Bridging science and practice in violence prevention: addressing ten key challenges.
ABSTRACT This article illustrates ideas for bridging science and practice generated during the Division of Violence Prevention's (DVP) dissemination/implementation planning process. The difficulty of moving what is known about what works into broader use is near universal, and this planning process pushed us to look beyond the common explanations (e.g., providers were resistant/unwilling to change practice) and think about the multiple layers and systems involved. As part of this planning process, the Interactive Systems Framework for Dissemination and Implementation (ISF) was developed and then applied to the fields of child maltreatment and youth violence prevention. Challenges for each of the three systems in the ISF are discussed as well as and action and research ideas to address the challenges. Also described are actions taken by DVP in response to the planning process to illustrate how a funder can use the ISF to bridge science and practice.
- Criminology & Public Policy 05/2013; 12(2).
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ABSTRACT: At Home/Chez Soi, a large, $110-million, randomized trial evaluating the effectiveness of Housing First services for 2,235 individuals who are homeless and experiencing mental illness, was implemented in five Canadian cities, beginning in fall 2009. This paper describes initial implementation of the Housing First model, focusing on specific strategies, including centrally coordinated training/technical assistance and local site coordinators as change agents in each city. Implementation of this complex intervention varied across sites but was remarkably consistent regarding the essential ingredients of the program model. A strategy that balanced a strong centrally coordinated approach to technical assistance with customization and adaptation on the local level was essential for achieving a high fidelity implementation.American Journal of Psychiatric Rehabilitation 10/2013; 16(4).
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ABSTRACT: This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates ( Foshee et al., 1996); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003).Aggression and Violent Behavior 07/2014; · 1.95 Impact Factor
Bridging Science and Practice in Violence Prevention:
Addressing Ten Key Challenges
Centers for Disease Control and Prevention
University of South Carolina
Centers for Disease Control and Prevention
University of South Carolina
University of South Carolina
Georgia Division of Public Health
The findings and conclusions in this report are those of the authors and do not necessarily
represent the views of the Centers for Disease Control and Prevention.
This article illustrates ideas for bridging science and practice generated during the
Division of Violence Prevention’s (DVP) dissemination/implementation planning process. The
difficulty of moving what is known about what works into broader use is near universal, and this
planning process pushed us to look beyond the common explanations (e.g., providers were
resistant/unwilling to change practice) and think about the multiple layers and systems involved.
As part of this planning process, the Interactive Systems Framework for Dissemination and
Implementation (ISF) was developed and then applied to the fields of child maltreatment and
youth violence prevention. Challenges for each of the three systems in the ISF are discussed as
well as and action and research ideas to address the challenges. Also described are actions taken
by DVP in response to the planning process to illustrate how a funder can use the ISF to bridge
science and practice.
Bridging Science and Practice in Violence Prevention:
Addressing Ten Key Challenges
As has been stated earlier in this volume (Saul et al.; Wandersman et al.), there is a gap
between what is known about preventing public health problems such as violence, and what we
as a society actually do to prevent these problems. In order to generate new ideas for bridging
science and practice, the Division of Violence Prevention (DVP) of the Centers for Disease
Control and Prevention (CDC) engaged in a dissemination/implementation (D/I) planning
process that began in 2005 (Saul et al., this issue). The intended results of the D/I planning
process were action plans for 1) new D/I activities and 2) new research on the D/I of innovations
for the prevention of child maltreatment and youth violence. The ideas for D/I activities were to
specify what could be disseminated and implemented now based upon current scientific
knowledge. For example, what should be disseminated, to whom, through what types of
mechanisms and what efforts should be put into place to support those D/I activities? The
research ideas were to suggest questions about the D/I process that, if answered, would improve
D/I efforts in the future and move the violence prevention field closer to widespread use of
science- and theory- based innovations. Throughout this article, we use the term innovation to
refer to new knowledge or information that could be useful to prevention efforts in the field. In
the realm of prevention, innovations typically can be categorized as programs, policies,
processes, and principles (see Saul et al., this volume).
