. "11 Implementation and Dissemination of Prevention Programs." Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press, 2009.
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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
also experienced significant recruitment challenges. The use of focus groups and community partnerships to adapt the intervention and select settings for data collection and intervention, as well as inclusion of program and evaluation staff with similar cultural backgrounds, have allowed these studies to maintain excellent participation rates over time (Murry and Brody, 2004). Other factors may also contribute to low participation rates, including the stigma associated with a program aimed at mental health, substance use, or problem behaviors; competing family demands, including multiple jobs or shift work; and community distrust of researchers.
Successful implementation, including the ability to sustain a program, requires investments in people, relationships, and time, as well as coordination around such critical issues as staffing and funding (Neumann and Sogolow, 2000). Organizations with little flexibility, fewer connections with professionals, and limited history with innovation may be the most in need of change but least capable of achieving it (Rogers, 1995; Kondrat, Greene, and Winbush, 2002; Hoagwood, Burns, et al., 2001; Schoenwald and Hoagwood, 2001). Many agencies that lack academic or other affiliations often need technical assistance, staff support, and implementation resources to implement preventive interventions (Spoth, Kavanagh, and Dishion, 2002). Community-based agencies often grapple with high staff turnover and lack of adequate space, facilities, and equipment, all of which can interfere with sustainability (Kellam and Langevin, 2003; Swisher, 2000). Technical tasks, such as maintenance of data systems to assess risk factors, fidelity, outcomes, and satisfaction, are especially challenging when implementation is guided by community-based organizations or partnerships (Dzewaltowski, Estabrooks, et al., 2004).
Empirical work demonstrates that the types of changes required to implement and sustain preventive interventions are difficult to achieve. Robertson, Roberts, and Porras (1993) noted in a meta-analysis that organizations that aimed at changing factors, such as organizational climate and culture, along with technological and strategic factors, were more successful than organizations that targeted only one of these areas. Valente’s (1996) social network threshold model for innovation, which pairs local champions of a program—who can provide information outside the organization about a program—with those in an organization who can change or shape its agenda is relevant to implementation of prevention programs.
Both organizational climate and culture reflect the norms, expectations, and values of the organization, and they have strong influences on innovation and the adoption of new mental health service programs (Glisson and James, 2002). Glisson and colleagues use a change agent to facilitate