good real-world utility in a state-wide effort to improve IBH across disparate levels of integration in diverse primary care settings. Findings identify feasible areas of measurement, particularly with EHR systems. Next steps include testing the relationship between the individual framework components and patient outcomes to help guide clinics towards prioritizing efforts focused on improving integration.