A qualitative synthesis of practice-based learning from case studies on COVID community champion programmes in England, UK.

BACKGROUND: Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS: A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS: The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS: By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.

Intake Characteristics as Predictors of Psychotherapy Outcome in a Practice Research Network in Argentina.

There are few studies exploring intake diagnostic characteristics as predictors of change in integrative naturalistic settings. The aim of this study is to explore baseline variables at the intake process and establish the predictive value of the individual trajectories of the patients. We recruited 259 patients undergoing an integrative psychotherapy network of psychotherapists from Buenos Aires, Argentina. Every therapist completed the intake form of each patient involved in the routine outcome monitoring. Thereafter step-wise regressions based on forward selection strategies were used, in order to identify meaningful baseline predictors of patients' clinical evolution, derived from the intake process. The selected predictors were social support network, subjective distress, the initial measure of clinical distress, unemployment, sociocultural status and reactance. When including those six variables in a multilevel model, the results indicate that social support network, subjective distress, and the initial measure of clinical distress were significant predictors of the trajectories of OQ-30, whereas unemployment, sociocultural status and reactance were not significant. The results regarding social support network are in line with the literature, while results of socioeconomic status (unemployment and sociocultural level) move in an opposite direction in comparison to the available evidence. Moreover, the mental health findings (initial OQ-30 and subjective distress) confirm the contradictory body of literature produced in this domain. Finally, reactance seems to be a significant predictor in previous study in contradiction of our results. Overall, this endeavor constitutes important but preliminary evidence to enhance the production of bottom-up science within practice research networks in the global south.

Practice-Oriented Research: An Introduction to New Developments and Future Directions.

Aimed at understanding and improving psychological therapies as they are conducted in clinical routine, practice-oriented research (POR) is now a well-established approach to the scientific foundations of mental health care services. Resting on the accumulation of a wide range of practice-based evidence related to treatment outcome and process, as well as factors associated with the participants of psychotherapy and its context, POR is ripe for new developments - regarding what to investigate and how to investigate it. This paper is the introduction of a series devoted to recent advances and future directions of POR as their pertained to routine outcome monitoring, technologies and artificial intelligence, the integration of constructs and methods from program evaluation and implementation science, and the investigation of populations with limited financial resources across various regions of the world. The series also includes commentaries from two leaders of POR.

Harnessing the potential of practice-based clinical optometry research in the United Kingdom.

Research is the core of evidence-based practice across all healthcare, in order to ensure optimum patient care. The College of Optometrists is a national standard setting institution for optometric practice in the United Kingdom. However, the standards are only as good as the available evidence, and currently there is little evidence relating directly to optometric practice. The National Institute of Health and Care Research, the General Medical Council and The College of Optometrists, amongst others, have published research strategies describing ambitious plans to expand the scope of healthcare research. The aim of this article is to raise awareness of these government initiatives and consider how they may relate to optometric practice. To improve optometrist research engagement, we need to address the barriers to research and implement strategies to overcome them. There are many opportunities to support research, with different degrees of involvement, from signposting patients to research studies, supporting recruitment or collecting data for a multicentre clinical trial, as well as undertaking an individual research project. Healthcare research is changing and there is scope for more practice-based research activities in optometry. Research should not be a solo endeavour but a multi-disciplinary effort. Greater collaborations across all stakeholders, including primary care, secondary care, academia, regulators and industry is needed to make this possible.

Therapeutic techniques and session impact: A practice-research network study in private practice.

Objective: This study investigated the relationship between therapeutic techniques and session impact, by examining the replicability of findings observed in a university-based training clinic (Boswell et al., 2010) in another practice-oriented setting: private practice.Method: N = 8 therapists completed session-level assessments of their technique use for N = 38 clients. The same client sample completed session-level assessments of session outcome. Technique-outcome associations were examined with multilevel models.Results: As in Boswell et al., common factors were associated with positive session impact. For clients who received higher average common factor techniques (relative to their own therapist's caseload), session impact was the poorest in sessions with higher behavioral change techniques use (relative to the client's own average). Moreover, clients with the lowest average common factor techniques (relative to their therapist's caseload) reported better session impact in sessions that involved a higher degree of session-level behavioral change techniques (relative to their own average).Conclusion: In line with Boswell et al., therapists should be mindful of the consistency of their routine technique use between- and within-clients, and this can be aided through collection of their own practice-oriented data.