In order to generate ideas for D/I activities and research, those involved in the planning
process first developed the Interactive Systems Framework for Dissemination and
Implementation (ISF) upon which discussions about D/I were centered (Wandersman, et. al, this
issue). Key challenges that stand in the way of successful dissemination and/or implementation
were then generated for each of the three systems in the framework (i.e., Prevention Synthesis
and Translation, Prevention Support, and Prevention Delivery Systems). The action ideas for D/I
activities and research are intended to address these obstacles.
In this article, we summarize 10 key challenges and accompanying action ideas that were
identified through the D/I planning process of expert meetings, reviews of relevant literature, and
planning team discussions. Eight of the challenges are primarily related to the Prevention
Synthesis and Translation System, Prevention Support System, or Prevention Delivery System,
whereas two of the issues cut across multiple systems. These challenges and action ideas (as well
as the ISF itself) were developed with the fields of child maltreatment and youth violence in
mind; however, we believe that they are broadly applicable to the D/I of prevention in other
fields. The Division of Violence Prevention (DVP) has taken steps in several different areas of
violence prevention based on the ISF and action ideas. In this article we present these steps taken
by DVP in the hopes that others might benefit from specific examples of how the framework and
action ideas can be applied.
Prevention Synthesis and Translation System
The Prevention Synthesis and Translation System (PSTS) works to distill information
generated through research, then prepares it for dissemination and implementation in the field.
The primary activities of this system are to synthesize existing research and translate it for use by
practitioners (Wandersman et al., this issue).
Key Issues for PSTS
Challenge #1 -- Lack of support for synthesis and translation activities.
The researchers who attended the expert meeting articulated that there is little to no
incentive for synthesizing and translating their research findings for use by the Prevention
Support and Prevention Delivery Systems. This type of work is generally not well supported by
funding agencies and the type of products that result (particularly from translation) are not
highly valued by the academic institutions in which many researchers work. This lack of support
discourages researchers from participating in research synthesis and translation, two critical
functions in the D/I process.
Challenge #2 – Lack of clear guidance for practitioners on accessing research syntheses.
Practitioners at the expert meeting emphasized that they are uncertain about where and
how they should access the best information on innovations, as well as how to best integrate the
information into their violence prevention efforts. They are often too busy to seek out
information that is not targeted directly to them (e.g., articles in peer reviewed journals). In other
cases, information overload can be an issue. For example, in the field of youth violence, there
are several “best practice” documents and lists available – these sources of synthesized
information use different terminology, different criteria for inclusion of innovations, and there is
some, but not complete, overlap of strategies across the various sources. Having multiple
sources for syntheses can serve to confuse rather than to clarify what strategy might be best for a
particular organization or community. Practitioners are sometimes unsure which sources of
synthesized information are credible and among those that are credible, which ones contain
content most relevant to their work.
Action Ideas for PSTS
The activities proposed to address PSTS key challenges revolve around increasing
support for the development and use of synthesis and translation products. Participants made
suggestions about the type of findings that should be translated, who should be involved in
creating synthesis and translation products and how the use of these products could be supported.
Activity ideas ranged from broad and overarching to very specific.
The need for syntheses and translations in several content areas were suggested,
including: effective prevention strategies (e.g., meta-analyses on “what works” to prevent
various forms of violence); effective approaches to building both general and innovation-specific
capacity (e.g., what does research say about the best approaches to training and technical
assistance?); and core elements that are common to effective programs when there is a large
body of research on “what works” in a given topic area (e.g., core elements of effective parenting
programs). Participants also stressed the need to translate what they called scientific “mini
findings.” In other words, they suggested that we should not wait for a large literature to amass
before addressing the relevance of research findings for the practice field. A specific example
would be to translate findings as they come out in areas where there is a dearth of information,
and thus, something like a meta-analysis would be premature (e.g., if evidence for a new
protective factor for youth violence was emerging in the literature).
