Technical Assistance Research Articles

The Brussels effect in Africa: is it beneficial for intra-regional trade in digital services?

Abstract With cross-border data flows being central to the African Union’s digital transformation, African countries have adopted varied approaches to governing data transfers. We categorize these approaches into three regulatory models—open, conditional, and control—reflecting frameworks promoted by the USA, the European Union, and China, respectively. Using a gravity model, we assess how these models, along with comprehensive data protection laws, influence intra-regional trade in digital services. Our findings show that countries following the US-inspired open model experience higher trade volumes with other African trade partners, while the widespread adoption of the EU-inspired conditional model negatively impacts intra-regional digital trade. We do not find significant effects for the China-inspired control model. Additionally, we find that the adoption of a comprehensive data protection law, which in the region is often modelled after the EU’s General Data Protection Regulation, correlates negatively with trade, particularly for lower-income countries, potentially due to the cost burden of compliance. In the context of the recent commitment to open data flows undertaken by African Union members in the African Continental Free Trade Area’s Digital Trade Protocol, we estimate that open data flows could boost intra-regional digital services trade by 10.3%, or around 125 million USD. When developing regional data rules, we recommend that policymakers consider the unique needs of lower-income countries and provide technical assistance to face compliance costs.

Development Under the Shadow of Guns: An Empirical Analysis of Security-Development Nexus in Afghanistan.

Foreign and national militaries around the world have been increasingly involved in post-conflict reconstruction and development practices. In post 9/11, the trend of militarization of aid has been observed in many conflict-ridden countries but it is perhaps most visible in Afghanistan. Several studies highlighted the various reasons for the intangible achievements between 2001 and 2021 in Afghanistan; however, literature covering the anomalies of the security-development nexus remains scarce. The main aim of the paper is to critically analyse the security-development nexus by answering the questions: Why did development aid couldn’t achieve positive results in Afghanistan? Whose security and interests were served with the development aid programs? The security-development nexus poses a confounding paradox: which one should come first? Over six months (November 2021–April 2022), 26 semi-structured interviews were conducted with key respondents using purposive and snowball sampling. The paper argues that development under the US military authority brought military and civilian actors under one umbrella yet the existing cooperative framework was heavily influenced, in design and operation, by military actors.

Recovery and Response: Responding to Mental Health Needs That Emerged in the Wake of the COVID-19 Pandemic in Chicago Public Schools.

The COVID-19 pandemic elevated mental health needs among students. As such, in 2022 Chicago Public Schools (CPS) introduced the Comprehensive Mental Health and Suicide Prevention Policy to deliver mental health awareness and services to all pK-12th grade students. While transitioning back to in-person learning, an evaluation was conducted in the 2022-2023 school year to identify current practices and barriers of delivery, and identify lessons learned to support the policy in schools. Interviews were conducted with 30 staff members who delivered mental health services. Interviews were recorded, transcribed, and thematically coded. Themes identified in the interview highlighted barriers to providing mental health supports included: 1) overwhelming number of mental health cases with limited time and capacity; 2) mental health stigma among families and staff, and 3) the lack of diversity representation among mental health professionals in schools and the communities. Implications for School Health Policy, Practice, and Equity: CPS prioritized and elevated awareness of resources, training sessions and policies guidance through toolkits, newsletters, mandated trainings, and communication about new state mental health laws. The pandemic disrupted mental health services and illuminated critical barriers to access. CPS' Office of Student Health and Wellness used these findings to provide additional training and technical assistance for staff, families, and the community.

Collaborative Working Relationships Between Community Prevention Coalitions and Their Technical Assistance Providers: A Mixed Methods Approach for the Development of an Innovative Implementation Measure.

Prior research suggests that technical assistance which includes one-on-one, individualized support, guidance, and assistance is necessary to promote high-quality implementation of evidence-based interventions. However, this area lacks measures. This paper uses a mixed methods and community-engaged approach to develop and then evaluate a standardized measure of the collaborative working relationship between technical assistance providers and coalitions/coalition leaders. For measure development, researchers interviewed eight coalition leaders and eight coalition technical assistance providers about their experience providing or receiving technical assistance, using a human-centered design approach. A heat-mapping technique used with the interview data identified 11 themes related to the provision of high-quality technical assistance. Researchers then created survey items through an iterative process. After multiple rounds of revision and feedback with coalition leaders and coalition and technical assistance researchers, the reliability of seven of the constructs was piloted with 52 coalition leaders. The seven constructs included the following: competence and autonomy support, responsiveness, authentic and meaningful participation, co-creation, trust and rapport, compliance, and negative interactions. Researchers used Cronbach's Alphas and correlational analyses to further refine the scales. Empirical results mapped well onto prior theoretical work and suggested that the collaborative working relationship is a multi-dimensional construct. This research moves prevention research methods and measurement development into a more community-engaged, stakeholder-involved approach.

