Technical Assistance for Systemic Change: Lessons Learned From a National Technical Assistance Center.

Despite the millions of dollars awarded annually by the United States Department of Education to build implementation capacity through technical assistance (TA), data on TA effectiveness are severely lacking. Foundational to the operationalization and consistent research on TA effectiveness is the development and use of standardized TA core competencies, practices, and structures. Despite advances toward a consistent definition of TA, a gap still exists in understanding how these competencies are used within an operationalized set of TA practices to produce targeted outcomes at both individual and organizational levels to facilitate implementation of evidence-based practices. The current article describes key insights derived from the evaluation of an operationalized set of TA practices used by a nationally funded TA center, the State Implementation & Scaling Up of Evidence Based Practices (SISEP) Center. The TA provided by the Center supports the uptake of evidence-based practices in K-12 education for students with disabilities. Lessons learned include: (1) the need to understand the complexities and dependencies of operationalizing TA both longitudinally and at multiple levels of the system (state, regional, local); (2) the relative importance of building general and innovation-specific capacity for implementation success; (3) the value of using a co-design and participatory approach for effective TA delivery; (4) the need to develop TA providers' educational and implementation fluency across areas and levels of the system receiving TA; and (5) the need to ensure coordination and alignment of TA providers from different centers. Gaining an understanding into optimal TA practices will not only provide clarity of definition fundamental to TA research, but it will also inform the conceptual framing and practice of TA.

Implementation Science to Advance Care Delivery: A Primer for Pharmacists and Other Health Professionals.

Health care is experiencing increasing pressure to implement evidence-based interventions that improve quality, control costs, and maximize value. Unfortunately, many clinical services and interventions to optimize medication use do not consistently produce the intended humanistic, clinical, and economic outcomes. The lack of conclusive results is believed to stem from the widely recognized research-to-practice gap. The field of implementation science seeks to discover and apply strategies designed to accelerate successful integration of interventions into routine practice. This primer provides an overview of implementation science principles for pharmacists and other health care providers interested in accelerating practice transformation to improve health care delivery and, ultimately, patient care.

The Active Implementation Frameworks: A roadmap for advancing implementation of Comprehensive Medication Management in Primary care.

Implementation of evidence-based health services interventions is complex and often limited in scope. The Active Implementation Frameworks (AIFs) are an evidence-based set of frameworks to use when attempting to put into practice any innovation of known dimensions. This article describes the novel application of the AIFs to facilitate the implementation and improvement of Comprehensive Medication Management (CMM) in primary care practices to optimize medication use and improve care for patients.

Exploration and validation of clusters of physically abused children.

OBJECTIVE: Cluster analysis was used to enhance understanding of heterogeneity in social adjustment of physically abused children. METHOD: Ninety-eight physically abused children (ages 5-10) were clustered on the basis of social adjustment, as measured by observed behavior with peers on the school playground and by teacher reports of social behavior. Seventy-seven matched nonabused children served as a comparison sample. Clusters were validated on the basis of observed parental sensitivity, parents' self-reported disciplinary tactics, and children's social information processing operations (i.e., generation of solutions to peer relationship problems and attributions of peer intentions in social situations). RESULTS: Three subgroups of physically abused children emerged from the cluster analysis; clusters were labeled Socially Well Adjusted, Hanging in There, and Social Difficulties. Examination of cluster differences on risk and protective factors provided substantial evidence in support of the external validity of the three-cluster solution. Specifically, clusters differed significantly in attributions of peer intent and in parenting (i.e., sensitivity and harshness of parenting). Clusters also differed in the ways in which they were similar to, or different from, the comparison group of nonabused children. CONCLUSIONS: Results supported the contention that there were clinically relevant subgroups of physically abused children with potentially unique treatment needs. Findings also pointed to the relevance of social information processing operations and parenting context in understanding diversity among physically abused children. PRACTICE IMPLICATIONS: Pending replication, findings provide support for the importance of considering unique treatment of needs among physically abused children. A singular approach to intervention is unlikely to be effective for these children. For example, some physically abused children might need a more intensive focus on development of prosocial skills in relationships with peers while the prosocial skills of other abused children will be developmentally appropriate. In contrast, most physically abused children might benefit from training in social problem-solving skills. Findings also point to the importance of promoting positive parenting practices in addition to reducing harsh discipline of physically abusive parents.

