Research and Services Partnerships: Partnership: A Fundamental Component of Dissemination and Implementation Research

In this section, we present three examples of partnered D&I studies, which range from testing existing models of partnership to developing and testing new partnership approaches and conducting partnered D&I research. These examples of ongoing work exemplify the shift in D&I research from a top-down, linear view of the spread of information and interventions to a complex, dynamic cycle of interaction among researchers, practitioners, and policy makers.

Patricia Chamberlain of the Oregon Social Learning Center and an interdisciplinary team are studying the implementation of multidimensional treatment foster care (MTFC) across counties in California and Ohio (6). MTFC is an evidence-based intervention to decrease problem behavior and increase developmentally appropriate and prosocial behavior among children and adolescents in need of out-of-home placement. Chamberlain and colleagues are testing community development teams, an organizational development-based partnership model pioneered by the California Institute of Mental Health, as a strategy for implementing MTFC. The investigators are conducting an ongoing randomized trial of MTFC implementation, examining whether community development teams increase the number of counties that successfully adopt, implement, and sustain MTFC programs compared with counties that are using standard implementation methods. An explicit purpose of the implementation model used by the teams is building positive relationships, collaborations, and partnerships among consumers, system and political leaders, agencies, and practitioners that have an impact on the MTFC implementation process. Well-specified mechanisms, such as multicounty team meetings and peer-to-peer exchange, target specific processes—culture, climate, and attitudes—to support MTFC implementation (6).

In another example, Sheryl Kataoka of the University of California, Los Angeles (UCLA), the Los Angeles Unified School District, and researchers at UCLA have collaborated in the development of a school-based intervention for youths who are symptomatic after exposure to a traumatic event. Cognitive-behavioral intervention for trauma in schools (CBITS), which has been shown to be effective in a randomized trial, is delivered to groups of youths on school campuses. Although it has been implemented in more than a dozen sites across the country, CBITS has not been broadly implemented or sustained in schools (7).

Kataoka and colleagues are pilot-testing the impact of learning collaboratives as an implementation strategy to increase the spread and sustainability of CBITS. Learning collaboratives, such as the Institute for Healthcare Improvement’s Breakthrough Series, are a frequently used implementation practice within broader health care systems. The study by Kataoka and colleagues (7) tests the benefit of convening multidisciplinary teams of administrators, supervisors, and clinicians from various organizations and engaging them in shared learning and problem solving to address school-specific organizational barriers to CBITS implementation, particularly organizational factors associated with implementation effectiveness.

Finally, Kenneth Wells of UCLA and RAND, Loretta Jones of Healthy African American Families, Inc., and a team of researchers and Los Angeles community members are studying whether a community partnership approach to implementing collaborative care for depression leads to better uptake of evidence-based models of care (8). The study team and research process employ the community-partnered participatory research (CPPR) model (9), which is used when a community identifies a health problem as a high priority and partners with academic researchers, each sharing resources and expertise to address the health problem. The resulting project, Community Partners in Care (CPIC), builds on prior work showing the benefit of collaborative care for underserved populations with depression. CPIC tests a community engagement and network development intervention to promote adoption of collaborative care in underserved Los Angeles communities. Community stakeholders have contributed ideas and guidance to all aspects of the research design, including selection of the targeted sample and key outcomes (notably the inclusion of functioning and employment) and recruitment practices.

Although these three examples represent early successes in the involvement of partners, we see several opportunities to further enhance partnership in D&I research.

Now more than ever, we see continued opportunities for growth in the capacity and complexity of the field of D&I research. The National Institutes of Health (NIH) recently reissued the standing program announcements (11–13), emphasizing the centrality of research-practice partnerships at the heart of the field. As the announcement states, “D&I research will include significant and ongoing collaboration with stakeholders from multiple public health and/or clinical practice settings as well as consumers of services and their families/social networks” (10). Furthermore, review criteria for the announcements encourage clear demonstration of stakeholder involvement within the project team. These explicit statements reflect the importance of partnership as a criterion for high-quality D&I research.

In addition, since 2011, the Training Institute on Dissemination and Implementation Research in Health, which is sponsored by NIH and the U.S. Department of Veterans Affairs, has offered a week-long curriculum for approximately 30 investigators annually to develop expertise in D&I research. Part of the application to participate in the institute asks investigators to specify existing networks and partnerships for future collaboration in research. The curriculum has multiple sessions (14) describing the importance of community partnerships to dissemination and implementation.

Through these and other mechanisms, we strive to create science-practice partnerships that conduct more rigorous and relevant research (15), ensure that research efforts do not end with publication, and increase the likelihood that benefits from research are sustained over time. D&I research is limited if it relies on individuals working in isolation; success in the field requires partnership as part of an “evidence integration triangle” (16).

Although we have seen promise and progress in the development of partnerships to conduct D&I research, we are still limited by the omnipresent divide between research, practice, and policy. Although D&I partnerships can help overcome the challenges of moving from a study to full-scale implementation, we see ultimate success in a new metaphor: a learning mental health care system, where research, practice, and policy coexist toward the ultimate gain of continuous improvement of outcomes for people who seek care, practitioners who offer it, and systems that organize it.

The authors report no competing interests.