Since the Institute of Medicine's seminal 2001 publication, Crossing the Quality Chasm, many have written about the 'research-practice gap'- whereby efficacious health innovations consistently fail to be adopted within real world practice settings. Addressing this gap is particularly important in the realm of maternal-child health, where implementing evidence-based practice has been more elusive than in other fields. The purpose of this K24 mid-career award is to apply the principles of dissemination and implementation science to family-based mental health, and to promote the adoption and spread of evidence-based interventions for maternal depression. Over the past nine years, Dr. Silverstein has developed and demonstrated the efficacy of Problem Solving Education (PSE) as a depression prevention strategy for low-income mothers. This K24 outlines a five year plan, whereby Dr. Silverstein will learn the theory and practice of dissemination and implementation science;conduct new research that embeds early implementation studies within a series of ongoing, R01- funded trials of PSE;and expand the reach and scope of his mentoring capacity. Dr. Silverstein's K24 career development activities include structured meetings with a team of experts in the fields of dissemination and implementation science, applied health services research, and child development;a two-year 'fellowship'with the Institute for Healthcare Improvement;and participation in didactic courses focusing on organizational behavior and innovation spread. This career development plan comes at a critical time in the course of Dr. Silverstein's research trajectory. Within the timeframe of the proposed K24, he will complete three depression prevention trials in diverse community-based and hospital settings. This presents a unique opportunity to compare the capacity of each setting to support essential program processes necessary for PSE's implementation and sustainability. The proposed K24 research plan includes 1) a Failure Modes and Effects Analysis to identify performance gaps in PSE's implementation across study settings;2) a series of qualitative interviews with stakeholders in each setting to provide insight into barriers and facilitators to PSE's implementation;and 3) a pilot test of an implementation strategy to promote fidelity to the PSE model in the neonatal intensive care unit - the site of a recently NICHD-funded multisite trial of PSE. Lastly, Dr. Silverstein will leverage his K24 research plans to expand the scope and reach of his mentoring capacity. His specific mentoring objectives are to assemble interdisciplinary mentoring teams with other researchers across the Boston University campus to guide junior investigators in conducting their work;expand the scope of his mentoring content to encompass dissemination and implementation research;and expand the reach of his mentoring to accommodate additional postdoctoral and junior faculty mentees. Dr. Silverstein's ultimate goal is to conduct - and to guide junior investigators in conducting - research that leads to the sustainable implementation of effective, generalizable programs for children and families.
Dr. Silverstein's career goal is to conduct - and to guide junior investigators in conducting - research that leads to the sustainable implementation of effective, generalizable programs for children and families. This K24 application is critical to achieving tha goal. It outlines a five year plan, whereby Dr. Silverstein will learn the theory and practice of dissemination and implementation science;conduct new research that embeds early implementation studies within a series of ongoing, R01-funded maternal depression prevention trials;and expand the reach and scope of his mentoring capacity among postdoctoral and junior faculty researchers.