Dissemination and Implementation Science with Sara Becker

Erin Spain, MS [00:00:03] Welcome to Science in Translation, a podcast from NUCATS, Northwestern University, Clinical and Translational Sciences Institute. I'm your host, Erin Spain. Translating evidence-based services and programs into clinical and community practice is a NUCATS priority and the focus of our dissemination and implementation program. Here to discuss best practices and exciting NUCATS initiatives in this area is Dr. Sara Becker. She is a professor of psychiatry and director of the newly formed Center for Dissemination and Implementation Science within the Institute for Public Health and Medicine at Feinberg. Welcome to the show, Dr. Becker.

Sara Becker, PhD [00:00:49] Thank you so much for having me, Aaron. It's a pleasure to be here and to speak about some of the exciting initiatives we have going on with NUCATS .

Erin Spain, MS [00:00:56] What is dissemination and implementation research? Why is it important and what are you trying to achieve through this work?

Sara Becker, PhD [00:01:04] Well, this is one of my favorite topics to speak about, so I'm really delighted that you asked this question, Erin. Broadly speaking, dissemination and implementation science or D&I science for short aims to answer the question how do we equitably and intentionally bridge the gap between public health and medical knowledge in terms of what we know and public health and medical practice in terms of what we do? And to your second question about why this is important. The simple answer is that this is really important because the status quo in academia and the typical ways that we conduct and disseminate our clinical translational research is really not effective in bridging this gap. It's been well-established that it takes about 17 years for only 14% of medical research to actually benefit patients. And so that means the vast majority of the research that we conduct is not actually improving patient outcomes and is also when it does help patients taking really long and inefficient time to do so. So the goal of dissemination and implementation science is to identify methods that can be used across different conditions, disease states and settings to really help to accelerate this pipeline from the discovery of things that work to the actual getting those things out into community and clinical practice settings.

Erin Spain, MS [00:02:26] How did you come into this field? And now at Northwestern, as the inaugural director of the Center for Dissemination Implementation Science and a really active member of NUCATS. Tell me about your path.

Sara Becker, PhD [00:02:38] Well, my path started over two decades ago and actually started through the business field. One of my first professional positions was as a strategy consultant for the Boston Consulting Group. That's a strategy consulting firm that works with Fortune 100 companies on all aspects of their business strategy. And I was in their change management practice area, which meant that I worked with large scale organizations to help them to make major organizational changes and to think about how to make those changes efficiently and effectively. I was situated specifically within their health care practice and biotechnology group, so I was doing organizational change work within a health care context. And it was at that time I decided that I really wanted to go back to academia to try and work with patients and community partners more directly. It was just really shocking to me how the concepts that I had learned in business about how to make changes effectively, how to market products and innovations to those that would deliver them and those that would ultimately receive them. All of the things that I'd been exposed to in business were completely absent from my training in graduate school. So I got really interested in the idea of how could we take lessons learned from business and from other fields that are knowledgeable about how to make large scale change, and how could we actually apply that to the types of behavioral health interventions and innovations that I was studying? And so fast forward to my postdoctoral fellowship when it was time for me to write my first ever grant. I wrote a training grant that was designed to try and apply principles that I'd learned in business and marketing to behavioral health interventions. And it was right at that time that the NIH or the National Institutes of Health announced their first inaugural training Institute in dissemination and implementation research in health. And when I saw the call for that training institute, I had that aha moment where I realized, Aha, this is really what I'm trying to do. This is the type of research that I'm passionate about. And so I attended that training in 2011 with many of the leaders that are now true luminaries in the field. In fact, two other Northwestern faculty, Rinad Beidas, and Hendricks Brown, were present at that event as well. And really the rest has been history me. From that point on, I've been an advocate and a champion of all things dissemination and implementation science.

Erin Spain, MS [00:05:01] Tell us about some of the work that you're doing and projects that you're working on.

Sara Becker, PhD [00:05:06] My research interests really span both the D and the I and dissemination and implementation science. So at the end of the day, I'm interested in increasing both patient demand for effective health services and the supply of those services out in community and clinical settings. And I view the D or the dissemination science side of things as work to increase consumer demand. On that side, I'm interested and my research studies explore things such as how do we market our treatments effectively, how do we design interventions that can reach patients and improve access to care such as digital health interventions? And on the implementation side, I study ways to increase the supply of effective services in community and clinical settings, and I do that through work, such as how do we design multi-level strategies that can be used to implement effective interventions in both health systems and in community partner settings. I also look at things like how do we support the workforce that is delivering these effective interventions? And I study a range of things such as what gets in the way when we try to implement something out in the community and how can we design our approaches in ways that address the things that could get in the way. 

Erin Spain, MS [00:06:24] Here at Northwestern, there is a big interest in this field, in this work, and in bringing this into the research enterprise. Can you tell me about that and your role here. 

