Introduction to the Special Issue: Catalyzing State Public Health Agency Actions to Prevent Injuries and Violence

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In 2014, the then director of the Centers for Disease Control and Prevention (CDC), Dr Thomas Frieden, published an article in the American Journal of Public Health that detailed 6 components necessary for effective public health program implementation.1 Successful implementation of proven interventions requires overcoming barriers, including, as Frieden notes, “limited and unstable funding, lack of automatic means to track and improve performance, workforce limitations, and insufficient political commitment.”1(p17) The article suggests that successful, sustainable implementation is linked to 6 key components: (1) innovations in science, medicine, evaluation, or systems; (2) a rigorously established technical package of evidence-based interventions; (3) management, including rigorous monitoring and evaluation, of interventions and effective human resource management; (4) partnerships, particularly between different levels of government agencies (local, state, federal) and between government agencies and nongovernmental organizations; (5) communication, using timely, effective, and sustained messages, particularly through new technology, to facilitate conversations and disseminate messages; and (6) political commitment, which is both bolstered by and bolsters the prior 5 components.1
This special issue of the Journal of Public Health Management & Practice includes implementation science and practice examples that build on this foundation and illustrate a systems approach to application of these components within programs of CDC's National Center for Injury Prevention and Control (CDC's Injury Center) (Table). Many, if not all of the articles, address more than 1 component; indeed, this is the intent: effective programs include all 6 components.1 All of the programs featured in the special issue required implementation of evidence-based strategies (component 2). However, none of the articles discuss this component in detail, primarily because extensive literature already exists for evidence-based programs, and the Injury Center has already developed several technical packages (https://www.cdc.gov/violenceprevention/pub/technical-packages.html) that specifically and thoroughly address this component. Thus, this special issue is devoted to the other 5 components: the systems that are critical to the successful implementation and coordination of the technical packages, for without these systems, technical packages are less likely to yield a population-level impact.
The first component in the Frieden model is innovation. Innovation is the fostering of new science, technology, or methods either in framing issues or in conducting operations. Several of the articles in this special issue advance innovation by reframing how researchers and practitioners have traditionally approached their work, moving away from traditional functional (research or practice) or topical (youth violence, sexual violence) or both silos. For example, in their commentary, “Minding the Gap: New Approaches to Addressing the Research to Practice Chasm,” Drs Smith and Wilkins call for a systems approach in how the work is accomplished—a functional shift. They encourage the advancement of “Action Research” by scholar-practitioners who value and use theory and practice to inform their work, and who move seamlessly between the 2 domains, rather than specializing in one or the other. Wilkins et al approach innovation from a structural perspective in “Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence.” The authors discuss 2 state examples of maximizing state resources by focusing on the risk and protective factors that are common across multiple forms of violence. The shared risk and protective factors approach represents an innovation in how violence prevention and intervention strategies are designed, implemented, and evaluated.
Public health programs are designed to have a population-level impact. However, identification of proximal, population-level indicators to evaluate impact is challenging.
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