In addition to ideas about the content and types of syntheses and translations, participants
at the meeting also discussed the process for developing translation products. First, they stressed
that it is critical to involve multidisciplinary teams in the translation process. Researchers are
needed to ensure that the final product is still scientifically accurate. However, translation
should not be done by researchers alone. Practitioners should also be part of the process to
ensure that the product being developed is accessible and relevant to the end users. In addition,
it may be helpful to include individuals with other types of expertise (e.g., communications,
social marketing). Another important aspect of translation development is the inclusion of “so
what” and “how to” pieces in each translation. In other words, why should practitioners care
about the information being translated – what benefit is it to them? And, how exactly, should
they go about using the information? An emphasis on answering the “so what” and “how to”
questions suggests that the translation function is more than just creating a straightforward
translation of scientific facts into non-research language. Translation also includes a marketing
function – communicating not only what science says about innovations, but also building the
case for why it would be beneficial to incorporate those innovations into practice.
Finally, the experts at our meetings suggested that DVP should develop support
documents or tools to help practitioners navigate the world of research, especially in areas where
there are large bodies of research and syntheses. Such a tool might include information about
how to locate synthesized information, assess the quality of synthesized information and the
strength of the evidence presented, determine how applicable the information is to their
organization or community, and begin the process of selecting and implementing strategies based
on the available information (e.g. identifying community needs and resources, goals, and key
stakeholders to include).
D/I research suggestions for the PSTS centered on the translation function, and
specifically the marketing aspect of translation. Research regarding the PSTS should build on
existing literature, such as research on factors that lead to selection and adoption of innovations,
particularly related to how practitioners weigh the costs/benefits (or “relative advantage”) of
adopting innovations (Fixsen et al., 2005). At the CDC expert meeting, many of those involved
in prevention practice pointed out that there are costs to changing practice which researchers and
funders often do not take into account. Some specific research questions of interest that were
identified included the following: what functions do existing strategies serve; what are the costs
to practitioners associated with changing strategies; what can be done to increase the perceived
advantage of using evidence-based prevention and lower perceived risks of use?
Recent Actions Taken by DVP
At the time of the expert meeting, scientists from DVP were already conducting a meta-
analysis on key components of effective parent training programs, a strategy commonly used in
child maltreatment and youth violence prevention. DVP is currently developing a product for
practitioners that will translate the parenting meta-analysis. This translation activity is in direct
response to several of the action ideas generated via the D/I planning process. The parent training
meta analysis identifies program components that are consistently associated with positive
outcomes for parents and children – this is the exact type of content that those at the expert
meeting thought should be translated for practitioners’ use. The content of the translation
product will not only include the results of the meta-analysis but will discuss why this
information is important to the fields of youth violence and child maltreatment prevention and
how the information can be used. The development process of this translation was heavily
influenced by the advice of the experts at the meeting. Most importantly, there has been a multi-
disciplinary team involved in the creation of the translation from its inception. This team
includes the researchers who conducted the meta-analysis, a review committee of practitioners,
and a communications expert. In addition to this core team, the product concept has been vetted
with many child maltreatment practitioners through presentations at meetings and conferences.
The inclusion of these different perspectives has influenced the content and format of the
product. For example, through the continued raising of “so what” and “how to” questions by the
review committee and other practitioners, two products are being drafted instead of the one that
was initially envisioned: a longer, more detailed version for programmatic decision makers as
well as a shorter version for front line practitioners.
The inclusion of the researchers has assured that the scientific integrity of the analysis has
remained intact through the different iterations of the translation. Because this project is fairly far
along, there are already a few “lessons learned.” The inclusive, multi-disciplinary process is very
time consuming and thus, should be streamlined so that each participants’ time is used
efficiently. In addition, the researchers who have been involved in this translation are CDC staff
members and the practitioners on the review committee already had close partnerships with
either CDC or the communications consultant. Therefore, this project could proceed without
seeking funds to compensate the majority of the participants for their time. In the future, this
may not be possible. Although not yet complete, the initial success of this process has led to the
planning of other translation products.
Prevention Support System (PSS)
The Prevention Support System (PSS) provides support for the successful
implementation of evidence-based prevention strategies via the Prevention Delivery System
(PDS). The primary functions identified for this system include: innovation-specific capacity
building (assistance that is related to using a specific innovation) and general capacity building
(assistance that enhances the infrastructure, skills, and motivation of an organization, but does
not focus on a specific innovation). This assistance can be provided in a number of ways, such as
training, technical assistance, and coaching.
