Technical Assistance Providers Research Articles

Spatial inequality in water access in the US: case studies and solutions

ABSTRACT In addition to the 2.2 million Americans without safe water and sanitation in their homes, millions more regularly face service shut-offs either due to breakages or because of non-payment of bills. Households in areas outside administrative and service boundaries struggle to maintain private systems. Historic disinvestment in majority of African American cities, and decades of underinvestment in water infrastructure, have led to near collapse of many systems. The 2021 Bipartisan Infrastructure and Investment Jobs Act, passed by the United States government, is a historic opportunity to reinvest in water, especially in underinvested communities. These communities need significant assistance to prioritize appropriate investments, apply for available funding, and identify implementation partners. If this does not happen, the inequalities in access will be worsened. Coalitions of technical assistance providers and community-based organizations can help by identifying and matching providers with appropriate funding streams in the short term, while building their capacity to apply for larger federal funds. However, capital investment is only the first step toward equity. It is crucial that water and sewer rates be adjusted to account for household income, and service providers who serve large under-resourced areas receive long-term assistance for operation and maintenance of valuable assets.

Convenings as a tool for enhancing implementation strategies: lessons from the Black Women First initiative

BackgroundThe Expert Recommendations for Implementing Change (ERIC) project identified 73 strategies for supporting the implementation of a novel intervention and evidence-informed practices. In this paper, we explore convenings, which engage stakeholders in proactive dialogues, as a mechanism to deliver multiple strategies that support sites adapting and implementing evidence-informed bundled interventions for Black women with HIV.MethodsWe use an instrumental case study design to explore strategies embedded in biannual convenings hosted by the Black Women First Initiative (BWF) Evaluation and Technical Assistance Provider (ETAP). Data sources including planning documents, direct observation of the convenings and analysis of convening attendee feedback surveys were analyzed.ResultsUsing instrumental case study design, we found that convenings were a helpful tool that allowed for cross-site communication and collaboration. Communal re-examination of implementation strategies, coupled with training and network-weaving, created a rich learning environment to identify potential intervention adaptations and changes, unify on data collection, and prepare to test these adaptations at each respective site.ConclusionsWe discuss lessons learned when using convenings to help health care and community-based settings collectively explore and address adaptation and implementation barriers as they implement evidence-informed interventions to improve health outcomes for populations affected by chronic conditions, such as HIV.

Sustaining Soil Health in High Tunnels: A Paradigm Shift toward Soil-centered Management

This review was conducted to synthesize current knowledge, learn producer and Extension specialist perspectives, and identify gaps in understanding of the role of soil health in sustaining production in high tunnel (HT) systems. This synthesis includes findings from scholarly resources related to soil health in HTs, including research and Extension-based literature, perspectives from experienced HT producers and technical assistance providers, and the direct observations of a broad network of university research and Extension personnel working with HTs. Findings are intended to identify knowledge gaps and additional research and Extension resource needs of greatest priority to the HT producer community and technical assistance providers that support them at the time of publication. A review of 68 research articles and 58 Extension resources was conducted. Focus group interviews were conducted with small groups of experienced HT farmers in four regions of the eastern half of the United States, with in-depth farm case studies conducted in individual farmers in three of these regions. Growers across regions identified soil fertility management, soilborne diseases, soil compaction, and lack of consistency of soil analyses specific to HTs as the greatest soil-related challenges to HT production. Research and resources for technical assistance providers on mitigation strategies to remediate yield-limiting HT soil conditions, such as excessive soil salinity and high pathogen populations, were also lacking. As such, process-based research on techniques such as leaching, soil steaming, solarization, and anaerobic soil disinfestation in tunnels that consider short- and long-term costs, benefits, and effects on soil and plant productivity should be prioritized in the future when considering the impact of HT production on soil health. Interviews also indicated a need for networking opportunities for technical assistance providers across agencies (e.g., Natural Resources Conservation Service, Extension, nongovernmental organizations). Despite a high and increasing rate of adoption, there is currently a lack of information about maintaining HT systems. Given that HTs play a critical and growing economic role for specialty crop growers throughout the eastern United States, comprehensive intervention across the research–Extension spectrum to sustain productivity in HT systems is recommended.

