Aware that implementing research-based programmes requires more than disseminating information about them, many countries and regions have established TA centres or networks. These entities serve as the bridge between academic researchers and findings, and the everyday world of the school and its reform efforts. Research-based programmes are often created by university social scientists or by individual developers, who do not have the interest or capacity themselves to disseminate information or provide support for scaling up implementation in many sites. TA centres are experienced in and can perform this valuable function for many projects and programmes.
The European Network of Health Promoting Schools, the more recent Latin American Network of Health Promoting Schools and similar organizations provide a range of TA including informal exchanges of experiences and materials between schools, structured continuing education activities, Web-based resources, publications and implementation tools.
Technology transfer is the movement of a new technology from its creator or researcher to a user. The TA centre’s function is to facilitate technology transfer by delivering products and services that lead users to adopt the new technique or product. Services may range from disseminating information about programmes to professional education, coaching and peer learning forums, which offer the opportunity to learn from other teachers and administrators from a range of school systems.
Over the past two decades, Health and Human Development Programs (HHD; http://www.hhd.org Accessed 21 January 2005), a division of Education Development Center, Inc. (EDC; http://www.edc.orgAccessed 21 January 2005), an international non-governmental organization working worldwide, has designed and operated more than six large TA centres enabling a variety of agencies to transfer research to improve policy and practice. Figure 8 lists the
URLs for these centres and the many resources they offer. Enriching our methods and resources are the lessons we have learned from other countries has been the TA work we have done in our role as a WHO Collaborating Centre to Promote Health Through Schools and Communities.
A typical scenario our U.S. TA centres may encounter follows. A local school district hires a professional writer to prepare a competitive grant proposal seeking federal funding for implementing an approved, research-based programme. In the 30 days available for proposal writing, the school district proposes to implement a research-based a programme, having done minimal or no assessment of its suitability for local conditions or assessment of the readiness and motivation to do so. Few processes may be in place for collaboration among staff within the school or between the school and community. After receiving Figure 8.Health and Human Development Programs’ TA Centres
Health and Human Development’s TA Centres Children’s Safety Network National Injury and Violence Prevention Resource Center USED’s Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention The National Center for Mental Health Promotion and Youth Violence Prevention
Northeast Center for the Application of Prevention Technologies (CAPT)
National Training Center for Middle School Drug Prevention and School Safety Coordinators The Suicide Prevention
Resource Center
URL
http://www.childrenssafetynetwork.org/
http://www.edc.org/hec/
http://www.promoteprevent.org/
http://www.northeastcapt.org/
http://www.k12coordinator.org/
http://www.sprc.org/
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the grant, the school has an uphill battle, facing obstacles such as stakeholder resistance, lack of time set aside for training, inadequate financial resources to purchase materials and cover training, etc. The grant recipient and TA provider must then solve these challenges.
Based on these experiences, and on research into technology transfer and innovation diffusion, we have developed a philosophy for delivering TA.
Research shows that the quality of implementation makes a difference in student outcomes (Kam et al. 2003). To effectively improve implementation quality, HHD/EDC’s approach to TA employs six major strategies:
1. Focus on building the relationship between the TA provider and the recipient.
2. Provide customized TA based on assessment and desired ultimate outcomes.
3. Offer a continuum and variety of TA and professional development modalities to accommodate different learning styles.
4. Develop the leadership capacity and skills of change agents at all levels.
5. Use electronic technologies creatively and cost-effectively.
6. Track and monitor progress, with continuous feedback on successes and challenges, to a range of stakeholders.
The following sections discuss these six strategies in detail.
1. Focus on building the relationship between the TA provider and the recipient.
We believe that the relationships we develop with school staff are most important in the change process. We base our approach on understanding their strengths and concerns, respecting what school staff know about what works for them and their students, families and communities. Loucks-Horsley’s (1996) ‘concerns-based adoption model’ offers the 80/20 rule: Unless you devote 80 percent of your attention to the user’s concerns, you have only a 20-percent chance of success.
Technology transfer is not about exchange between expert and non-expert, but between people who possess different spheres of knowledge, each essential for the success of the project. One sphere may relate to the science of intervention and circumstances needed for success; the other sphere may concern the school environment and conditions in which the intervention will be introduced.
HHD/EDC uses numerous techniques—basic conversation, surveys and focus groups—to understand school staff’s concerns about the innovation, as well as the strengths they bring to the effort.
2. Provide customized TA based on assessment and desired ultimate outcomes.
Each school’s circumstances and stage of readiness are unique and TA must be customized to meet the school where it is in the process. HHD/EDC created a developmental TA model, by which we meet each school at its particular stage of development in the research-to-practice process. A major challenge that schools face in using evidence-based programmes is assessing the fit between characteristics of the setting where results were achieved and the features of their own students and school. Many of the early research-based programmes were developed in more affluent, homogeneous, suburban communities, not ethnically diverse, poorer, urban or rural areas. How does a school choose a programme or approach so that it can achieve the same results as the model.
