Dissemination and Implementation Core

传播和实施核心

• 批准号: 8195062
• 负责人: SARAH E LORD
• 金额: $ 20.34万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8195062
• 关键词: AIDS prevention; Address; Administrator; Adopted; Adoption; Behavior Therapy; Behavioral; Budgets; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Charge; Client; Clinic; Clinical Trials Network; Collaborations; Communication; Competence; Criminal Justice; Data; Development; Diffusion; Diffusion of Innovation; Disease; Drug Courts; Ensure; Evaluation; Evidence based intervention; Evidence based practice; Evidence based program; Evidence based treatment; Funding; Funding Agency; Goals; HIV; Health Personnel; Health Services; Health Technology; Healthcare; Hybrids; Individual; Intervention; Journals; Knowledge; Leadership; Learning; Light; Mainstreaming; Medical; Mental Health; Methods; Modeling; National Institute of Drug Abuse; Occupations; Organizational Change; Pamphlets; Patients; Performance at work; Persons; Philosophy; Physicians; Policies; Policy Maker; Process; Professional counselor; Protocols documentation; Provider; Public Health; Readiness; Reading; Registries; Relative (related person); Research; Research Infrastructure; Research Methodology; Research Personnel; Research Support; Resources; Risk Behaviors; Role; Science; Seeds; Services; Shapes; Social Work; Substance Abuse Treatment Centers; Substance Use Disorder; Substance abuse problem; System; Technology; Technology Transfer; Therapeutic; Time; Training; Training and Education; Translating; Treatment Effectiveness; Treatment Protocols; United States Substance Abuse and Mental Health Services Administration; Work; addiction; base; behavior change; behavioral health; care systems; community based service; community setting; cost effective; cost effectiveness; court personnel; evidence base; flexibility; improved; innovation; multidisciplinary; news; next generation; peer; practical application; programs; psychosocial; research study; substance abuse treatment; symposium; theories; tool; treatment program; uptake

Interdisciplinarv research focused on the development and evaluation of technology-based behavior change interventions for substance use disorders should be disseminated to a broad array of stakeholders across different organization levels to increase its likelihood of having a marked public health impact. While it is widely acknowledged across health service systems that treatment practices often do not align with research knowledge, substance abuse treatment programs have been particularly slow to adopt evidence-based practices (1,2). While substance abuse treatment providers are generally open to learning new treatment practices, particularly those they believe can help them do their job, there is considerable variability in practitioner readiness to adopt evidence-based interventions (EBls)(6). Practitioners grounded in more traditional addiction models, such as AA or a related 12-step, are less likely to use EBIs than practitioners trained in evidence-based practices(2). Clinicians in settings involved in research (e.g..Clinical Trials Network) are among those most likely to adopt evidence-based treatment practices ( 7). Many person-delivered EBIs, however, are labor-intensive and costly to deliver, and therefore do not align with the time and budget realities of most substance abuse treatment settings. Similar barriers to EBI adoption exist in other systems where individuals with substance use disorders could receive care, such as criminal justice and health care settings (4). In addition to practitioners' philosophies regarding treatment and organizational barriers to adoption of EBIs, the channels of knowledge transfer about treatment innovations are different for researchers vs. service providers. Researchers typically rely