Program Champions Research Articles

Creating «the Ultimate Retro-Future»: Music, Nostalgia and Futurity in «Tron» (1982) and «Tron: Legacy» (2010)

Tron, a computer program champion who fights for the human Users against the megalomaniacal Master Control Program of the ENCOM computer mainframe.

Project GREAT: Immersing physicians and doctorally-trained psychologists in recovery-oriented care.

The advocacy of recovery-oriented practices in mental health care with its emphasis on freedom and choice in care has been gaining considerable traction in recent years. In response to the growing recognition and promotion of recovery-oriented services, several training initiatives have been developed to bring about mental health care system transformation. These initiatives, however, have been primarily focused on broad organizational and procedural changes as well as hospital and clinic staff development. Relatively neglected have been initiatives to educate physicians and doctorally trained psychologists in the concepts and practices of recovery-oriented care. This article describes a case study of the efforts of Project GREAT (Georgia Recovery-Based Educational Approach to Treatment) that has aspired to transform the education and practice of an academic department of psychiatry into a recovery-oriented one with the focus on shaping the recovery knowledge, attitudes, and practices of psychiatry and psychology faculty and trainees. Core issues in the transformation effort were identified and led to the implementation of the following change interventions: (a) administrative leadership and support, (b) consumer mediated interventions, (c) educational presentations/materials, (d) interactive small groups/ program champions, (e) reminders/prompts/practice tools, (f) newsletters/pamphlets, and (g) educational outreach visits. It is proposed that this transformation experience provided valuable lessons that are generally applicable to other academic programs for psychiatrists and psychologists attempting to adopt recovery-oriented training and care.

Factors influencing perceived sustainability of Dutch community health programs

We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as 'program champions'.

Empowering change: Realist evaluation of a Scottish Government programme to support normal birth

Backgroundmidwife-led care has consistently been found to be safe and effective in reducing routine childbirth interventions and improving women's experience of care. Despite consistent UK policy support for maximising the role of the midwife as the lead care provider for women with healthy pregnancies, implementation has been inconsistent and the persistent use of routine interventions in labour has given rise to concern. In response the Scottish Government initiated Keeping Childbirth Natural and Dynamic (KCND), a maternity care programme that aimed to support normal birth by implementing multiprofessional care pathways and making midwife-led care for healthy pregnant women the national norm. Aimthe evaluation was informed by realist evaluation. It aimed to explore and explain the ways in which the KCND programme worked or did not work in different maternity care contexts. Methodsthe evaluation was conducted in three phases. In phase one semi-structured interviews and focus groups were conducted with key informants to elicit the programme theory. At phase two, this theory was tested using a multiple case study approach. Semi-structured interviews and focus groups were conducted and a case record audit was undertaken. In the final phase the programme theory was refined through analyses and interpretation of the data. Setting and participantsthe setting for the evaluation was NHS Scotland. In phase one, 12 national programme stakeholders and 13 consultant midwives participated. In phase two case studies were undertaken in three health boards; overall 73 participants took part in interviews or focus groups. A case record audit was undertaken of all births in Scotland during one week in two consecutive years before and after pathway implementation. Findingsgovernment and health board level commitment to, and support of, the programme signalled its importance and facilitated change. Consultant midwives tailored change strategies, using different approaches in response to the culture of care and inter-professional relationships within contexts. In contexts where practice was already changing KCND was seen as validating and facilitating. In areas where a more medical culture existed there was strong resistance to change from midwives and medical staff and robust implementation strategies were required. Overall the pathways appeared to enable midwives to achieve change. Key conclusionsour study highlighted the importance of those involved in a change programme working across levels of hierarchy within an organisation and from the macro-context of national policy and institutions to the meso-context of regional health service delivery and the micro-context of practitioner's experiences of providing care. The assumptions and propositions that inform programmes of change, which are often left at a tacit level and unexamined by those charged with implementing them, were made explicit. This examination illuminated the roles of the three key change mechanisms adopted in the KCND programme – appointment of consultant midwives as programme champions, multidisciplinary care pathways, and midwife-led care. It revealed the role of the commitment mechanism, which built on the appointment of the local change champions. The analysis indicated that the process of change, despite these clear mechanisms, needed to be adapted to local contexts and responses to the implementation of KCND. Implications for practiceinitial formative evaluation should be conducted prior to development of complex healthcare programmes to ensure that (1) the interventions will address the changes required, (2) key stakeholders who may support or resist change are identified, and (3) appropriate facilitation strategies are developed tailored to context.