Beginning with the end in mind, as illustrated in the logic model, what resources, inputs and activities will it take to achieve those outcomes?
Consistent with the educational goals of the school, what health outcomes does the school want to produce? Guiding schools through this consideration of content and process can focus and align the resources.
HHD/EDC has also developed easy-to-use tools to assist schools in assessing both their readiness to undertake implementation and the feasibility of implementing a research-based programme. One U.S. state required every school and community agency that received state funds to use our tools for the process of selecting research-based programmes. By assessing readiness and feasibility with user-friendly tools, local agencies reported that the tools made it much easier for them to understand the research to science process and to select programs that were relevant (Harding and Goddard 2000).
3. Offer a continuum and multiple modalities of professional development events.
Research on professional development for educators reports that less than 10 percent of the content taught in one-time workshops or seminars is applied to practice and that ongoing coaching and mentoring are necessary for practice change (Langer 2000). Therefore, our TA offers a continuous series of learning events, with different formats, for different stages in the implementation cycle.
As described earlier, HHD/EDC aims to reach teams, not merely individuals, from a school or ministry, to ensure that a critical mass of people returns to the organization and changes its ethos and capacities.
Offering a continuum of learning events, from assessment to face-to-face workshops, we focus not only on developing knowledge and skills, but also on building relationships. Typically, we bring teams from the same institution to
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an event so they can support one another in creating change when they return home. Our learning events are never one-time only; rather, face-to-face experiences are followed by on-line courses, additional print and Web-based resources and telephone TA. As TA recipients try new things, they generally experience setbacks and obstacles; ongoing support from the TA centre can help them work through their problems and succeed.
4. Develop the leadership capacity and skills of change agents at all levels.
Often, we expect people in senior leadership positions at the school or district level to assume this responsibility. We have found that designated leaders may not always act as such and that others emerge who must be nurtured and supported. Therefore, leadership talent must be developed not only in those designated with the responsibility, but also in staff at various levels. As a nurse in one of our programmes stated, “Leadership is having the courage and imagination to do what is necessary without waiting for someone to tell you what to do.”
To build leadership for reducing heavy and harmful drinking on college campuses, HHD/EDC’s Higher Education Centre for Alcohol and Other Drug Abuse and Violence Prevention (HEC) searched for presidents of colleges and universities who were creating new prevention strategies. After recruiting six outstanding candidates who were making a difference and serving as leaders, the TA centre created a campaign, The President’s Leadership Group, funded by the Robert Wood Johnson Foundation. Using case studies from these six exemplary leaders, the campaign, called on all college presidents to take leadership roles on this issue. HEC used many strategies, including rallying all college presidents within a state to come together and sign a commitment to act. This strategy was effective because it avoided single campuses’ having to declare that they had a problem. The six original innovators also participated in many media and public events, calling for change. This initiative has proven to be an effective way to engage presidents in making commitments to action, giving them visibility for their courage and leadership and holding them publicly accountable for policies and prevention strategies on their campuses.
Another example of the way we build leadership is the National Training Centre for Safe and Drug-Free School Coordinators, which developed the competencies of approximately 1,000 newly appointed school and community coordinators who were responsible for implementing evidence-based school strategies. Guided and funded by USED, the Centre developed and implemented
a leadership institute, where coordinators could learn leadership skills for creating change and institutionalizing their work. Targeted to individuals, who identified the need for these skills, the institute focused on four broad areas:
skills development, knowledge acquisition, personal reflection, and networking and support system development. Content was taken from the fields of prevention, systems change and organizational development. Individual assessments of skills and style were interwoven with time devoted to personal reflection. Opportunities to network with other participants were provided, creating a support system designed to reduce participants’ sense of isolation after they returned home.
5. Use electronic technologies creatively and cost-effectively.
The Internet makes it possible to provide ongoing support and services to schools after face-to-face training. Based on research into what is effective, HHD/EDC has mastered the art of creating Web sites that support the imple-mentation of research-based programmes. Our TA centre web sites typically have the following features:
• Employ a research-based conceptual framework for approaches to a particular issue, such as substance abuse and violence
• Incorporate a range of searchable databases containing publications; tools;
research articles; directories of experts, peers and evaluators; etc. Schools can use this wealth of information to learn, network and find solutions for their own problems
• Deliver web-based follow-up courses after face-to-face workshops – one form of ongoing coaching and mentoring that research shows is necessary for practice change. Research demonstrates that web-based courses can achieve learning outcomes similar to those of face-to-face courses (Cukier 1997). However the initial cost of developing web-based courses can exceed the costs of developing face-to-face workshops, unless the final product can be used with large numbers of people. Extensive evaluation of our on-line follow-up courses has shown significant changes in participants’ knowledge and practice, even up to six months after the course (Harding and Formica 2001). Most striking are the reported increases in the number of middle school coordinators, who reported that they initiated evidence-based programmes (from 45 to 82 percent) and who increased programme evaluation (from 35 to 78 percent) (Harding and Formica 2001).
