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Volume 11, Issue 1 (2020) Implementation in Real World Settings: The Untold Challenges

Implementation in Real-World Settings—The Untold Challenges: Evidence to Strengthen Your Toolkit

Researchers and practitioners are often working to improve practices both within their own organizations as well as in community settings—away from the highly controlled environments of laboratories. Anyone who has been part of program delivery, quality improvement projects, or community-based research knows it “ain’t easy.” There is often tension between delivering a program with fidelity--how the research says we should — and what is feasible and practical within the context it is being implemented. Furthermore, because this work is occurring in the “real world”, we must contend with changes and unexpected events that could potentially impact and jeopardize the work— pandemics, hurricanes, staffing changes, leadership changes, reorganization, mission change, site/agency closures, new policies at the federal level, new policies and procedures at the site or agency level, and new requirements from funders, just to name a few. It is what makes this work exciting and what makes it exhausting. Those of us in this business know that on top of being a subject matter expert in whichever field we work in, our job also includes a lot of problem solving, and in many cases problem solving with another organization(s) and often with people who have different goals and directives.

Luckily, there is an emerging field of implementation sciences and a growing body of literature around dissemination and implementation. Toolkits and frameworks have been developed to assist in the planning process, in the implementation and dissemination phases, and for evaluation and sustainability. However, as Crawford, Varghese, and Monsegue-Bailey point out in their article in this issue, “Despite decades of research on implementation and a vast array of studies proposing solutions … many implementation challenges continue to persist and perplex practitioners and researchers.”

In this special issue of the Journal of Applied Research on Children, we wanted to provide an opportunity to more fully examine the challenges faced when implementing new programs and practices aimed at impacting children and families within community settings as well as provide space to discuss tried/tested solutions to these challenges and related policy implications. It is far too common a practice to minimize discussion of the challenges encountered, and instead focus on the successes, leaving out what it took to get there. Consequently, new program administrators and researchers are continuously “reinventing the wheel” and “learning the hard way” versus learning, anticipating, and innovating from the previous work of their peers and leaders.

Our hope is that the efforts described within this issue will be used by fellow researchers and program staff working with children and families so that they may be able to anticipate potential challenges and be better prepared to find solutions. Additionally, we hope this issue provides useful insights for funders and policymakers so that they may, for example, decide that a planning period is needed and worth funding, or that infrastructure supporting long-term implementation and evaluation is valuable, or that policy changes (such as increased wages for childcare workers) are needed to best make use of the dollars spent on research and programming.

Introduction by guest editor Bethanie S. Van Horne, DrPH

Articles

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Adopting and growing a community-based early language program: Challenges and solutions for implementation success
Cary M. Cain, Kimberly Kay Lopez, Lynda Chima Aririguzo, and Angela Cummings

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The Implementation and Scaling of an Early Education Program
April Crawford, PhD; Cheryl Varghese, PhD; and Pauline Monsegue-Bailey, PhD

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Implementation Evaluation of an Education Program in Pediatric Clinics
Yen H. Nong, Kimberly Kay Lopez, and Dorothy Mandell

Original Contribution

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Integration of Behavioral Health Services into Primary Pediatric Care: The behind the scenes story of a pilot study in Southeast, Texas
Stephanie Chapman, Nancy Correa, Angela Cummings, Bethanie S. Van Horne, and Heidi Schwarzwald

New Research

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Factors Influencing the Implementation of Social Determinants of Health Screening and Referral Processes in Pediatric Settings Serving Medically Complex Patients
Katelyn K. Jetelina, Patricia Rodriguez, Oluwaseun K. Oke, M. Sunil Mathew, Susan Schoppa, Quiera Booker-Nubie, and Sarah E. Messiah

Supleam Doctrina (Additional Scholarship)

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Factors Promoting or Preventing Caregivers from Allowing Pediatric Participation in Research
José R. Fernández, Thomas Taylor, Yenni E. Cedillo, Beatriz Maciel, Daria Salyakina, and Jennifer McCafferty