What if we wait? Using synthetic waiting lists to estimate treatment effects in routine outcome data.

Objective: Due to the lack of randomization, pre-post routine outcome data precludes causal conclusions. We propose the "synthetic waiting list" (SWL) control group to overcome this limitation.Method: First, a step-by-step introduction illustrates this novel approach. Then, this approach is demonstrated using an empirical example with data from an outpatient cognitive-behavioral therapy (CBT) clinic (N = 139). We trained an ensemble machine learning model ("Super Learner") on a data set of patients waiting for treatment (N = 311) to make counterfactual predictions of symptom change during this hypothetical period.Results: The between-group treatment effect was estimated to be d = 0.42. Of the patients who received CBT, 43.88% achieved reliable and clinically significant change, while this probability was estimated to be 14.54% in the SWL group. Counterfactual estimates suggest a clear net benefit of psychotherapy for 41% of patients. In 32%, the benefit was unclear, and 27% would have improved similarly without receiving CBT.Conclusions: The SWL is a viable new approach that provides between-group outcome estimates similar to those reported in the literature comparing psychotherapy with high-intensity control interventions. It holds the potential to mitigate common limitations of routine outcome data analysis.

Implementation Science and Practice-Oriented Research: Convergence and Complementarity.

Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.

Substance use workforce training needs during intersecting epidemics: an analysis of events offered by a regional training center from 2017 to 2020.

BACKGROUND: Intersecting opioid overdose, COVID-19, and systemic racism epidemics have brought unprecedented challenges to the addiction treatment and recovery workforce. From 2017 to 2020, the New England Addiction Technology Transfer Center (ATTC) collected data in real-time on the training and technical assistance (TA) requested and attended by the front-line workforce. This article synthesizes practice-based evidence on the types of TA requests, topics of TA, attendance numbers, and socio-demographics of TA attendees over a 3-year period spanning an unprecedented public health syndemic. METHODS: We assessed TA events hosted by the New England ATTC using SAMHSA's Performance Accountability and Reporting System post-event survey data from 2017 to 2020. Events were coded by common themes to identify the most frequently requested training types/topics and most frequently attended training events. We also evaluated change in training topics and attendee demographics over the three-year timeline. RESULTS: A total of 258 ATTC events reaching 10,143 participants were analyzed. The number of TA events and attendance numbers surged in the 2019-2020 fiscal year as TA events shifted to fully virtual during the COVID-19 pandemic. The absolute number of opioid-related events increased, but the relative proportion remained stable over time. The relative proportions of events and attendance rates focused on evidence-based practice and health equity both increased over the 3-year period, with the largest increase after the onset of the pandemic and the murder of George Floyd. As events shifted to virtual, events were attended by providers with a broader range of educational backgrounds. CONCLUSIONS: Results of the current analysis indicate that the demand for TA increased during the pandemic, with a prioritization of TA focused on evidence-based practice and health equity. The practice-based evidence generated from the New England ATTC may help other training and TA centers to anticipate and nimbly respond to the needs of the workforce in the face of the intersecting epidemics.

Instrumentation during the second stage of periodontal therapy: a European survey.

OBJECTIVES: To gather practice-based information about instrumentation during the second stage of periodontal therapy among the members of the European Federation of Periodontology. METHODS: This survey was conducted to investigate periodontal instrumentation (e.g., frequency, instruments, their maintenance) during the second stage of periodontal therapy. RESULTS: Questionnaires from 2008 responders actively involved in periodontal therapy (general dental practitioners, periodontists, and dental hygienists) were analyzed. The frequency of use of hand and mechanical instruments was similar during the second stage of periodontal therapy and 94.4% of the participants combined both. The most popular hand instruments were Gracey curettes, and the preferred mechanical devices were ultrasonic scalers. For the latter, mostly the combination of standard and micro/slim inserts was preferred (42.4%) over solely standard inserts (32.1%) or micro/slim inserts (25.5%). The wear of hand instruments was sytematically checked by 46.1% of the respondents and the wear of the inserts by 41.3%. The more experienced the dental professional, the more frequent the wear of the instruments and inserts was checked. CONCLUSION: The most popular periodontal instrumentation technique in clinical practice during the second stage of periodontal therapy is a combination of hand and mechanical instruments. CLINICAL RELEVANCE: Clinicians should check the wear of their instruments systematically to have the most performant instruments possible for periodontal instrumentation. Scientists should see the results of this questionnaire as an incentive to set up studies investigating whether the combination of hand and mechanical instruments, the preferred treatment method of clinicians, is better than either of these instruments alone.