Naloxone vending machines in county jail

IntroductionThe overdose epidemic in the United States has intensified following the introduction of illicitly manufactured fentanyl to drug markets with recent estimates indicating 110,000 deaths in 2022 and longer-term trends adversely impacting national life expectancy. A period of incarceration has been identified as a critical touchpoint for overdose prevention given its strong association with risk of overdose. In this paper we describe efforts funded by the Centers for Disease Control and Prevention (CDC) Overdose Data to Action (OD2A) grant to design and implement naloxone vending machines that provide free naloxone within county jails to returning citizens and those visiting county jail facilities. MethodsThis study utilized three sources of data. First, we describe the results of a pre-implementation survey administered by technical assistance providers to 18 jails across the state of Michigan. Second, among the 6 jail facilities that accepted a naloxone vending machine we examine administrative data from Michigan Department of Health and Human Services on naloxone orders to look at changes 6-months before and after implementation. Third and lastly, we conducted semi-structured interviews (N = 6) with jail administrators (i.e., County Sheriffs) on the barriers and facilitators to implementing a naloxone vending machine. ResultsSix facilities indicated they would accept a vending machine to distribute free naloxone. Overall, the total number of naloxone box orders that were distributed across all jail sites increased by 63.5 % from 4104 boxes pre-naloxone vending machine to 6708 boxes post-naloxone vending machine implementation. Qualitative interviews revealed that prior naloxone distribution efforts and foundational knowledge about opioids, overdose, and naloxone emerged as facilitators for vending machine implementation. ConclusionThis study illustrates the utility of policy-driven funding strategies aimed at mitigating accidental overdose deaths among a high-risk population while building community naloxone saturation efforts.

The butterfly matchmaking model for circular construction: Towards a digital matchmaking platform tailored to French policy

Digitalization has gained recognition as a crucial factor for implementing circular economy principles in construction. However, digital platforms for circular construction do not adequately match supply and demand in the emerging secondary materials and products market yet. Therefore, this research questions how digital matchmaking platforms could be (re)defined to better support circular construction practitioners. By applying a participatory action research methodology with a technical assistance provider, the study employs a three-stage research design to comprehensively identify, collect, and react to stakeholders' needs in the French context, experiencing recent policy change. Our resulting butterfly matchmaking model defines two distinct, yet interoperable matchmaking loops: the first one matches auditors, contractors, and collectors for deconstruction, and the second one matches designers, contractors, and dealers for construction. This strategy presents a paradigm shift in current platform thinking by ensuring autonomy for circular construction and deconstruction as well as by providing a multi-sided matchmaking environment for key stakeholders' inclusion. Our proposition prompts platform developers to transition from mainstream project-centered matchmaking to a more holistic profession-centered matchmaking approach. By promoting tighter coordination between digitalization, policy, and practice, we contribute to the development of advanced digital matchmaking platforms, supporting the industrialization of circular construction. These results will be used to develop a functional prototype of a digital matchmaking platform for analyzing real business models.

Online tools helped direct market farmers during the COVID-19 pandemic, but resources are needed for equitable adoption

This paper examines the use by California’s direct market farmers (DMFs) of online sales and market­ing during the early onset of the COVID-19 pan­demic in the United States, from March through December 2020. The pandemic caused market dis­ruptions that accelerated the trend toward market digitalization. This paper reports quantitative find­ings based on 364 responses to an online survey of DMFs in California and qualitative findings from participant observation and 33 semi-structured interviews with DMFs and technical assistance providers. We found that online sales and market­ing tools, such as social media and websites, were important for withstanding economic disruptions associated with the pandemic, and farmers who had an online presence were more likely to increase their sales and profitability during its early onset. However, we also found that many farmers lacked the necessary resources to access these tools and use them effectively, and that technical assistance providers experienced challenges in helping farm­ers with online technology use. We argue that DMFs need reliable access to the internet, as well as advice, resources, and training to access and benefit from online sales and marketing tools. These resources must be available in languages other than English (e.g., Spanish). Research-informed programs and policies can help DMFs navigate market digitalization and strengthen their resilience to future economic disruptions.