on academic journals for the dissemination of new knowledge, while providers are more likely to learn about new practices through colleagues or clients, seeing something in the news, reading a brochure, via a SAMHSA/CSAT-supported Treatment Improvement Protocol (TIP) or attending a professional conference(2). To achieve the goal of building evidence-based program knowledge among practitioners, program directors and policy makers, research information about treatment innovations needs to be synthesized and translated in a way that is accessible to the intended audience and clearly describes implications of the work for practice, organization, and policy (2,8). Furthermore, dissemination activities should be accompanied by evaluations to identify dissemination strategies that are most effective. Momentum for promoting evidence-based substance abuse treatment has grown in the past decade. Many federal funding agencies, such as SAMHSA/CSAT and CDC, require use of EBIs for organizations to receive funding(8). The efforts of NIDA and SAMHSA/CSAT to bridge the gap between research and practice have yielded important initiatives, including the Clinical Trials Network (CTN: NIDA), Addiction Technology Transfer Centers (CSAT/NIDA), Treatment Improvement Protocols (TIP: SAMHSA/CSAT, and the National Registry for Evidence-Based Programs and Practices (NREPP: SAMHSA). Still, the data highlight the continued challenges of EBI dissemination. To effectively translate the science of technology-based interventions for individuals with substance use disorders to practice, dissemination efforts must reach the diverse stakeholder and service system audiences, including patients/consumers, practitioners, program directors and administrators, researchers, service payors and policy-makers, with meaningful information and support material to optimize potential for program adoption within service systems. This is the goal of the Dissemination and Implementation (D&l) Core of the Center for Technology and Health (CTH). The Diffusion of Innovation(5) (DOI) theory is a useful framework to guide dissemination plans for technoloqv-based behavioral interventions to optimize their likelihood of adoption.The DOI model describes the process through which an innovation, defined as an idea perceived as new (i.e., technology-based treatments for substance abuse), spreads over time within a system (5). The model derives from a rich, multidisciplinary evidence base on the uptake of innovations, ranging from hybrid seed corn to HIV prevention (9,10). This groundbreaking model has contributed to a greater understanding of behavioral and organizational change, and has a broad scope of practical applications in the field of public health (10). The DOI model distinguishes between diffusion (passive spread of innovation), dissemination (active and planned efforts to persuade target groups to adopt an innovation), implementation (active and planned efforts to mainstream an innovation within an organization), and sustainability (making an innovation routine)(9). The (passive) diffusion of innovations typically occurs via unplanned, informal, decentralized, and horizontal communication channels (e.g., peer-to-peer), while active dissemination of an innovation is typically more centralized and likely to occur through vertical communication mechanisms (e.g., provider-program director)(9). The DOI model frames adoption of innovations as a function of characteristics of the innovation (e.g., technology-based behavior change interventions for individuals with substance use disorders), of individual adopters (e.g., consumers, substance abuse treatment counselors, physicians, drug court personnel) and of the organizations or systems within which the innovation could be adopted (e.g., criminal justice, substance abuse treatment