Learning from the Closure of Clinical Programs: A Case Series from the Hospital Elder Life Program

Clinical programs in geriatrics face a challenging fiscal environment. Although recent research offers lessons from successful programs to help others like them sustain operations, it is not clear whether these lessons apply to programs that are beginning to fail. This study takes an approach that is frequently recommended, but rarely applied: examining failed programs to develop guidance for those at risk. It uses the example of an evidence-based, cost-effective geriatrics program that has been successfully implemented at more than 200 sites: the Hospital Elder Life Program (HELP). Data come from 14 in-depth interviews conducted between January and May 2011 with staff and hospital administrators affiliated with the six fully operational sites that closed between 2006 and 2011. Using the constant comparative method, researchers identified major themes suggesting that former HELP sites closed because of two interrelated problems centered on a major financial crisis or restructuring at the hospital or health system level. First, the crisis created challenges, such as the removal of program champions and a new focus on revenue-generating programs. Second, there were on-going vulnerabilities that the crisis revealed but that had not previously posed a threat to program viability. These included problems such as insufficient support from physicians and nursing leaders and limited documentation of program outcomes. Results suggest that, to protect against closure, clinical programs need to prepare for major crises at the hospital or health system level by ensuring support from multiple senior champions, with a special emphasis on nursing and physician leaders.

Full Circle - Do Intergenerational Approaches Hold Promise for Preventing and Managing Obesity Among Aboriginal Populations?

s / Can J Diabetes 37 (2013) S217eS289 S287 a key program champion and formation of a school nutrition task force (community ownership, self-reliance), bulk food delivery (between-community knowledge sharing) and enhanced facilities for running the program (prioritization of resources). After 2.5 years, vegetable and fruit intakes improved from 2.3 to 3.6 servings/day (p1⁄40.019), a demonstration of community members’ enhanced capacity in independently delivering the program. Conclusions: The success strategies for program sustainability generated through this research partnership may be helpful to other communities facing similar circumstances. The lessons learned can also be used in the implementation of new health promotion strategies. Long-term improvements in vegetable and fruit intakes demonstrate improved nutrition capacity as a result of the participatory research.

Managing carbon in times of political change: the rise and fall of the New Zealand Carbon Neutral Public Service program

The New Zealand (NZ) government, under Prime Minister Helen Clark's Labour-led administration, sought in 2007 to move government core organisations towards carbon neutrality. In late 2008, the NZ government changed from a Labour-led to a National-led (traditionally more conservative) government, and this saw a shift in its carbon neutrality agenda, including the dismantling of the NZ Carbon Neutral Public Service (CNPS) program. In this paper, we explore the experiences of public servants from the lead core agencies involved in the CNPS program to investigate the rise and fall of the program in a time of political change, and to assess the evidence for Cabinet Minister Dr Nick Smith's rationale for program termination. Our research approach comprises a series of semi-structured interviews with the lead core agencies involved in the CNPS program, as well as the program champion, former Prime Minister, Helen Clark. We find that, in spite of initial challenges, the CNPS program appeared to deliver emission reductions, financial cost savings and a range of non-financial benefits. Whilst program costs would have likely outweighed the financial savings, due to high set-up and offsetting costs, we conclude that Nick Smith's case is unsupported by the evidence.

Getting started: assimilatory processes of uptake of mental health promotion and primary prevention programmes in elementary schools

Although there is evidence that multi-systemic mental health promotion and primary prevention programmes can improve children's mental health, lack of widespread dissemination of evidence-based programmes limits their impact on population levels of health. Schools and teachers are frequent collaborators in programme development, evaluation and implementation. However, we know little about the pre-implementation processes that affect adoption (rather than implementation) of evidence-based programmes in new school sites. In this two-wave study, which spanned across one academic school year, qualitative interviews were collected from 20 school staff involved in the initiation of the WITS® Programs (The WITS® acronym stands for Walk Away, Ignore, Talk it Out and Seek Help.) for the prevention of peer victimization in rural elementary schools. These Program champions and early starters describe iterative processes of personalization that assimilated Program objectives to personal beliefs. They also worked to i...