Implementing a Needs Assessment to Advance Health Equity in Overdose Prevention and Surveillance Initiatives.

State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity. ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data. Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions. Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity.

Principals or Agents? How State Education Agencies Build Trust to Balance Support and Accountability in Turnaround Policy Implementation

In recent years, policymakers and scholars argued that state education agencies (SEAs) should move away from simply acting as compliance monitors and take on more prominent roles as providers of technical support to schools and school districts. Scholars find that SEAs have struggled to do so, yet there is little empirical work to explain what SEAs do or why they struggle. This study looks at Michigan's Partnership model for School and District turnaround, which began in 2018 and includes the Michigan Department of Education (MDE) as a formal partner in building the capacity of school districts to craft and meet ambitious student learning targets. Analyzing interviews with MDE “liaisons” and turnaround leaders, I find that Partnership leaders reported a deeper sense of trust with the SEA compared to prior years because liaisons were more focused on support and understanding individual school/district contexts. However, supports were generally “passive” (e.g., sending standardized emails with resources/links; helping navigate compliance issues) rather than targeted technical assistance that helped Partnership leaders build capacity. I argue that this was in part due to the SEA's conflicting role as both accountability monitor and technical assistance provider. I show how SEAs navigated this dynamic and provide suggestions for how SEAs can balance district autonomy with support through trust building, ideas of “controlled autonomy,” and “flexible specificity,” which recommends highly specific technical guidance paired with ongoing processes of feedback and experimentation from implementers so that guidance matches context.

Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward

Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs’ cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.

Exploring the School Heads Working Condition in Supporting Communities of Practice (CoP) and Technical Assistance (TA) to Teachers: A Multiple Case Study

This study explored the school heads’ working conditions in supporting Communities of Practice and Technical Assistance to teachers as vehicles to address problems in the teaching and learning processes and promote learning and collaboration within organizations. A qualitative research design employing multiple case study methods was utilized. The study included one (1) Principal-in-Charge (PIC), three (3) school heads, and three (3) master teacher positions. A total of seven (7) participants participated in this study. Moreover, the study employed semi-structured interview guide questions. The data were analyzed using Colizzi's thematic analysis.
 The results showed that the working conditions supporting the communities of practice and technical assistance to teachers are classroom observation, learning action cell, In-Service Training (InSeT), and conference and urgency. The following working conditions may affect or influence school heads and master teachers in supporting communities of practice and technical assistance to teachers: intellectance (openness to new experiences), communication channels, schedules, lack of leadership, and knowledge of technical assistance providers. Participants experienced challenges, motivations, fulfillment, and positivity in implementing CoPs and TAs. The following themes were coded on the influence of experiences on communities of practice and technical assistance to teachers: positivity, flexibility, thriving, social support and interaction, and positivity.
 The openness to new experiences, such as a sense of curiosity, open-mindedness, and acceptance of novel experiences, is needed for CoPs and TAs to prosper in school. Communication channels should be clear and appropriate to their audience, allow deeper conversations, and exchange ideas, thoughts, opinions, knowledge, and data in CoP and TA should be understood with clarity and purpose. School leaders must be empowered with managerial and leadership skills to support and influence communities of practice and technical assistance to teachers.