centers, HIV clinics) (5). Characteristics of innovations that increase the likelihood of adoption of an innovation, such as a technology-based behavioral intervention, include (5,9) : (a) Relative advantage: extent to which potential end-users perceive a clear advantage for using the innovation, such as better treatment effectiveness, cost-effectiveness, or improved job performance, (b) Compatibility: extent to which innovations are compatible with intended users' values, norms, and perceived needs. Interventions to improve feasibility and workability of innovations at both individual and organizational levels can improve chances of successful adoption (c) Simplicity: extent to which innovations are perceived as easy to use and understand. Training and education can help build competence regarding use, (d) Trialability: extent to which intended users can try out or experiment with the innovation before making a decision about adoption, (e) Flexibility: degree to which an innovation can be readily integrated into a system's infrastructure, (f) Knowledge: extent of ready knowledge transfer about how to use an innovation, and (g) Support: extent to which innovations include augmented support (e.g., on-demand support, customization, help desk, etc., as needed)

跨学科研究的重点是基于技术行为的发展和评估 对于物质使用障碍的变更干预措施应分散到不同组织层面的各种利益相关者，以增加其对公共卫生影响明显的可能性。尽管在整个卫生服务系统中都广泛认为治疗实践通常与研究知识不符，但滥用药物治疗方案的采用基于证据的做法特别缓慢（1,2）。尽管药物滥用治疗提供者通常可以学习新的治疗方法，尤其是他们认为可以帮助他们完成工作的治疗方法，但从业人员准备采用基于证据的干预措施（EBLS）有很大的差异（6）。与接受循证实践培训的从业人员相比，以更传统的成瘾模型（例如AA或相关的12步）进行的基于更传统的成瘾模型（例如AA或相关的12步）的从业人员不太可能使用EBI（2）。在参与研究的环境中（例如，临床试验网络）的临床医生是最有可能采用循证治疗实践的临床医生（7）。但是，许多人交付的EBI是劳动力密集的，交付的成本很高，因此与大多数药物滥用治疗环境的时间和预算现实不符。在其他有毒品使用障碍的人可以接受护理的系统中，采用EBI采用的类似障碍，例如刑事司法和医疗保健环境（4）。 除了从业人员关于治疗和采用组织障碍的哲学 EBIS，有关治疗创新的知识转移渠道对于研究人员与服务提供商是不同的。研究人员通常依靠学术期刊来传播新知识，而提供者更有可能通过同事或客户了解新实践，通过SAMHSA/CSAT支持的治疗改进协议（TIP）或参加专业会议（2）（2）。为了实现在从业人员，计划董事和政策制定者之间建立基于证据的计划知识的目标，需要以预期受众可以访问的方式综合和翻译有关治疗创新的研究信息，并清楚地描述了作品对实践，组织和政策的含义（2,8）。此外，应该伴随评估活动，以确定最有效的传播策略。 在过去的十年中，促进基于证据的药物滥用治疗的动力已经增长。 许多联邦资助机构，例如SAMHSA/CSAT和CDC，都需要使用EBI供组织获得资金（8）。 The efforts of NIDA and SAMHSA/CSAT to bridge the gap between research and practice have yielded important initiatives, including the Clinical Trials Network (CTN: NIDA), Addiction Technology Transfer Centers (CSAT/NIDA), Treatment Improvement Protocols (TIP: SAMHSA/CSAT, and the National Registry for Evidence-Based Programs and Practices (NREPP: SAMHSA). Still, the data highlight the continued challenges of EBI传播，有效地转化了对物质使用障碍的个人进行基于技术的干预措施，以实现各种各样的利益相关者和服务系统，包括患者/消费者，从业人员，计划董事，计划主管和管理人员，研究人员，研究人员，研究人员，服务付款人和政策制造者，并提供有意义的信息和支持材料，以最大程度地掌握该系统的服务。用于技术与健康（CTH）。 创新的扩散（5）（doi）理论是指导传播计划的有用框架 基于技术的行为干预措施以优化其采用可能性。DOI模型描述了一种过程，该过程被定义为一种被认为是新的（即基于技术的药物滥用治疗方法）的创新，在系统中会随着时间的推移（5）散布。该模型源于从杂种玉米到预防艾滋病毒的丰富，多学科证据基础（9,10）。这种开创性的模型有助于对行为和组织变革有了更大的了解，并且在公共卫生领域具有广泛的实际应用范围（10）。 DOI模型区分了扩散（创新的被动传播），传播（主动和 计划说服目标群体采取创新的努力），实施（积极和计划的努力，使组织内部的创新成为创新）和可持续性（制定创新常规）（9）。创新的（被动）扩散通常是通过计划外，非正式，分散和水平沟通通道（例如，对等通道）发生的，而创新的主动传播通常更为集中，并且可能是通过垂直通信机制（例如，提供者，Provider-program主管）发生的（9）。 DOI模型框架采用创新作为创新特征的函数（例如， 基于技术的行为改变对物质使用障碍的人的行为改变干预措施），个人采用者（例如，消费者，滥用药物滥用治疗顾问，医师，药物法院人员）以及可以通过创新的组织或系统（例如，刑事司法，毒品滥用治疗中心，HIV诊所）（5）。创新的特征增加了采用创新可能性的可能性，例如基于技术的行为干预措施，包括（5,9）：（a）相对优势：潜在的最终用户在多大程度上对使用创新具有明显的优势，用于使用诸如更好的治疗效率，成本效益或改善的工作绩效，（b）的范围，（b）适当地兼容了范围，并正常地适应了范围。提高个人和组织层面创新的可行性和可行性的干预措施可以提高成功采用的机会（C）简单性：认为创新易于使用和理解的创新程度。 Training and education can help build competence regarding use, (d) Trialability: extent to which intended users can try out or experiment with the innovation before making a decision about adoption, (e) Flexibility: degree to which an innovation can be readily integrated into a system's infrastructure, (f) Knowledge: extent of ready knowledge transfer about how to use an innovation, and (g) Support: extent to which innovations include augmented support (e.g., on-demand support,根据需要定制，帮助台等）