Sara Becker, PhD [00:06:35] When talking about the interest and excitement around dissemination and implementation science I really need to give a shout out of gratitude to NUCATS as being one of the voices that was really central to the creation of my role, that there were a number of key voices, including NUCATS, another being the Institute for Public Health and Medicine, that were noting that they had a number of investigators that were hungry for support, integrating dissemination and implementation science research methods into their projects across the translational pipeline. And there was recognition that we needed dedicated support to help be providing the types of services that were needed for people to be effective in this type of research. And so my center was formed, and we really have three key aspirations. The first is that we want to help accelerate the impact of research across the translational continuum, and we aim to do that via research that's truly collaborative in nature and that can be deployed across diverse settings. The second is that we aim to really build the next generation of dissemination and implementation scientists by supporting the incredible faculty that are already here at the Feinberg School of Medicine and helping to expand our pipeline of students, trainees, staff and faculty that are passionate about accelerating research translation And then a third is that we aim to foster collaborations across Northwestern and the Feinberg School of Medicine in order to really galvanize our progress towards a shared goal of improving public health and health equity.

Erin Spain, MS [00:08:01] So NUCATS had been offering grant consultations, education and resources on D&I science. But now you are able to collaborate with NUCATS and really enhance these offerings. Tell me about that. 

Sara Becker, PhD [00:08:15] That's one of the things that has been such a joy since coming is that there was already a lot of incredible momentum in these areas. Our colleagues at the Center for Community Health had really been pioneers in noting that there needed to be service support, and so they really developed what was the start of the dissemination implementation research program. Historically, if you wanted a dissemination, implementation, research consultation, you had to go into the NUCATS system and know to ask for community engaged consultation. And then within that system you could request support on writing grants. We have since rebranded and made it a lot easier for people to find the types of consults that we offer. So if you click request for support or request a consultation from NUCATS, there's now a really big obvious doorway that says: request a dissemination and implementation research consultation. And now that we have a dedicated center, we've been able to expand the breadth of what people can request support in. So people can request support writing a manuscript, they can request a training, they can request mentorship. If this is an area that they'd like to get into, they can just request strategic advice about how to be thinking about integrating these methods into the work that they're already doing. And I'm delighted to say that since we've rebranded this consultation in partnership with NUCATS in early February, we've had more requests for consultation in the last 7 to 8 weeks than they had had the entire prior calendar year. So we went from eight consultation requests over an academic year to 11 in just the last eight weeks, and we're steadily getting about three a week, which I think just shows the incredible excitement around this type of work within that Feinberg community. 

Erin Spain, MS [00:09:56] Although it's such a great success story, the NUCATS Dissemination Implementation Pilot awards are also something that is really key to helping our investigators explore innovative approaches to dissemination and implementation. Can you tell me about this initiative?

Sara Becker, PhD [00:10:13] Yes, and this is something that we're very excited about with NUCATS. So historically, if you wanted to apply for Pilot award support from NUCATS, which hopefully people did, if you're listening and if you didn't, then you should consider doing so in the future because it's a wonderful mechanism to support early career researchers or established researchers that are looking to gather data in a new and exciting area. But historically, if you applied, there were two separate pots. There was a dissemination and implementation research program that was pretty small in nature. And then there was a second program that was considered a clinical translational research program. The contact principal investigator for NUCATs, Rich D'Aquila really recognized that at the end of the day, all of the pilot grants should be supporting translational science and the acceleration of science across the continuum. So we have really intentionally rebranded the NUCATS pilot program so that now we don't think about clinical translational research and dissemination, implementation research as separate things. We now recognize that all research that NUCATS  is supporting should be translational in nature and should be conducted with the goal of generating lessons that can be learned across that specific study. And so all of the pilot grants are now called Translational Science Awards. And within that there are special emphasis areas. And so you can still very much apply if you're an early stage lab based researcher. We still want you to be thinking, though, about how the lessons learned in your study can translate to other projects. And I will also note that dissemination and implementation research is considered a priority area within this pilot grant program.

Erin Spain, MS [00:11:49] Thinking about that from a researcher's perspective, at what point in your research project should you be considering dissemination and implementation?

Sara Becker, PhD [00:11:57] This is probably my favorite question that you could have asked, so I'm delighted that you asked. I never think it's too early to be thinking about dissemination, implementation, science. I think that's partly why historically we've had such a problem. Bridging the gap from research to practice is that there was this perception that this was what happened last. People thought that you had to first establish that something worked under ideal and very controlled circumstances. Then you would test it in the real world, and only then would you think about how to implement it and to get it out into the community. We now recognize that we need to infuse this way of thinking throughout the entire translational pipeline. So even if you are just testing a signal to see if an innovation works, we can be doing that with the end point in mind. I also like to tell people, if you're trying to develop something new, we can think about how to design for dissemination right up front in the very first stages of our research, because we need to be thinking about the context where we are ultimately going to deliver these interventions in order for the things that we develop and design to be effective at the end of the day.