Addressing Challenges in Long-Term Strategic Energy Planning in LMICs: Learning Pathways in an Energy Planning Ecosystem

This paper presents an innovative approach to addressing critical global challenges in long-term energy planning for low- and middle-income countries (LMICs). The paper proposes and tests an international enabling environment, a delivery ecosystem, and a community of practice. These components are integrated into workflows that yield four self-sustaining capacity-development outcomes. Planning long-term energy strategies in LMICs is particularly challenging due to limited national agency and poor international coordination. While outsourcing energy planning to foreign experts may appear to be a viable solution, it can lead to a reduction in government agency (the ability of a government to make its own informed analysis and decisions). Additionally, studies commissioned by external experts may have conflicting terms of reference, and a lack of familiarity with local conditions can result in misrepresentations of on-the-ground realities. It is argued here that enhancing national agency and analytical capacity can improve coordination and lead to more robust planning across line ministries and technical assistance (TA) providers. Moreover, the prevailing consulting model hampers the release and accessibility of underlying analytics, making it difficult to retrieve, reuse, and reconstruct consultant outputs. The absence of interoperability among outputs from various consultants hinders the ability to combine and audit the insights they provide. To overcome these challenges, five strategic principles for energy planning in LMICs have been introduced and developed in collaboration with 21 international and research organizations, including the AfDB, IEA, IRENA, IAEA, UNDP, UNECA, the World Bank, and WRI. These principles prioritize national ownership, coherence and inclusivity, capacity, robustness, transparency and accessibility. In this enabling environment, a unique delivery ecosystem consisting of knowledge products and activities is established. The paper focuses on two key knowledge products as examples of this ecosystem: the open-source energy modeling system (OSeMOSYS) and the power system flexibility tool (IRENA FlexTool). These ecosystem elements are designed to meet user-friendliness, retrievability, reusability, reconstructability, repeatability, interoperability, and audibility (U4RIA) goals. To ensure the sustainability of this ecosystem, OpTIMUS is introduced—a community of practice dedicated to maintaining, supporting, expanding, and nurturing the elements within the ecosystem. Among other ecosystem elements, training and research initiatives are introduced, namely the Energy Modelling Platform for Africa, Latin America and the Caribbean, and Asia-Pacific as well as the ICTP Joint Summer School on Modelling Tools for Sustainable Development. Once deployed via workflows, the preliminary outcomes of these capacity-development learning pathways show promise. Further investigation is necessary to evaluate their long-term impacts, scalability, replication, and deployment costs.

State embeddedness and public-private dynamics in central American coffee leaf rust management

This paper examines how differences in state's ‘embedded autonomy’ (i.e., the historical relationship between farmers and the state, public institutions, and state capacity) in El Salvador, Honduras, and Nicaragua shaped the management of the 2012 coffee leaf rust (CLR) epidemic, resulting in differential responses. We conducted 80 interviews with key coffee-sector actors and six focus groups representing 20 farmer organizations and 19 technical assistance providers to understand these divergent responses. We first examined the dynamic, historical, and relational contexts of contradictions, contestation, and negotiation in agri-food networks influencing each response. We then explored how the role of the state and agrarian structures in each country affected farmers' performance and access to different support systems for renovating and rehabilitating coffee plantations in response to the CLR epidemic. In El Salvador and Nicaragua, oligarchic control, weak state relationships with small coffee farmers and fragmented bureaucracies hindered effective CLR crisis response and recovery. Although farmers' organizations, NGOs, and the private sector attempt to fill the gap using market or ‘user pay’ mechanisms for CLR management, they cannot fully compensate for the state's shortcomings. In contrast, Honduras, which is closest to a ‘developmental state’ in the coffee sector, performed better. This is attributed to its more pro-smallholder development path since the 1970s, which bolstered state institutional structures and fostered social ties and dynamism within smallholder organizations in the coffee sector. However, decentralization and clientelist relations limited the country's ability to propose long-term CLR management strategies. We argue that a state's ‘embedded autonomy’ is critical in determining its approach and effectiveness in managing CLR crises and collaborating with and supporting coffee farmers. Finally, we highlight the importance of considering both conjunctural factors (such as meteorological and economic conditions) and the state's historical capacity and embeddedness in analyzing CLR outbreaks and their effects across different countries.

