Creating the HHS COVID-19 Public Education Media Campaign: Applying Systems Change Learnings.

The COVID-19 Public Education Media Campaign was initiated in July 2020 by the US Department of Health and Human Services (HHS). The process by which the Campaign was developed and operated by the HHS Office of the Assistant Secretary for Public Affairs (ASPA) was different than for other HHS campaigns. Nine learnings from recent ASPA systems change efforts were employed to guide development and implementation of the Campaign. The learnings, based in communication science as well as experience, have not been applied or have been inconsistently applied in other HHS campaigns. In this case, their application kept the Campaign's work focused on public health needs and not on political diversions. Separable from content and media aspects of the Campaign, the development and operational process guided by the nine learnings resulted in accomplishments such as: (1) advisory input and operation by a team of Federal employees from across the US Government; (2) award of large Federal contracts in a much shorter time than is typical, (3) proactive response to concerns from Congress, largely driven by the news media, (4) ability to make Campaign revisions in the context of the rapidly evolving science about the pandemic, and (5) ability to transcend the unusual political realities of a Presidential election season and the transition of administrations. Ways the nine learnings were applied to the Campaign's creation and operation may provide useful guidance to U.S. Government officials and others planning and conducting similar efforts in politically charged environments.

Creating a Robust Digital Communications Strategy for the US Department of Health & Human Services.

The US Department of Health and Human Services (HHS) has developed and is implementing an agency-wide Digital Communications Strategy. A robust strategy to coordinate digital communications is vital at times of crisis, such as the COVID-19 pandemic - and will be needed as part of an effective HHS campaign to motivate individuals who are hesitant to accept coronavirus vaccines. Using science-based principles of systems change, a four-phase approach was developed in alignment with the 21st Century Integrated Digital Experience Act (IDEA). Phase I involved announcing a plan for creating and implementing the HHS Digital Communications Strategy, including support for it from the HHS Secretary. Phase II involved gathering information and stakeholder support, with an interview research study as the central component for providing input and encouraging stakeholder engagement. Phase III focused on building the Strategy through an iterative process. Phase IV, which is ongoing, concentrates on implementing the Strategy, measuring the impact of digital communications and supporting the budget required to modernize Federal digital communications approaches to meet the American public's needs. Learnings from the work so far are consistent with those from prior HHS systems change efforts in communications - and are helping to improve the Strategy in real time.

Facilitators and Barriers to Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care in Integrated Health Care Settings.

BACKGROUND: Substance abuse in the United States is a serious public health concern impacting morbidity and mortality. However, systematic screening and intervention has not been widely adopted into routine practice by health care organizations and routine screening and intervention is not currently in place for primary care at Kaiser Permanente Colorado. Therefore, a formative evaluation was conducted to explore and enhance implementation of the Substance Abuse and Mental Health Services Administration (SAMHSA) screening, brief intervention, and referral to treatment (SBIRT) approach in the organization. METHODS: Key clinical stakeholders, including internal and family medicine physicians, primary care nurses, mental health therapists, chemical dependency clinicians, and clinic-based psychologists provided feedback. Two focus groups were also conducted with patient stakeholders: one in English and one in Spanish. RESULTS: All clinical stakeholders promoted clinic-based psychologists to conduct brief intervention and determine referral to treatment as the optimal implementation program. Inclusion of the patient perspective also highlighted the importance of considering this perspective in implementation. Both patient groups were generally supportive of SBIRT, especially the educational value of screening questions defining healthy drinking limits; however, English-speaking patients noted privacy concerns and Spanish-speaking patients noted frequently being asked about drug or alcohol use. Organizationally, systems exist to facilitate drug and alcohol use screening, intervention, and referral to treatment. However, physician time, alignment with other priorities, and lack of consistent communication were noted potential barriers to SBIRT implementation. CONCLUSIONS: Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening, but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.

Mobilizing communities to implement evidence-based practices in youth violence prevention: the state of the art.

Community mobilization can increase the effective implementation of evidence-based practices (EBPs) in youth violence prevention. These strategies bring together people and organizations in a community to try to solve or reduce a problem. They help communities address the challenges of identifying EBPs, disseminating them to local decision-makers, and then implementing and sustaining them if they are successful. Science-based systems for implementing EBPs such as PROSPER and Communities That Care can help to integrate this complex work in communities. Further insight about implementing EBPs in youth violence prevention is being developed through the CDC-funded Academic Centers for Excellence in Youth Violence Prevention. Community mobilization approaches for seven of these programs are discussed, highlighting successful approaches and challenges encountered.

Cognitive impairments and the prevention of homelessness: research and practice review.

Cognitive impairments can increase significantly a person's level of risk for becoming or remaining homeless. Five topics are explored that address these impairments in preventing homelessness: (1) the nature and estimated prevalence of cognitive impairments among people who are homeless, especially those with vulnerabilities like mental illness or substance abuse; (2) the multiple origins of these impairments; (3) how these impairments impact services for people at risk for homelessness; (4) good practice approaches to handling cognitive impairments in homeless shelters, supported housing programs, and other service systems for people at risk for homelessness; and, (5) important research and practice issues requiring further action.

The role of effective discharge planning in preventing homelessness.

Effective discharge planning can contribute significantly to preventing homelessness. As part of a larger continuum of care, this process can help people reach goals of stable housing, recovery, and increased quality of life in the community. Discharge planning identifies and organizes services a person with mental illness, substance abuse, and other vulnerabilities needs when leaving an institutional or custodial setting and returning to the community. A three-component model is presented, relating discharge planning to institutional assessment and treatment, and to community services. Service challenges, innovative programs (based on a state-by-state analysis), and recommendations for enhancing discharge planning also are discussed.

Research to practice: efforts to bring effective prevention to every community.

This manuscript describes the pioneering efforts of the Substance Abuse and Mental Health Services Administration's attempts to catalog knowledge, support, and further evaluate the application of evidence-based prevention. The paper begins with a discussion of scientific inquiry, including discussion of cause-and-effect relationships, theory that is useful in explaining those relationships, and suggestion of the opportunities and limitations of research in these and other areas. The authors then describe a system that has been introduced by the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention (CSAP) to systematically access and review applied research efforts in drug abuse prevention and related fields. In addition to identifying the key elements of this National Registry of Effective Prevention Programs (NREPP), the authors provide a brief history of prior efforts that have led us to this point.