Integrating Evidence-Based Tobacco Cessation Interventions in Free Medical Clinics

Free medical clinics serve a critical role in health care delivery of America's uninsured population, who are less likely to receive tobacco cessation counseling and 1½ times more likely than the general population to use tobacco. The authors evaluate the opportunities for and challenges to implementing the U.S. Public Health Service Guidelines for tobacco cessation in free clinics. Six free clinics participated in this pilot study. Five objectives were targeted: implementation of a tobacco user identification system, education of all clinic staff and volunteers, dedication of a program champion, use of evidence-based treatment, and creation of a supportive environment that reinforces provider behavior. Key informant interviews and focus group data were used to describe the opportunities and barriers of implementing the Public Health Service Guidelines. All clinics adopted a user identification system, dedicated a program champion, adopted evidence-based counseling, and created an environment conducive for cessation. Common challenges included getting volunteers to attend on-site training programs, accessing nicotine replacement therapy, and promoting Quit Line usage, all of which are part of evidence-based treatment. With more than 1,200 free clinics nationwide, it is very important to understand the opportunities and barriers of implementing tobacco cessation services and systems in free clinics.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

Implementing the MOVE! Weight-Management Program in the Veterans Health Administration, 2007-2010: A Qualitative Study

One-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities. Using a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays. Organizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale. Policy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation.

Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network

The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care. Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits. Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions. The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care. Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.

Lessons Learned from a State-Funded Workplace Literacy Program

Findings from an evaluation of a workplace literacy program funded by the State of Indiana are presented. Working with employers, providers were given considerable latitude to design their own training regimens. The state awarded certificates to workers who achieved certain levels of proficiency in reading, math, critical thinking, problem solving (assessed by CASAS), and computer literacy (certified by IC3). The evaluation relied on qualitative and quantitative data. Multiple site visits were undertaken and a survey of participants (n = 1800), learning gains, and earnings histories were quantitatively analyzed.Key findings include a significant interest in college attendance by incumbent workers, higher-than-expected levels of literacy in pre-assessments, little reliance on contextualization, and the importance of a program champion and supervisory support at workplaces. Business return was not formally measured, but employers and workers reported significant morale gains and frequent productivity gains.

SCHOOL-BASED PROMOTION OF FRUIT AND VEGETABLE CONSUMPTION IN MULTICULTURALLY DIVERSE, URBAN SCHOOLS.

Rates of childhood overweight have reached epidemic proportions (U.S. Department of Health and Human Services, 2001), and schools have been called on to play a role in the prevention of this medical condition. This article describes a multiyear health promotion effort-the Athletes in Service fruit and vegetable (F&V) promotion program-which is based on social learning theory for urban, elementary school children in kindergarten through third grade. Children participate in the program for a period of 3 years. The goals of the program are to increase opportunities for children to be more physically active during the school day and to help students increase their F&V consumption. This article describes the F&V promotion components of the program that were implemented in year 1, including implementation integrity and treatment acceptability data. Year 1 evaluation data demonstrated that the program is acceptable from the perspective of school staff and was implemented by school staff with high levels of integrity. Hallmarks of the program's successful implementation and high acceptability include (a) having a school-based program champion; (b) designing the program to include low-cost, attractive, interactive materials; (c) including many school staff members to facilitate a culture of healthy eating in the school; and (d) spreading out implementation responsibilities among the multiple staff members so that each individual's involvement is time efficient.

A Framework for Research Utilization Applied to Seven Case Studies

It is widely acknowledged that prevention research often is not fully or adequately used in health practice and/or policies. This study sought to answer two main questions: (1) Are there characteristics of research utilization in communities that suggest stages in a process? (2) What factors, including barriers and facilitators, are associated with the use of prevention research in community-based programs, policies, and practices? Researchers used a multiple case study design to retrospectively describe the research-utilization process. A conceptual framework modified from Rogers's diffusion of innovations model and Green's theory of participation were used. Data were gathered from archival sources and interviews with key people related to any one of seven community-based practices, programs, or policies. Fifty-two semistructured interviews were conducted with program or project staff members, funding agency project managers, community administrators and leaders, community project liaisons, innovation champions, and other members of the research user system. Participation in the process of research utilization was described by using characteristics of collaborative efforts among stakeholders. Program champions or agents linking research resources to the community moved the research-utilization process forward. Practices, programs, or policies characterized by greater community participation generally resulted in more advanced stages of research utilization. Investigating the interactions among and contributions of linking agents and resource and user systems can illuminate the potential paths of prevention research utilization in community settings. Because community participation is a critical factor in research utilization, prevention researchers must take into account the context and needs of communities throughout the research process.