Rapid start antiretroviral therapies for improved engagement in HIV care: implementation science evaluation protocol

BackgroundIn 2020, the Health Resources and Services Administration’s HIV/AIDS Bureau funded an initiative to promote implementation of rapid antiretroviral therapy initiation in 14 HIV treatment settings across the U.S. The goal of this initiative is to accelerate uptake of this evidence-based strategy and provide an implementation blueprint for other HIV care settings to reduce the time from HIV diagnosis to entry into care, for re-engagement in care for those out of care, initiation of treatment, and viral suppression. As part of the effort, an evaluation and technical assistance provider (ETAP) was funded to study implementation of the model in the 14 implementation sites.MethodThe ETAP has used implementation science methods framed by the Dynamic Capabilities Model integrated with the Conceptual Model of Implementation Research to develop a Hybrid Type II, multi-site mixed-methods evaluation, described in this paper. The results of the evaluation will describe strategies associated with uptake, implementation outcomes, and HIV-related health outcomes for patients.DiscussionThis approach will allow us to understand in detail the processes that sites to implement and integrate rapid initiation of antiretroviral therapy as standard of care as a means of achieving equity in HIV care.

Technical Assistance Providers Identify Climate Change Adaptation Practices and Barriers to Adoption among California Agricultural Producers

Climate change will challenge California agriculture, requiring producers (i.e., farmers and ranchers) to adopt climate-adaptive management practices to sustain production. Agricultural technical assistance providers (TAPs) play a significant role in supporting producers’ efforts to adopt climate-smart management practices. It is therefore important to understand current TAP perceptions of climate change, TAP recommendations for climate adaptation, and the barriers to adopting climate-smart practices. To understand these issues, we held four focus group discussions with small groups of TAPs from across the state and evaluated transcripts from the discussions to identify common themes and concepts. The TAPs that participated in the focus groups understood climate change and its impacts on California agriculture, with climate extremes and water-related issues being the most frequently cited climate-related challenges. Focus group discussions and subsequent evaluation revealed that while TAPs recommend science-backed practices for adapting California agriculture to climate change, producers may not be accepting of some recommendations. Critically, the TAP focus groups cited insufficient monetary support—both for themselves and for producers—and insufficient information and messaging around climate-adaptive practices as key barriers to practice adoption. This improved understanding of the intersection of TAPs’ work on climate change and climate adaptation in California agriculture is useful for the development of information and resources that can bridge these identified barriers.

Demand Forecasting Approaches for New Contraceptive Technologies: A Landscape Review and Recommendations for Alignment.

Market size estimations and demand forecasts use a variety of methodological approaches to inform decision-making around new (and lesser-used) contraceptive methods. For contraceptive products already available at scale in a market, historical procurement and consumption data can help to inform these forecasts. However, little published guidance is available on appropriate approaches to estimating contraceptive demand in the absence of historical data. This landscape review aimed to describe the variety of approaches for modeling demand for new contraceptive methods, highlight opportunities for alignment around forecasting practices, and make recommendations to support more accurate forecasting and sound decision-making based on forecasts. We used the published scientific and gray literature to inform the development of a semistructured guide for key informant interviews. We conducted interviews with 29 experts representing a spectrum of interests in market size estimation and demand forecasting for new contraceptive methods (e.g., ministries of health, donors, manufacturers, technical assistance providers, and demand forecasting specialists). We coded notes from the interviews using thematic content analysis. The purposes of market size estimation and demand forecasting for new contraceptive methods vary widely, as do associated model inputs and outputs. Key informants revealed a need for more standardized language around market size estimation and demand forecasting and highlighted key recommendations: select models that are fit-for-purpose, clearly articulate assumptions and uncertainty in model outputs, consider a broad range of contraceptive options in a forecast to capture the complete contraceptive supply environment, and perform a reality check of results and refresh assumptions. We recommend following a simple decision pathway to ensure that forecasts are fit-for-purpose, with appropriate inputs, outputs, and assumptions clearly articulated. Common pitfalls around overestimating demand should be avoided. Incorporating best practices into forecasting exercises will ensure that models are useful for the stakeholders.