The BeWell Champion Program: A Worksite Wellness Initiative

Background: Adults spend most of their waking hours at work, which offers a setting to improve employee well-being. This paper describes the impact of an evidence-based employee wellness initiative on employees at a large health system. Methods: The project team provided virtual technical assistance and training to a designated champion at 22 enrolled clinical sites. Measures included an abridged version of the Centers for Disease Control and Prevention (CDC) Worksite ScoreCard, a process evaluation, and employee participation data. Champions used baseline data for their site to select wellness initiatives. Results: Results demonstrated positive improvements in multiple domains on the CDC Worksite ScoreCard, with significant improvements in organizational support and the overall score. Conclusion: Utilization of evidence-based models, flexibility to meet the needs of varied clinical practice sites, and capacity for sustainability indicate this approach may be adaptable and feasible for other large health systems.

Training and Technical Assistance Increase the Fidelity of Implementation of a Universal Prevention Initiative in Rural Schools: Results from a 3-Year Cluster-Randomized Trial.

The need for well-implemented evidence-based interventions (EBIs) for the prevention of behavioral issues among children and adolescents is substantial. In rural areas, the need often matches or surpasses that of urban areas. Schools have a wide reach for prevention-focused EBIs. However, implementation in rural schools is often hindered by limited resources and capacity. Rural School Support Strategies (RS3) are a bundle of implementation supports that address implementation challenges in rural settings. They include providing additional leadership and coaching training, individualized technical assistance (mostly virtual), and monthly meetings of a virtual learning collaborative. A cluster-randomized Hybrid Type 3 implementation-effectiveness trial tested RS3 for implementing school-wide positive behavioral interventions and supports (PBIS), a universal prevention approach to improving student behavior, academic outcomes, and school climate. Forty rural schools received a multi-day training on PBIS each summer for 3years. Half were randomized to also receive RS3 support. Linear and logistic regression models examined the effect of treatment condition and dosage of support on implementation fidelity for Tier 1 (universal) PBIS. Condition and dosage (number of hours) of support increased the odds of schools achieving the 70% threshold for adequate implementation fidelity. In the first year, the higher dosage of technical assistance events increased the likelihood of schools reaching fidelity, whereas later in the trial, the higher dosage of attendance at the virtual learning collaborative sessions yielded significant improvements in fidelity. Implications for accelerating the implementation of universal prevention initiatives in schools-particularly in rural settings-are discussed. This study was prospectively registered on ClinicalTrials.gov (NCT03736395), on November 9, 2018.

National Initiatives—Law Enforcement Training and Technical Assistance (DOJ)

National Initiatives—Law Enforcement Training and Technical Assistance (DOJ)

Using state opioid response grant funding to disseminate contingency management for substance use disorder treatment in Indiana

IntroductionContingency management (CM) is an efficacious psychosocial intervention for substance use disorders with over 25-years of empirical support, yet CM adoption in SUD treatment settings is limited. In 2020, SAMHSA's State Opioid Response Grant (SOR) initiative included CM as an allowable activity to “treat stimulant use disorder and concurrent substance misuse, and to improve retention in care.” This policy-driven funding mechanism has significant potential to expand CM implementation nationally. This study describes an SOR-funded program to disseminate CM in Indiana. MethodsIndiana government and university partners developed a multi-component, statewide CM dissemination and implementation plan, including 1) statewide promotion, 2) detailed application process for interested SUD treatment agencies, 3) live, expert-led CM workshop, 4) technical assistance (TA) sessions for participating agencies, and 5) agency-level start-up funds to offset CM-related expenses. The study collected data on provider/staff characteristics, CM knowledge and attitudes, readiness, perceived barriers, and CM implementation at pre- and post-training workshop and at 3- and 6-month follow-up. In Year 2, the study collected client-reported quality assurance data. ResultsStaff (N = 72) from 12 selected agencies (13 sites) attended the CM workshop. About half (57 %) had some familiarity with CM, but only 14 % had any prior CM experience or training. Post workshop, participants reported increased CM knowledge and increased confidence in ability to implement CM. Sites completed 3–7 CM TA sessions and developed a tailored CM program. By 6 months, 9 sites had begun CM implementation. These sites averaged 57 days of implementation (range = 25–122), engagement of 23 clients (range = 4–77), delivery of 208 CM reinforcers (gift card codes; range = 8–366), and per-client payouts of $33.77 (range = $11.25–$49.48). Identified barriers to CM implementation included lack of time, client referrals, and resources (administrative, economic). Client-level quality assurance data indicated provider adherence to CM. ConclusionsA multi-component training model funded by SOR yielded several new CM programs that operated successfully within SAMHSA's guidelines. Organizational barriers related to readiness/capacity, turnover, and buy-in remained for some sites and warrant attention in future CM dissemination and implementation efforts. This work illustrates the promise of applying SAMHSA SOR awards to disseminate CM in community agencies.

The cost-efficiency of vitamin A supplementation services in Kenya: An assessment of a Malezi Bora event in Kenya.

