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.

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.

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.

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).

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.

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).

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.