Practice-based evidence: Perspectives of effective characteristics of Australian group-based physical activity programs for postpartum women.

ISSUE ADDRESSED: Many postpartum women often do not achieve recommendations of at least 150 minutes moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has focused on postpartum women's barriers and challenges to being active, with recent research starting to explore the characteristics of PA programs and women who are active during the postpartum period. Yet, little research has focused on the characteristics of key stakeholders and community organisations that support women to sustain their PA engagement during the postpartum period. METHODS: This research generates practice-based evidence to provide essential insights for effective implementation, strategies and actions of community group-based PA programs that recruit and retain postpartum women to ensure future interventions are scalable and sustainable. Ten participants (90% female), ranging in age from 34 to 40 years, were recruited from nine community organisations/businesses. The ten participants engaged in semi-structured interviews for an average length of 31 minutes. RESULTS: Inductive thematic analysis revealed four overarching themes (i) effective practitioners have a history of, and passion for women's health and PA; (ii) low-cost, connected approaches attract postpartum women into community group-based PA programs; (iii) inclusive, flexible, varied, and holistic approaches sustain postpartum women's participation; and (iv) utilise connections to overcome barriers to community group-based PA programs. These four themes were informed by twelve sub-themes relating to the background of stakeholders and practitioners and the approaches that they use to attract and sustain postpartum women in community group-based PA programs. CONCLUSIONS: Practice-based findings should inform future practices and the development of future real-world group-based PA interventions for postpartum women. SO WHAT?: Specifically, interventions will need to be designed and implemented by practitioners who have a history of, and passion for women's health and PA, be low-cost, connected approaches, that are inclusive, flexible, varied, and holistic that prioritise physical, emotional, and social wellbeing.

A Grounded Model of How Educators Earn Students' Trust in a High Performing U.S. Urban High School.

This article presents a grounded model of how educators earn students' trust in a high performing U.S. urban high school. This long-term anthropological project set out to understand the beliefs and practices of experienced teachers and staff members nominated by students as helping them feel like they belonged in school. Analysis of study data revealed a process of mutual discernment whereby adults and young people were reading one another as they explored the possibilities of entering into learning partnerships. For the educators, study data led us to infer that their trust building strategies were largely based on imagining the student discernment process, and responding to a set of unspoken queries about them that, over time, they seem to have learned were often on the minds of students (e.g. "Why are they here?" "How much do they respect me?"). The grounded model and practice-based evidence presented here summarize the strategies and approaches educators used to respond to these unspoken queries and communicate to students various aspects of their selves and their stance, including their motivation, empathy and respect for students, self-awareness and credibility, their professional ability, and finally, their commitment to helping students and investing emotional labor in them. Throughout, data are also presented regarding how students perceived and experienced these strategies, and ultimately how they interpreted and appraised their relationships with educators, as trusting relationships were developed.

A national evaluation of the Irish public health counselling in primary care service- examination of initial effectiveness data.

BACKGROUND: The Counselling in Primary Care service (CIPC) is the first and only nationally available public counselling service in the Republic of Ireland. This study provides initial data for the effectiveness of short-term psychotherapy delivered in a primary care setting in Ireland for the first time. METHOD: A practice-based observational research approach was employed to examine outcome data from 2806 clients receiving therapy from 130 therapists spread over 150 primary care locations throughout Ireland. Pre-post outcomes were assessed using the CORE-OM and reliable and clinically significant change proportions. Binary logistic regression examined the effect of pre therapy symptom severity on the log odds of recovering. Six and 12 month follow up data from a subsample of 276 clients were also analysed using growth curve analysis. RESULTS: Of 14,156 referred clients, 5356 presented for assessment and 52.3% (N = 2806) consented to participate. Between assessment and post-therapy a large reduction in severity of symptoms was observed- Cohen's d = 0.98. Furthermore, 47% of clients achieved recovery,a further 15.5% reliably improved, 2.7% reliably deteriorated and34.7% showed no reliable improvement. Higher initial severity was associated with less chance of recovering at post-therapy. Significant gains were maintained between assessment and12 months after therapy- Cohen's d = 0.50. CONCLUSIONS: Outcomes for clients in the CIPC service compared favourably with large scale counselling and psychotherapy services in jurisdictions in the U.K., the U.S.A., Norway and Sweden. This study expands the international primary care psychotherapy research base to include the entire Republic of Ireland jurisdiction.

