Initial discussions of a possible meeting about dissemination science occurred in the Academy of Psychological Clinical Science (APCS), an organization of science-oriented doctoral programs, and the APCS member program at the University of Delaware proposed to co-sponsor and host such a meeting in October, 2011. As this “Delaware Project” gained traction, with major additional sponsorship from NIMH, NIDA and OBSSR, its scope expanded beyond APCS programs and beyond dissemination to include the entire spectrum of intervention development – from basic translational research to implementation and dissemination. A particular concern was not to marginalize dissemination science by splitting it off from other arenas of intervention development, but rather to locate and integrate implementation within the broader stage model (adapted from Rounsaville, Carroll, & Onken, 2001) that several NIH institutes use to guide the funding of research projects.
By organizing the conference according to the NIH Stage Model, we were able to examine training possibilities along the entire spectrum of intervention science – from basic, translational, and efficacy research to dissemination and implementation. In addition to identifying continuities, we have grappled with the competing priorities and inevitable tensions the stage model presents, at least as these inform training. For example, the dialectic of internal versus external validity was a central theme throughout. The stage model focus should help to increase correspondence between graduate training and the structure of NIH funding. We recognize, however, that the stages may be less linear than recursive, with findings and experiences at later stages feeding back to influence research questions at earlier stages, as well as vice versa see Stages of Intervention Science, Appendix 2.
The initial two-day meeting at the University of Delaware had a participatory format Appendix 1, alternating between plenary (full group) and break out (work group) sessions. The main purpose of plenary sessions was to provide input and feedback that fuels the work group process. There were five work groups, each comprised of approximately 10 participants and commissioned to focus primarily (but not exclusively) on a particular stage of the intervention development stage model Appendix 2 and Appendix 3. The meeting has also included observers from NIH and other stakeholder organizations.
As noted above, the stage model focus highlights not only continuities but also tensions and competing priorities across the intervention development spectrum. In plenary 1, co-organizer Onken outlined current thinking about the NIH stage model; featured stimulus speakers Foa and Chorpita have heightened this dialectical tension; and Project chair Shoham then encouraged participants to consider possible synthesis. The dialectical theme will carry over to the work groups, where leaders and recorders bring expertise and familiarity with research at a given stage while work group ‘anchors’ bring complementary perspectives from other stages.
In extending this to the arena of training, the Delaware Project addressed two broad questions: (1) What should psychological clinical scientists of the future know and be able to do across the spectrum of intervention development? (2) How, when, and where can we best help them accomplish this? A set of more specific stimulus questions Appendix 4, distributed to participants before the meeting, served to sharpen this focus with respect to particular stages and their interrelationships, as well as for clinical science training in general. The stimulus questions have also distinguished training content (knowledge, skills, attitudes) from pedagogy (how to help trainees learn) and tried to locate both in the context of training stages (pre-internship, internship, post-doc) and settings (e.g., university clinics, VA centers, community and school-based programs).
Day-1 discussions were grouped according to the five stages of treatment development (see summaries in Appendix 6, A-E. Another set of product-focused questions, which emerged from Day-1 discussion, guided newly-composed workgroup activities on Day 2. These emergent group were charged with (a) articulating approaches to problem/project/inquiry-based learning, (b) identifying strategies for creating cross-stage, cross-institution training opportunities (c) outlining didactic and experiential resources for training in implementation and dissemination (d) proposing training experiences to reduce or eliminate, and (e) identifying ways to expand the context of clinical science training, outside the ivory tower. (See summaries of group discussions in Appendix 7, A-E.
The products of the meeting are now emerging. First we publish the conclusions and recommendations of day 1 and day 2 work-group discussions on the Project’s website Appendix6, Appendix 7. We are currently working on publishing some of the Project’s conclusions as a Special Section of Clinical Psychological Science. No less important, the website aims to provide a variety of Project products in training and scientific resources for dissemination to graduate programs, internships, and other training centers. To that end, the Project website committee invites submissions from the field. Longer-term products may include cross-program demonstration projects and practice-research training networks.
- Appendix 1: Meeting Agenda
- Appendix 2: Stages of Intervention Science
- Appendix 3: Work group composition
- Appendix 4: Stimulus questions for the work groups
- Appendix 5a: Reading list CORE
- Appendix 5b: Reading list SUPPLEMENTAL
- Appendix 6A: Basic
- Appendix 6B: Tx Generation
- Appendix 6C: Efficacy
- Appendix 6D: Effectiveness
- Appendix 6E: Implementation
- Appendix 7A: Project-based
- Appendix 7B: Cross-institution
- Appendix 7C: Training Resources
- Appedix 7D: Jettison
- Appendix 7E: Context