Maintaining prevention in practice: Survival of PPIP in primary care settings

Introduction: Put Prevention Into Practice (PPIP) consists of a kit of office-based tools intended to support the provision of preventive services by primary care providers. The purpose of this study was to examine the institutionalization of PPIP within five primary care clinics funded by the Texas Department of Health to implement PPIP, and to examine the organizational determinants of program institutionalization. Methods: We utilized an adaptation of the Level of Institutionalizaton (LoIn) scales for qualitative data collection and for development of an institutionalization score for each site. The determinants of institutionalization were derived from the organizational behavior and health promotion literatures and used as categories for analysis. In addition, for purposes of triangulation, chart audit data for three documentation behaviors were also collected. Results: PPIP has been maintained—at varying degrees of integration—in four of the five sites studied, for 6 years after adoption. Organizational factors that facilitated the institutionalization process were the site’s institutional strength, the integration of PIPP within extant programs and services, visibility of the program within and outside the site, planning for the termination of grant funding, and presence of a program champion with mid- to upper-level managerial authority. Successful initiation of the program was not a predictor of institutionalization outcomes. Conclusions: We have highlighted the need to consider organizational determinants of institutionalization in relation to their specific sociopolitical contexts, and in relation to each other, not in isolation.

Identifying Policy Opportunities to Increase Physical Activity in the Southeast Asian Community in Long Beach, California

This article describes how implementing policy changes in organizations and communities supported physical activity in the Southeast Asian community. Case studies describe the components of successful policy development for physical activity in the Families in Good Health program in Long Beach, California. Levels of policy attainment are described in two examples: organizational policy change at a local YMCA and advocacy attempts toward a city-developed policy to support community gardens. Increased policy opportunities occurred when high levels of five factors were present: Program champions were cultivated; strong partnerships were formed; the community gave approval of program results; community leaders were involved; and organizations or resources were ready for policy development. This article also proposes elements of a model approach that is applicable to future health promotion efforts in Southeast Asian communities.

Training teams to deliver better psychiatric rehabilitation programs.

Introduction by the column editors: Most rehabilitation programs for persons with severe mental illness are provided by interdisciplinary teams whose members include professionals, paraprofessionals, and, sometimes, “prosumers”— individuals who both provide and consume mental health services. Despite the ubiquity with which psychiatric rehabilitation techniques such as social skills training, vocational rehabilitation, and family psychoeducation are used within a team approach, with few exceptions practitioners are taught these techniques without reference to how they may fit in with a team that delivers the mental health services. One exception is the approach of the Program for Assertive Community Treatment (PACT), which emphasizes adequate preparation of practitioners for working together as a team. Staff members who work on PACT teams have clearly specified roles and frequent face-to-face meetings and use methods of group problem solving that have been operationalized for day-to-day practice. Without recognition of the importance of the team context in which rehabilitation modalities are delivered, rehabilitation practitioners may compromise clinical goals and lose a valuable source of social support and encouragement—namely, positive feedback and reciprocal reinforcement from their teammates. In this month’s Rehab Rounds column, Patrick W. Corrigan, Psy.D., and Stanley G. McCracken, Ph.D., describe their method of combining educational and organizational strategies for teaching teams to deliver better psychiatric rehabilitation programs. They show how combinations of strategies offer the greatest promise for assisting rehabilitation teams in developing programs that meet clients’ needs effectively.

Correlates of the Sustainability of Community-Based Heart Health Promotion Interventions

Objectives.This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada.Methods.Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years.Results.Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4)).Conclusion.Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community.

Public administrators and policy legitimization: Policy analysis, politics and power

This article discusses the factors public administration faculty should incorporate into the curriculum in order to equip students to engage in the policy legitimization process. In order to produce leaders, public administration programs should emphasize the nature of the political system, an understanding of the legitimacy of subgovernments, the importance of coalition building and the psychological factors associated with policy choices. Integration of policy analysis into the public administration curriculum requires that students be equipped with an in-depth understanding of both the political environment and the political process. This is true because public administrators are deeply involved in the stages of policy development, adoption, and implementation; activities which reach beyond the narrow confines of program management and into the realm of politics. Consequently, public administrators serve in a variety of capacities: as policy advocates, program champions, or as defenders of client inter...