State Deafblind Technical Assistance Project Staffs’ Reported Use and Perceived Skill of Implementing the System of Least Prompts with Students Who Are Deafblind

This study evaluated state deafblind project technical assistance providers (TA) reported use of systematic instruction, specifically the system of least prompts (SLP), and examined perceptions of implementation and accuracy of description of components. In a census, 151 TA providers were asked to report instructional methods used. A majority of respondents reported using systematic response prompting historically. Fewer than half reported providing TA with the goal of increasing others’ use; of this group, 78.9% rated themselves as confident that they could coach others in use of the SLP. Only one respondent accurately answered all questions about components of the SLP. TA providers reported emphasizing modifications and adaptations to the environment based on child characteristics. Instructional methods reportedly employed highlighted child-guided methods. Overall, responses suggested systematic instruction is not commonly or accurately used. We discuss implications of limited use for children with deafblindness, make suggestions to increase use, and suggest future research.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

The Process of Applying Principles-Focused Evaluation to the Sexual Violence Prevention Field: Implications for Practice in Other Social Services Fields

Principles focused evaluation (PFE) can complement existing formative and outcome evaluation plans by identifying Effectiveness Principles (EPs), an operationalization of values and standards that guide practitioners during program implementation. To date, however, few examples of PFE are available in the literature. This description of the application of PFE to the Washington State Rape Prevention and Education (RPE) sexual violence prevention program provides an example of how this flexible approach can augment an existing evaluation plan to distill shared evaluation components across different organizations implementing diverse prevention programming. Specifically, we describe the process used by a team of practitioners, funders, evaluation consultants and state-level sexual violence prevention technical assistance providers to identify EPs, operationalize indicators for each EP, and develop and test an EP measurement approach. In this process, the seven very different RPE-funded organizations, each serving a unique community, were able to identify and endorse shared, core EPs. This description illustrates PFE's promise for augmenting a shared evaluation approach and identifying common guiding tenets across uniquely situated organizations in a larger community of practice.

Evaluating Technical and Issue Bias in Teacher Evaluation Policy Briefs and State Handbooks

Recognizing the need for scientific fidelity and balanced representation in the evidence that informs public policy, this study investigates technical and issue bias in 43 policy briefs and state handbooks that provided information about the use of Student Learning Objectives to evaluate teachers’ performance. The author uses multiple qualitative methods to categorize the contributors to the focal documents, identify the evidence they drew upon, and determine how they represented the information to their targeted audiences. The study reinforces the findings of prior research by documenting the outsized impact of advocacy groups in a policy-related evidence base. The results make an important addition to the scholarly literature by cataloging an array of technical assistance providers that translated and disseminated evidence to decision makers and spotlighting the various ways biased information appeared in the publications. Throughout, the study reinforces how incentives and timing shape evidence production and use in policymaking.

Moving from Policy to Practice for Early Childhood Obesity Prevention: A Nationwide Evaluation of State Implementation Strategies in Childcare.

Policies requiring childcare settings to promote healthy eating, physical activity, and limited screentime have the potential to improve young children’s health. However, policies may have limited impact without effective implementation strategies to promote policy adoption. In this mixed-methods study, we evaluated the type, quality, and dose of implementation strategies for state-level childcare licensing regulations focused on healthy eating, physical activity, or screentime using: (1) a survey of state licensing staff and technical assistance providers (n = 89) in 32 states; (2) a structured review of each state’s childcare licensing and training websites for childcare providers; and (3) in-depth, semi-structured interviews with 31 childcare licensing administrators and technical assistance providers across 17 states. Implementation strategies for supporting childcare providers in adopting healthy eating, physical activity, and screentime regulations vary substantially by state, in quantity and structure. Childcare programs’ financial challenges, staff turnover, and lack of adequate facilities were identified as key barriers to adoption. Access to federal food programs was seen as critical to implementing nutrition regulations. Implementation resources such as training and informational materials were rarely available in multiple languages or targeted to providers serving low-income or racially/ethnically diverse families. There is a substantial need for implementation supports for ensuring policies are successfully and equitably implemented in childcare.