Key Issues for the PSS
Challenge #3– Lack of access to existing prevention support.
Prevention support is potentially available from a number of national, state, and local
resources, but meeting participants suggested that practitioners are sometimes unaware of what
resources are available and from what sources they should obtain prevention support. Barriers to
accessing existing support may present particular challenges to those who could benefit most
from capacity building. A study on use of technical assistance suggests that those with the least
capacity are less likely than those with more capacity to seek out technical assistance, even when
it is made available (Mitchell, Stone-Wiggins, Stevens, & Florin, 2004).
Challenge #4 – Lack of systematic, high-quality prevention support.
Although some prevention support is available for practitioners, our experts suggested the
available support is not always based on what we know about effective capacity building. For
example, popular mechanisms for providing prevention support are one-time, didactic,
continuing education courses and training workshops, despite a literature suggesting that these
approaches are unlikely to change practitioner behavior (Davis, 1995; Joyce & Showers, 2002;
Schectman, et. al, 2003; Smeele, et. al, 1999). In addition, those who attended the expert
meetings pointed out critical gaps in the capacity building literature, including a need for more
information on the most effective strategies for increasing general and innovation-specific
The extent to which these PSS challenges exist may depend on the field of inquiry. At
our expert meeting, the youth violence experts discussed the limited existence of capacity
building infrastructure within their field. Conversely, child maltreatment experts acknowledged
that there is a good deal of capacity building infrastructure within their field. Therefore, their
concerns were more focused on the issues of quality and coordination.
Action Ideas for the PSS
Suggestions for addressing PSS challenges focus on: improving practitioners’ access to
what currently exists in the PSS, and providing incentives to improve the reach and quality of
capacity building functions of the PSS. One action idea raised at the expert meeting was to
identify and catalogue available PSS resources, so that this information can be communicated to
practitioners in a clearer and more systematic way. A comprehensive catalogue of prevention
support (e.g., type, topic, source) could reduce confusion among practitioners about how and
where to obtain capacity building resources. Funders can play a key role in strengthening the
PSS by increasing incentives to provide effective capacity building. Those who are funded as
providers of prevention support could be encouraged or even required to use evidence-based
approaches to capacity building and to evaluate their training and technical assistance activities
just as those who deliver programs are required to evaluate their efforts. For example, training
providers could be asked to incorporate what is known about successful adult learning
approaches into their training programs. An additional strategy for improving the PSS includes
an explicit link to the PSTS. Those who provide capacity building may not be aware of what the
literature says about effective prevention strategies. Thus, synthesizing and translating the
literature about “what works” and ensuring that this information drives the content of capacity
building efforts would serve to strengthen the prevention support available to practitioners.
The need for more information on how to effectively build capacity suggests several
potential areas of inquiry for research. An initial step in understanding the PSS will be to clearly
define and operationalize general and innovation-specific capacity and to develop measures of
these constructs. In addition, capacity building evaluations should consistently move beyond
examining process and short-term outcomes, such as how many people attended training and
how satisfied the participants were. Although important for improving training, these types of
outcomes do not demonstrate whether or not training or technical assistance actually resulted in
increased capacity among those who will deliver prevention strategies or the changes in practice
expected to accompany increased capacity. Thus, measures of capacity and changes in practice
(e.g., use of evidence-based prevention innovations) at the individual and organizational level
should be key outcomes when evaluating capacity building efforts.
Another limitation of the existing research on capacity building is that it focuses
primarily on providing innovation-specific support for the implementation of programs.