Vitamin A supplementation (VAS) remains a cornerstone of global child survival programs. As available funding declines, countries are seeking alternative delivery platforms. We examine a VAS-deworming delivery event in 2019 in Kenya, called Malezi Bora (MB), that employed four delivery platforms: health clinics, Early Childhood Development centers, community distribution points, and home visits. VAS coverage data were collected via household surveys in four subcounties, three of which received financial and technical assistance, and one of which received technical assistance only. Data on costs were collected using structured and semi-structured questionnaires. Only one subcounty achieved the targeted VAS coverage rate (80%) across most age subgroups; the subcounty not receiving financial assistance covered just 37% of children 6-59 months of age. Two other funded subcounties had higher coverage rates but failed to achieve 80% coverage for any age subgroup. Most children in the funded subcounties received VAS in their homes. Most children in the unfunded subcounty received VAS at a health facility. Being aware of MB was the most important factor associated with receiving VAS. Cost per child reached, including opportunity costs, varied across subcounties from $1.81 to $11.13 USD. Salaries were the main cost drivers.

Training and Technical Assistance for Peer-Delivered Contingency Management

Training and Technical Assistance for Peer-Delivered Contingency Management

Ralstonia pseudosolanacearum Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations on candidate priority pests, focusing on the lag period, rate of expansion and impacts on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Ralstonia pseudosolanacearum, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Spodoptera frugiperda Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations on candidate priority pests, focusing on the lag period, rate of expansion and the impact on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Spodoptera frugiperda, delivered to the European Commission's Joint Research Centre, to feed into the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Bactericera cockerelli Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted expert knowledge elicitations on candidate priority pests, focusing on the lag period, rate of expansion and impact on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Bactericera cockerelli, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Popillia japonica Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations for candidate priority pests on the lag period, rate of expansion and impacts on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Popillia japonica, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Xylella fastidiosa Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance regarding the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations on candidate priority pests, focusing on the lag period, rate of expansion and impacts on the production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Xylella fastidiosa, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Arrhenodes minutus Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations for candidate priority pests on the lag period, rate of expansion and impact on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Arrhenodes minutus, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Nepovirus myrtilli Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted expert knowledge elicitations for candidate priority pests, focusing on the lag period, expansion rate and impact on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Nepovirus myrtilli, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Thrips palmi Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations on candidate priority pests, focusing on the lag period, rate of expansion and impact on production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Thrips palmi, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Polygraphus proximus Pest Report to support the ranking of EU candidate priority pests

Abstract In 2022, EFSA was mandated by the European Commission's Directorate‐General for Health and Food Safety (M‐2022‐00070) to provide technical assistance on the list of Union quarantine pests qualifying as priority pests, as specified in Article 6(2) of Regulation (EU) 2016/2031 on protective measures against plant pests. As part of Task C, EFSA conducted comprehensive expert knowledge elicitations for candidate priority pests on the lag period, rate of expansion and impacts on the production (yield and quality losses) and the environment. This report provides the rationale for the dataset on Polygraphus proximus, delivered to the European Commission's Joint Research Centre, to feed the Impact Indicator for Priority Pest (I2P2) model and complete the pest prioritisation ranking exercise.

Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care

BackgroundMaintaining functional status, defined as the ability to perform daily activities such as bathing, dressing, and preparing meals, is central to older adults’ quality of life, health, and ability to remain independent. Identifying functional impairments – defined as having difficulty or needing help performing these activities – is essential for clinicians to provide optimal care to older adults, and on a population level, understanding function can help anticipate service needs. Yet uptake of standardized measurement of functional status into routine patient care has been slow and inconsistent due to the burden posed by current tools. The goal of the Patient-Aligned Care Team (PACT) Functional Status Screening Initiative is to implement and evaluate a patient-centered, low-burden intervention to improve identification and management of functional impairment among older veterans in Veterans Health Administration (VHA) primary care settings.MethodsWe will conduct a hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial at 8 VHA sites using the Practical, Robust Implementation and Sustainability Model (PRISM) to guide implementation and evaluation. During a Pre-Implementation phase, we will engage clinical partners and develop local adaptations to maximize intervention-setting fit. During an Implementation phase, we will launch a standard bundle of implementation strategies (coalition building, champions, technical assistance) and system-level audit and feedback, identify sites with low uptake, and randomize those sites to receive continued standard vs. enhanced strategies (standard strategies plus clinician-level audit and feedback). The primary implementation outcome is reach (proportion of eligible patients at each site who receive screening/assessment) and the primary effectiveness outcome is appropriate management of impairment (proportion of patients with identified impairments who receive related referrals).DiscussionImplementing routine measurement of functional status in primary care has the potential to improve identification and management of functional impairment for older veterans. Improved management includes increasing access to services and supports for veterans and family caregivers, reducing potentially preventable acute care utilization, and allowing veterans to live in the least restrictive setting for as long as possible. Implementation will also provide data to inform the delivery of proactive interventions to prevent and delay development of functional impairment and improve quality of life, health, and independence.Trial registrationRegistered at ClinicalTrials.gov on May 7, 2024, at NCT06404970 (https://clinicaltrials.gov/).Reporting guidelinesStandards for Reporting Implementation Studies (Additional file 1).