Erin Spain, MS [00:13:07] NUCATS has had a dissemination and implementation reading course for quite some time, but that is also an area that is undergoing some changes. Tell us what we can expect. 

Sara Becker, PhD [00:13:18] Yes, exactly. As you noted, Erin, the reading course is something that NUCATS has been doing for some time now, and it's really a pleasure to be engaged with this exciting work. About five years ago, a number of very strong implementation scientists within Feinberg were truly pioneers in terms of recognizing that there was a hunger for training in dissemination, implementation science and that it would be more efficient and that we could improve the reach of our training if we were to actually do something in a structured format that could accept multiple people at once. So a number of true leaders within this field at Feinberg, which include Hendricks Brown, Dennis Lee, Miriam Rafferty and JD Smith, came together and created what they coined a implementation science reading course that was designed to help the attendees cover all of what we would consider beginner level competencies in the field of implementation. The hope was that by having people attend this course that they would then be equipped to go forward and help educate their colleagues and could also serve as co-investigators or principal investigators of their own grants as opposed to needing to always seek out additional support. And I'll note that five years ago when this started, it was in a single small room at Feinberg. My understanding is that there were 17 attendees and now this is a fully virtual ten session experience, and we continue to break records each year of the number of enrollees. This year we rebranded it and restructured it a little bit, and we are proud to say that we have over 85 people attending. And one of the things that most excites us is that we look at our data, and I believe that this year fewer than 10% say that they have any implementation, science, training or background. So we're really addressing a need to be equipping people with these fundamental skills. And this year we've made a few changes that we're especially excited about one of those changes. Is that historically we relied on a text book that had key chapters for people to go through. And this year we pivoted to using some of the key hallmark manuscripts or peer reviewed publications in the field. And we've done that because we recognize that if people go forward and write grants, those are the types of papers or models that reviewers are going to be looking for them to be using in their work. And so we wanted to make it easier for people to be competitive and to use that the key Hallmark articles that would likely be recognized. Another shift that we've made this year is that we've involved a much broader bench of implementation scientists. So when this course started, it was mostly led by the colleagues I mentioned before Hendricks, JD, Miriam and Dennis, and it was always some combination of those four people that were leading it. And just as recently as last year, Dennis and Miriam were really the two people that led every course throughout the experience. This year we have two lecturers for each of the ten sessions and we really have a bench of over ten scientists that are engaged. And we do that because we want people to have exposure to a number of different scientists, have exposure of diversity of thought, and also for people to realize that there's lots of people here within Feinberg that they can reach out to and build relationships with. And so as we are growing in terms of our strength, we've been intentionally growing the reading course to really showcase that strength at Feinberg so that people throughout the system can recognize all the talent that we have here now. 

Erin Spain, MS [00:16:50] Has the course taken place yet, or is there still a chance to sign up?

Sara Becker, PhD [00:16:53] The course is very much going on right now. I believe that we're about four sessions and we've had really exciting course meetings thus far on theories, models and frameworks was our first topic. Our second was on implementation strategies, and then our third has been on contextual determinants and we have seven more to go.

Erin Spain, MS [00:17:15] What do you hope that someone does after attending? 

Sara Becker, PhD [00:17:18] So one of our primary goals for our reading course is to be increasing our attendees knowledge and their confidence in addressing 20 beginner level competencies that we viewed as most critical for conducting this type of research. There's actually a paper that we based this on that outlined 43 beginner level competencies in the field. We narrowed that down to the 20 that we thought were most critical to be able to be a methodologist or consultant on this type of research. And our hope is that at the end of the course, people feel much more confident in their ability to demonstrate those skills and that they feel more knowledgeable in those areas. And so in partnership with NUCATS, we've actually designed a pre course survey and a post course survey that measures exactly those issues, both people's knowledge and their confidence applying these areas of skill.

Erin Spain, MS [00:18:12] You've been really busy since you came to Northwestern. Just was it last year?

Sara Becker, PhD [00:18:16] Yes, I had the pleasure of joining the Northwestern community on August 1st of 2022. 

Erin Spain, MS [00:18:21] You've accomplished quite a bit already. What is the reception been like from the NUCATS community and your colleagues at Feinberg?

