. "10 Opportunities for Innovative Reforms and Knowledge Development." Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: The National Academies Press, 2009.
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Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention
innovation. We then review major issues related to the adoption, implementation, and dissemination of evidence-based parental depression care programs. Next, a guide to adopting innovations prepared the by Agency for Healthcare Research and Quality (AHRQ) is discussed (Brach et al., 2008). The AHRQ guide serves as an example of the generic resources available to planners and community partners seeking pragmatic information on the implementation of new health care programs. The section concludes with a research agenda to help support innovation, dissemination, and implementation of evidence-based depression care programs for depressed parents and their children across a wide range of venues.
The Mechanisms of Learning
Dissemination and implementation of promising models draw explicit attention to the mechanisms of learning, such as assimilation and use. Improved outcomes from depression care require that planners and practioners assimilate and skillfully use evidence-based practices and promising programs. Individual practitioners tasked with providing depression care for parents and children need opportunities to share their experience with new practices and programs with each other and with their service organizations and systems.
Despite significant advances in other fields, the importance of learning through the assimilation and use of evidence-based approaches has gone underappreciated in the health care and human services literature. Two emerging principles (cognitive load and context dependence), in particular, appear germane to the challenge of implementing practices and programs in depression care.
The first reflects the realization that the human ability to learn is constrained by cognitive load (Singley and Anderson, 1989). While some knowledge, such as the use of language, comes naturally and easily (except in unusual circumstances), most knowledge, when first received, has to be processed through the brain’s working memory (Geary, 2002). Although the capacity of working memory varies across individuals, it is unreasonable to expect that the knowledge entailed in often complex interventions can be converted into constructive actions among diverse clinicians on a reliable basis. Effective learning in organized settings generally takes time (Levitt and March, 1988). Clinical care guidelines have had a mixed record of uptake and effective use (Cabana et al., 1999; Grimshaw et al., 2004; Solberg et al., 2000; Stone, Sonnad, and Schweikhart, 2001), and the adoption of depression care guidelines, especially among clinicians who do not specialize in mental health, may be impaired in the absence of clear strategy to foster their use.
A second principle emerging from research is that learning always oc-