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• Encourage and facilitate peer learning and exchange of tacit knowledge about experience with the implementation process. By supporting Web-based conversations among practitioners all over a country, we enable them to learn from each other. We have also transformed the Web-based exchange about lessons learned concerning implementation into print products for broad circulation to others (EDC 2002)
6. Track and monitor progress, with continuous feedback from stakeholders Our TA centres must strive to answer two critical questions: What impact are the products and services having on organizations’ and practitioners’ ability to implement research-based programmes? And what is the relative effectiveness – including cost-effectiveness – of various TA approaches?
Built into the work of each HHD/EDC TA centre is an evaluation component, conducted by a third-party organization. An evaluation begins by assessing each client and then measures which TA products and services were delivered to whom on which topics. We examine the short- and longer- outcomes (from 3 to 24 months) of specific learning events, examining changes in practitioner knowledge, skill development, actions taken, organizational changes in policy and structure, and customer satisfaction. Some evaluators also maintain databases of anecdotal success; in-depth notes on each TA conversation; and anthropological case studies of what changes took place, how they were brought about and the facilitating and inhibiting factors. The centre often transforms these cases into additional teaching and TA tools.
TA centre evaluations have contributed to the documentation and understanding of the many results we have described here. The future demands that we conduct more research on the implementation process itself, to learn in more depth about the cost-effectiveness of various techniques and ways to bring research into practice, shortening the research-to-practice time gap and improving the health of students and staff.
Conclusion
If individual children and nations are to achieve their educational goals, more attention must be dedicated to the physical, social and emotional health of students and school staff. In the last 15 years, research has taught us so much about effective strategies for promoting healthy behaviours and environments,
but many of these lessons have not yet been applied. The challenge is still to convince education policymakers that health is vital to academic performance and then to strengthen school capacity to implement research-based health promotion policies and programmes. Quality TA can be instrumental in ensuring quality implementation, which in turn improves student and staff outcomes.
In our TA centres, we see that many education and public health agencies are familiar with the concept of research-based approaches and funders’
demands to use funds for this purpose. But the saturation, depth and quality of implementation do not match the level of familiarity with the concepts.
There is a long way to go in providing professional development in TA services to school and community staff to gain these competencies. The schools receiving TA are typically the most capable ones, with strong track records in winning grants. By mandate, most TA services go to those funded groups.
However, thousands of other school and community agencies need capacity building and a much broader audience could be served.
But even this first wave of change has produced numerous benefits. Education and community practitioners have gained new understanding of social science research and methods of evaluating school-based interventions and are asking important questions about programme selection and implementation.
Through many training and TA events, TA recipients have become more aware of the need to use local data carefully to ensure the best fit between the intervention and the particular health issue(s), audience and setting.
Practitioners have also gained knowledge and skills related to the many organizational and human factors that contribute to success, including the need for collaboration and cost savings and the invaluable impact of a principal or headmaster’s leadership.
Planners and school staff have gained confidence from acquiring these new competencies. One school health coordinator commented:
“The first thing I learned is to talk the language of the school. Once I could convey how research-based approaches would address academics, discipline and behavioural management, teachers saw the value and were drawn in to participate.”
Another benefit of TA is that through forums facilitated by TA centres, researchers and developers have come together with practitioners and national and state
policymakers. The trend itself has increased the connections and dialogue about the many issues involved in using research to improve practice and generated new research questions and evaluation efforts to make more programmes eligible to be judged as exemplary.
One of the drawbacks of this recent trend, however, is that many of the approved programmes that have met rigorous criteria for evaluation are single-element, single-topic programmes. Many have been evaluated in mainstream, resource-rich communities. Because of the cost and difficulty of conducting controlled studies of multiple elements, relatively few such studies exist.
Lacking an organizing framework and evidence for broader strategies, many schools select ‘packaged programmes’ that tend to be narrow. Even when schools select multiple research-based components, the components are typically unrelated in terms of health topics, as well as uncoordinated in terms of implementation. The schools thus miss an opportunity to maximize impact.
As the evidence about what works grows, what remains most valuable for implementing schools and agencies is acquisition of the knowledge and skills needed to understand social science and public health methodologies. With such knowledge and skills in place, they can continually assess the ever-changing needs of their constituents and plan, implement and monitor proven approaches. With high staff turnover rates in schools, ongoing ways to develop and evaluate these competencies are essential.
For TA centres to be effective, innovative work for the future lies in improving services by evaluating 1) the relative effectiveness and cost-effectiveness of various TA strategies and dosages; 2) the effect of financial incentives requiring that funding be used primarily or only for research-based programmes; and 3) the impact of TA strategies on practitioners’ knowledge and skills, the organization itself, and the education and health outcomes for students and staff.
With the growing realization of the interdependence of health, education
With the growing realization of the interdependence of health, education