Sara Becker, PhD [00:18:30] The level of enthusiasm for implementation science, both within NUCATS and throughout the broader Feinberg School of Medicine, has truly been exceptional. We had for our Center for Dissemination and Implementation Science a major strategic planning retreat in November of 2022. And the attendance was really phenomenal. We had over 100 leaders within the Feinberg community that were truly engaged in helping us to do collaborative decision making and prioritization of the resource and infrastructure needs that our center should prioritize. We then, after that strategic planning retreat, asked all of the attendees to complete a survey. We had fantastic engagement and detailed feedback in that survey of what people needed, and we recently had a monthly forum where we invited people to come and hear what we've been up to and attendance at that was really excellent as well. And I would say that NUCATS has been a key strategic partner every step of the way, and I really do want to acknowledge that Rich D'Aquila and his team within NUCATS are really committed to accelerating the research pipeline. And I think it's not simply because they like this type of work, but it's that because at the end of the day they're really committed to trying to increase the impact of work that happens across Feinberg. And we don't believe that dissemination, implementation science is a magic solution that will solve everything. But our hope is that by infusing this way of thinking into our existing studies, that we can help to move the needle and help to increase the impact of our work. I also do want to note that across the entire National Consortium of CTSAs, there is a move towards really embracing implementation science. And in fact when you look at the request for proposals for the CTSA hubs, as they're called across the country. Translational science and the terms dissemination, implementation, science are really salient. So it's exciting to see that at NUCATS, there's certainly been an extremely high level of energy around this way of thinking. And there's also an amazing opportunity for these CTSA recipients to come together as a consortium and really be advancing this throughout the country.

Erin Spain, MS [00:20:46] Tell me about some of the grants that you've received as an implementation scientist in the work that is involved.

Sara Becker, PhD [00:20:51] The grants in my portfolio currently represent my passion for both dissemination and implementation science work really beautifully. So on the dissemination side, I'm currently leading a mechanism that's called an R 37, which is basically if folks listening are familiar with an R01, it's an R01 that's renewable at the end for up to ten years of continuous funding, and that is really trying to disseminate an effective intervention for parents of adolescents in residential treatment, doing so via a very light touch digital health intervention. On the implementation side, I have a couple projects, one in South Africa and one domestically here in the Chicagoland region as well as in the New England region where I used to live. And their domestic project is taking a very effective intervention that we know works called contingency management and studying the best way to help implement it in programs that serve patients with opioid use disorders. And that project is great fun because the intervention is one of the most effective interventions that exist for this patient population. But it's one of the least effective treatments available in community in clinical settings. So we are really looking at how do you train organizations, how do you support them, and seeing if different types of supports are more effective than others and trying to get this into practice. And our project in South Africa is similarly taking a very effective approach for screening for alcohol use and trying to integrate that into HIV service settings across the country. We are using an approach called a train the trainer model, and in that project it's really been exciting to see. We've to date trained 12 master trainers who went on to train over 200 frontline providers, and those providers have gone on to screen over 65,000 patients. So it's a great example of how a little bit of support in a very structured and methodical way can really have incredible scale. Some other projects that I'm excited about are center grants funded by different mechanisms. One is a P50 and one is what's called a UTC, and those grants address another issue in the field of implementation science that I think is really critical, and that's near and dear to my heart, and that's what I'd call the expertise capacity gap. So I spoke with you before about how we have issues on the demand side of implementation. We also have issues on the supply side. So we don't have enough demand for services, we don't have enough supply. We also don't have enough people that know how to do this type of research. And so the two center grants that I'm part of are really all about addressing that problem and trying to increase our pipeline of researchers throughout the field and also helping people that are doing other types of research, such as earlier translational research to infuse implementation science methods into their work. So those two center grants are a beautiful parallel to the work we are trying to do within the Center for Dissemination and Implementation Science here at Feinberg. And it's really wonderful for me to be able to do that work at CDIS here in partnership with NUCATS and Feinberg, and then to have these center grants to be able to also do this within the field with researchers outside of Northwestern.

Erin Spain, MS [00:24:00] So, for folks who are listening, who they haven't really dipped their toe into dissemination and implementation science yet within their own research projects, but they're intrigued and they want to get involved. What's the best way to start?

Sara Becker, PhD [00:24:12] Well, here I think I'll answer by putting in a plug for NUCATS that NUCATS has a wonderful service portal where you can request a consultation in a number of areas. And so if you Google NUCATS request a consultation, you'll be brought to a page that offers you a menu of supports. And one of those is to request a dissemination and implementation science consult. So if you're eager to learn a bit more to lean in, feel free to go visit that page and fill out a consultation and you can request a meeting with myself or a member of our team that will be happy to talk to you about the type of work you do now and what some of your goals are for leaning a bit more into this space. 

Erin Spain, MS [00:24:53] Thank you so much, Dr. Sara Becker, for being on the podcast, telling us about your new role and all the work that you're doing with us here at NUCATs. Thank you.

Sara Becker, PhD [00:25:02] Such a pleasure to be with you, Erin. And thanks to those who are listening for.

Erin Spain, MS [00:25:10] Subscribe to Science and Translation wherever you listen to your podcast. To find out more about NUCATS check out our website. NUCATS.Northwestern.edu.