Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework

Aby, Martha

doi:10.1007/s10488-020-01033-2

Cited by 8 publications

(6 citation statements)

References 33 publications

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“…Models provide a roadmap-a systematic structure for the development, management, and evaluation of all parts of a study [21]. While there are over 100 models to guide implementation science research, only a handful explicitly include health equity [20,90,94,[106][107][108][109]. These frameworks are informed by development and use of a larger set of models on health and equity [110].…”

Section: Integrate Equity Into Implementation Modelsmentioning

confidence: 99%

“…The research process does not always align with priorities of those experiencing inequities and often moves more slowly than innovations in practice and policy. In a study of implementation of mental health services, Aby found three important themes showing how participants experienced implementation: invisibility (e.g., not enough mental health providers of color), isolation (e.g., separation and lack of collaboration among key stakeholder), and inequity (e.g., feeling tokenized or unwelcome) [ 94 ].…”

Section: Recommendationsmentioning

confidence: 99%

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Implementation science should give higher priority to health equity

et al. 2021

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Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

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Section: Integrate Equity Into Implementation Modelsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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“…The growing rates of suicide attempts among Black adolescents, for example, were faster among Black girls than their male counterpart. Yet, little is known about how various social identities intersect and affect suicidal trajectories and how intersectionality can guide equity-focused implementation efforts (Aby 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study

Xiao

Lindsey

2021

Adm Policy Ment Health

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Suicide is the second leading cause of death for people aged 10–34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents ( M age = 14.99 [SD = 1.61]) from Waves I–IV National Longitudinal Study of Adolescent to Adult Health (1994–2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01–2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21–2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69–4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08–2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage. Supplementary Information The online version contains supplementary material available at 10.1007/s10488-021-01122-w.

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“…Rapid implementation may not be desirable without sufficient tension for change and in some cases may trigger the subsequent need for de-implementation [ 22 ]. Furthermore, focusing solely on rapid approaches may allow for less time to elicit multiple and diverse perspectives to inform the implementation process and could even exacerbate inequities and health disparities, as demonstrated in previous implementation research [ 23 , 24 ].…”

Section: Implications For Implementation Researchersmentioning

confidence: 99%

Applying concepts from “rapid” and “agile” implementation to advance implementation research

Quanbeck

Garza

Park

2022

Implement Sci Commun

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Background The translation of research findings into practice can be improved to maximize benefits more quickly and with greater flexibility. To expedite translation, researchers have developed innovative approaches to implementation branded as “rapid” and “agile” implementation. Rapid implementation has roots in precision medicine and agile implementation has roots in systems engineering and software design. Research has shown that innovation often derives from learning and applying ideas that have impacted other fields. Implications for implementation researchers This commentary examines “rapid” and “agile” approaches to implementation and provides recommendations to implementation researchers stemming from these approaches. Four key ideas are synthesized that may be broadly applicable to implementation research, including (1) adopting a problem orientation, (2) applying lessons from behavioral economics, (3) using adaptive study designs and adaptive interventions, and (4) using multi-level models to guide implementation. Examples are highlighted from the field where researchers are applying these key ideas to illustrate their potential impact. Conclusions “Rapid” and “agile” implementation approaches to implementation stem from diverse fields. Elements of these approaches show potential for advancing implementation research, although adopting them may entail shifting scientific norms in the field.

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Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework

Cited by 8 publications

References 33 publications

Implementation science should give higher priority to health equity

Implementation science should give higher priority to health equity

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study

Applying concepts from “rapid” and “agile” implementation to advance implementation research

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