Research is needed on building general capacity as well as innovation-specific capacity for other
types of innovations (e.g., prevention principles, processes, and policy change). We do not yet
know whether the same methods and techniques commonly used for innovation-specific capacity
building for prevention programs should also be used when providing support for building
general capacity or innovation-specific capacity for using prevention principles, processes, and
DVP Actions Taken in Response to these Issues
DVP’s experiences working with the PDS in various fields of violence prevention were
integrated into the discussions at the expert meeting and subsequently influenced the inclusion of
the PSS as one of the focal points of the ISF. It has become very clear over the years that
varying levels of both general and innovation-specific capacity exist within the PDS. For
example, many organizations with which we were working had sufficient capacity to function as
organizations; however the capacity to deliver specific violence prevention strategies was more
varied. The D/I planning process and the development of the ISF have provided DVP with an
explicit frame for developing a PSS to build general and innovation-specific capacity. These
concepts are being used in the Division’s programmatic efforts in all violence prevention areas.
DVP has committed resources for the establishment of a PSS for violence prevention
called the Capacity and Prevention Support System (CAPSS). CAPSS will provide an
infrastructure to increase both the general and innovation-specific capacity of violence
prevention organizations through training, technical assistance and coaching on organizational
functioning (e.g., developing logic models, hiring evaluation support, building communities of
practice, etc) as well as on the principles of implementing a public health approach to violence
prevention (e.g., focus on primary prevention, use of data to make decisions).
Another way that DVP has integrated these action ideas into its work is in the evaluation
of capacity building efforts with grantees. DVP’s DELTA1 and EMPOWER2 programs aim to
1 DELTA -- Domestic Violence Prevention Enhancement and Leadership through Alliances
2 EMPOWER -- Enhancing and Making Programs and Outcomes Work to End Rape
prevent intimate partner violence and sexual violence, respectively. The capacity building efforts
within these programs are currently focused upon increasing the capacity of grantees to engage
in primary prevention. In addition, both programs include a significant evaluation component
that will assess whether or not DELTA and EMPOWER grantees have increased skills and
motivation for engaging in primary prevention after their exposure to efforts to build prevention
Prevention Delivery System (PDS)
The Prevention Delivery System (PDS) carries out the activities necessary to implement
prevention innovations within practice settings in local communities, or at state or national
levels. The individuals, organizations, and communities that carry out prevention delivery
activities have varying levels of existing capacity which is defined by Saul and colleagues (this
issue) as including both ability and motivation to implement prevention. Within the ISF,
Wandersman, et. al (this issue) distinguish between two types of capacity: general capacity to
carry out activities related to maintaining a functioning organization, and innovation-specific
capacity to implement a specific innovation with quality and continue its use over time.
Key Challenges for the PDS
Challenge #5 – Lack of prevention infrastructure.
A key assertion of the ISF is that in order for the PDS to function effectively, a
prevention infrastructure is necessary. That is, there need to be prevention-oriented
organizations, networks and financial resources focused on the delivery of prevention
innovations. Participants in the expert meetings raised a number of concerns about the limitations
of the infrastructure in the fields of youth violence prevention and child maltreatment prevention.
They noted that many of the organizations devoted to serving youth and children do not
specifically focus on the prevention of youth violence and child maltreatment, even if the work
they do is relevant to the prevention of these problems (e.g., youth development organizations).
Another challenge identified is that even among organizations that include violence prevention
as a part of their mission, prevention activities may take a back seat to other priorities or there
may be tension between prevention and providing services to those already affected by violence.
At least part of this tension may be due to the lack of availability of staff to work on prevention.
The experts were concerned about the ability of practice organizations to build capacity to carry
out prevention if staff had no time or resources to acquire the necessary knowledge and skills to
do the work. In addition, it was pointed out that the lack of a clear professional identity for those
working in prevention further limits the growth of a strong infrastructure and may contribute to
high staff turnover in the field.
Challenge #6 -- Need to better understand the implementation process.
Even when infrastructures do exist for the delivery of violence prevention strategies,
effective implementation of an innovation is a major challenge (e.g., Durlak & Dupree, this
issue). Multiple authors have pointed out that the implementation of innovations (whether
programs, processes, or principles) is itself an ongoing process including specific stages (e.g.
Rogers, 1995; Simpson, 2002). While a number of frameworks for organizing the process of
implementation have been developed, many questions about the factors that affect this process
remain. The majority of research published to date has focused on the early end of the