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首页> 外文期刊>Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 >From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families
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From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families

机译：从计划到系统：部署实施科学和实践以在儿童和家庭服务中确保现实世界的持续有效性

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The transfer of knowledge of effective practice, especially into "usual care" settings, remains challenging. This article argues that to close this gap we need to recognize the particular challenges of whole-system improvement. We need to move beyond a limited focus on individual programs and experimental research on their effectiveness. The rapidly developing field of implementation science and practice (ISP) provides a particular lens and a set of important constructs that can helpfully accelerate progress. A review of selected key constructs and distinctive features of ISP, including recognizing invisible system infrastructure, co-construction involving active collaboration between stakeholders, and attention to active implementation, supports for providers beyond education and training. Key aspects of an implementation lens likely to be most helpful in sustaining effectiveness include assisting innovators to identify and accommodate the architecture of existing systems, understand the implementation process as a series of distinct but nonlinear stages, identify implementation outcomes as prerequisites for treatment outcomes, and analyse implementation challenges using frameworks of implementation drivers. In complex adaptive systems, how services are implemented may matter more than their specific content, and how services align and adapt to local context may determine their sustained usefulness. To improve implementation-relevant research, we need better process evaluation and cannot rely on experimental methods that do not capture complex systemic contexts. Deployment of an implementation lens may perhaps help to avoid future "rigor mortis," enabling more productively flexible and integrative approaches to both program design and evaluation.
机译：有效实践知识的转移，尤其是向“常规护理”环境的转移，仍然具有挑战性。本文认为，要弥合这一差距，我们需要认识到整个系统改进的特殊挑战。我们需要超越对单个程序的有限关注，并对其有效性进行实验研究。迅速发展的实施科学与实践（ISP）领域提供了一个特殊的视角和一组重要的构造，可以帮助加速进步。对ISP选定的关键结构和独特功能的审查，包括认识到看不见的系统基础架构，涉及利益相关者之间积极合作的共同构建以及对积极实施的关注，为提供者提供了教育和培训以外的支持。实施透镜可能对保持有效性最有帮助的关键方面包括：协助创新者识别和适应现有系统的架构，将实施过程理解为一系列不同但非线性的阶段，将实施结果确定为治疗结果的前提，以及使用实施驱动程序框架分析实施挑战。在复杂的自适应系统中，服务的实现方式可能比其特定内容更为重要，服务如何与本地环境保持一致并适应其可能会决定其持续的实用性。为了改善与实施相关的研究，我们需要更好的过程评估，并且不能依赖无法捕获复杂系统环境的实验方法。部署实施透镜可能有助于避免将来的“严峻考验”，从而为程序设计和评估提供更具生产力的灵活性和集成性的方法。

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