A practice-based evidence investigation of God representations in spiritually integrated psychotherapies.

OBJECTIVE: This practice-based evidence study examined trajectories of God representations and psychological distress among Christians participating in spiritually integrated psychotherapies (SIPs). METHODS: In total, 17 clinicians practicing SIPs in a mid-sized city on the US Gulf Coast implemented session-to-session assessments of these outcomes with 158 clients over a 4-month period and also reported their use of specific spiritual interventions after each session (e.g., affirmed client's divine worth). RESULTS: Multivariate growth modeling revealed clients' psychological distress decreased over the study period whereas authoritarian God representations increased and benevolent God representations remained stable. In addition, clients who increased in benevolent representations of God had a greater likelihood of experiencing alleviation of psychological distress. CONCLUSION: These findings affirm the potential efficacy of SIPs and cultural importance of belief in a benevolent deity as a source of strength, identity, and potential healing among Christians clients who prefer a spiritually integrated approach in psychotherapy.

Strengthening public health nutrition: findings from a situational assessment to inform system-wide capacity building in Ontario, Canada.

OBJECTIVE: To assess public health nutrition practice within the public health system in Ontario, Canada to identify provincial-wide needs for scientific and technical support. DESIGN: A qualitative descriptive study was conducted to identify activities, strengths, challenges and opportunities in public health nutrition practice using semi-structured key informant interviews (n 21) and focus groups (n 10). Recorded notes were analysed concurrently with data generation using content analysis. System needs were prioritised through a survey. SETTING: Public health units. PARTICIPANTS: Eighty-nine practitioners, managers, directors, medical officers of health, researchers and other stakeholders were purposively recruited through snowball and extreme case sampling. RESULTS: Five themes were generated: (i) current public health nutrition practice was broad, complex, in transition and collaborative; (ii) data/evidence/research relevant to public health needs were insufficiently available and accessible; (iii) the amount and specificity of guidance/leadership was perceived to be mismatched with strong evidence that diet is a risk factor for poor health; (iv) resources/capacity were varied but insufficient and (v) understanding of nutrition expertise in public health among colleagues, leadership and other organisations can be improved. Top ranked needs were increased understanding, visibility and prioritisation of healthy eating and food environments; improved access to data and evidence; improved collaboration and coordination; and increased alignment of activities and goals. CONCLUSIONS: Collective capacity in the public health nutrition can be improved through strategic system-wide capacity-building interventions. Research is needed to explore how improvements in data, evidence and local contexts can bridge research and practice to effectively and efficiently improve population diets and health.

Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use.

Adolescent substance use-the consumption of alcohol, tobacco, and other harmful drugs-remains a persistent global problem and has presented ongoing challenges for public health authorities and society. In response to the high rates of adolescent substance use during the 1990s, Iceland has pioneered in the development of the Icelandic Model for Primary Prevention of Substance Use-a theory-based approach that has demonstrated effectiveness in reducing substance use in Iceland over the past 20 years. In an effort to document our approach and inform potentially replicable practice-based processes for implementation in other country settings, we outline in a two-part series of articles the background and theory, guiding principles of the approach, and the core steps used in the successful implementation of the model. In this article, we describe the background context, theoretical orientation, and development of the approach and briefly review published evaluation findings. In addition, we present the five guiding principles that underlie the Icelandic Prevention Model's approach to adolescent substance use prevention and discuss the accumulated evidence that supports effectiveness of the model. In a subsequent Part 2 article, we will identify and describe key processes and the 10 core steps of effective practice-based implementation of the model.

Implementing the Icelandic Model for Preventing Adolescent Substance Use.

This is the second in a two-part series of articles about the Icelandic Model for Primary Prevention of Substance Use (IPM) in this volume of Health Promotion Practice. IPM is a community collaborative approach that has demonstrated remarkable effectiveness in reducing substance use initiation among youth in Iceland over the past 20 years. While the first article focused attention on the background context, theoretical orientation, evaluation and evidence of effectiveness, and the five guiding principles of the model, this second article describes the 10 core steps to practical implementation. Steps 1 to 3 focus on building and maintaining community capacity for model implementation. Steps 4 to 6 focus on implementing a rigorous system of data collection, processing, dissemination, and translation of findings. Steps 7 to 9 are designed to focus community attention and to maximize community engagement in creating and sustaining a social environment in which young people become progressively less likely to engage in substance use, including demonstrative examples from Iceland. And Step 10 focuses on the iterative, repetitive, and long-term nature of the IPM and describes a predictable arc of implementation-related opportunities and challenges. The article is concluded with a brief discussion about potential variation in community factors for implementation.