Diversity in adjustment of maltreated children: factors associated with resilient functioning.

Many decades of research indicate that physical abuse and neglect are associated with substantial risk for maladaptation across many developmental tasks of childhood, adolescence, and adulthood. Recent investigations, however, indicate that in spite of elevated risk for negative outcomes, some abused and neglected children demonstrate relatively positive adjustment and success in developmental tasks. An overview of studies of resilient functioning among maltreated children is provided, and results indicate that although a proportion of maltreated children do appear to be resilient to harsh and inadequate caretaking, resilient functioning might be short-lived and/or limited to single areas of functioning. A summary of factors associated with resilient functioning among abused and neglected children is provided. Such factors include individual child characteristics (e.g., self-regulatory processes), features of the child's family context (e.g., supportive parenting), and experiences in the broader environment (e.g., close friendships). Methodological considerations and recommendations for further research are provided, and implications of this literature for clinical and policy applications are presented.

Factor structure and validity of the parenting stress index-short form.

The psychometric properties of the Parenting Stress Index-Short Form (PSI-SF) were examined in a sample of 185 mothers and fathers. Factor analysis revealed 2 reasonably distinct factors involving parental distress and dysfunctional parent-child interactions. Both scales were internally consistent, and these scales were correlated with measures of parent psychopathology, parental perceptions of child adjustment, and observed parent and child behavior. PSI-SF scores were related to parent reports of child behavior 1 year later, and the Childrearing Stress subscale was a significant predictor of a parental history of abuse.

Subgroups of physically abusive parents based on cluster analysis of parenting behavior and affect.

Cluster analysis of observed parenting and self-reported discipline was used to categorize 83 abusive parents into subgroups. A 2-cluster solution received support for validity. Cluster 1 parents were relatively warm, positive, sensitive, and engaged during interactions with their children, whereas Cluster 2 parents were relatively negative, disengaged or intrusive, and insensitive. Further, clusters differed in emotional health, parenting stress, perceptions of children, and problem solving. Children of parents in the 2 clusters differed on several indexes of social adjustment. Cluster 1 parents were similar to nonabusive parents (n = 66) on parenting and related constructs, but Cluster 2 parents differed from nonabusive parents on all clustering variables and many validation variables. Results highlight clinically relevant diversity in parenting practices and functioning among abusive parents.

Child-related cognitions and affective functioning of physically abusive and comparison parents.

OBJECTIVE: The goal of this research was to utilize the cognitive behavioral model of abusive parenting to select and examine risk factors to illuminate the unique and combined influences of social cognitive and affective variables in predicting abuse group membership. METHODOLOGY: Participants included physically abusive parents (n=56) and a closely-matched group of comparison parents (n=62). Social cognitive risk variables measured were (a) parent's expectations for children's abilities and maturity, (b) parental attributions of intentionality of child misbehavior, and (c) parents' perceptions of their children's adjustment. Affective risk variables included (a) psychopathology and (b) parenting stress. A series of logistic regression models were constructed to test the individual, combined, and interactive effects of risk variables on abuse group membership. RESULTS: The full set of five risk variables was predictive of abuse status; however, not all variables were predictive when considered individually and interactions did not contribute significantly to prediction. A risk composite score computed for each parent based on the five risk variables significantly predicted abuse status. Wide individual differences in risk across the five variables were apparent within the sample of abusive parents. CONCLUSIONS: Findings were generally consistent with a cognitive behavioral model of abuse, with cognitive variables being more salient in predicting abuse status than affective factors. Results point to the importance of considering diversity in characteristics of abusive parents.