Latent trajectories of change for clients at a psychodynamic training clinic.

OBJECTIVE: Employing practice-based research methods, we addressed the need to examine the effectiveness of psychodynamic treatment as a supplement to the efficacy evidence offered by randomized clinical trials. METHOD: We used person-centered analyses to generate latent subgroups of clients (N = 118; M age = 40.92; 53.4% female; 81.4% Caucasian; 80.5% heterosexual) receiving contemporary relational psychotherapy (CRP) at a psychodynamic community mental health training clinic. RESULTS: Subgroups of clients reported a change in depression, social conflict, and anxiety symptomatology, and overall life satisfaction, depicted by significant quadratic growth curves. Findings also offered exploratory support for a theoretical proposition from CRP that improved relational functioning would correspond to improved affect dysregulation and overall life satisfaction. CONCLUSION: Clinical and training implications highlight the need to distinguish subgroups of "responders" and "nonresponders" to inform treatment.

Enhancing the National Dialogue on the Prevention of Intimate Partner Violence.

Little systematic information exists about how community-based prevention efforts at the state and local levels contribute to our knowledge of intimate partner violence (IPV) prevention. The Centers for Disease Control and Prevention's (CDC) DELTA FOCUS program funds ten state domestic violence coalitions to engage in IPV primary prevention through approaches addressing the outer layers of the social ecology. This paper explored the ways in which DELTA FOCUS recipients have contributed to a national-level dialogue on IPV prevention. Previously undefined, the authors define national-level dialogue and retrospectively apply the CDC Science Impact Framework (SIF) to describe contributions DELTA FOCUS recipients made to it. Authors conducted document review and qualitative content analysis of recipient semi-annual progress reports from 2014 to 2016 (N = 40) using NVivo. A semi-structured coding scheme was applied across the five SIF domains: Creating Awareness, Catalyzing Action, Effecting Change, Disseminating Science, and Shaping the Future. All recipients sought to promote IPV prevention by communicating and sharing with non-CDC-funded state coalitions, national partners, and other IPV stakeholders information and resources accumulated through practice-based prevention efforts. Through implementing and disseminating their prevention work in myriad ways, DELTA FOCUS recipients are building practice-based evidence on community-based IPV prevention.

A Practice-Based Research Database to Study Perinatal Nurse Home Visiting to Pregnant Women With Diabetes.

BACKGROUND AND AIMS: Accumulation of real-world evidence from practice-based perinatal nurse home visits to pregnant women with diabetes prompted this translational perinatal health disparities research. Given the global diabetes epidemic, this academic-community partnered research team is studying the utilization, processes, and outcomes of this understudied model of perinatal nurse home visiting that provide home-based enhanced diabetes care to pregnant women. Because the nursing records provide the rich source of data for the study, our aim is to provide an in-depth description of the Philadelphia Pregnancy and Diabetes Home Visiting (PPD-HV) research database developed from data in the longitudinal nursing records. METHODS: This descriptive study uses retrospective data abstracted from paper-based perinatal nurse home visiting clinical records to create the PPD-HV, a HIPAA compliant, secure REDCap electronic research database. The sample includes 248 urban, pregnant women with diabetes who received a total of 1,644 home visits during the year 2012. The setting was Philadelphia, a large metropolitan city in the northeastern part of the United States. The PPD-HV database followed the information fields of the paper-based clinical nursing forms, which were originally designed by following the Omaha System to guide documenting the nursing process used in caring for patients in their homes. RESULTS: Using REDCap, the PPD-HV research database is robust with 239 variables and captures longitudinal clinical nursing data. Among the pregnant women with diabetes receiving nurse home visits, the mean age was 30.7 years, most were single, and had given birth to other children. LINKING EVIDENCE TO ACTION: Real-world clinical nursing practice data provide a rich source of research data to advance understandings about this model of enhanced diabetes care and the pregnant women with diabetes receiving the care. Considering the global epidemic of diabetes, this is a perinatal nurse home visiting model to replicate and evaluate.

Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research.

Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and its application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan, deliver, and evaluate the preventive dose of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. Although there is general agreement among practitioners and scientists on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when, and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity building will foster more effective public health practice.