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...scars of serious engagement" (p. 207). Concerning goals, it noted how scientists primarily seek fundamental understanding or theory-building, while practitioners predominantly desire to improve local quality of life (Price & Behrens, 2003; Wandersman, 2003). In the domain of community intervention implementation, scientists typically set the goal of replication with assurance of implementation fidelity; practitioners often want to adapt to local needs and recognize the limitations of the extant research base in guiding implementation (Sarason, 2003).
As concerns the method-related aspects of implementing and evaluating community-based interventions, scientists often take a cautious and skeptical approach, seeking clarity and precision; community practitioners follow the imperatives of "real world" community action (Kelly, 2003), seeking practical solutions, but ones that are often unvalidated or untested. In addition, scientists are inclined to do carefully controlled, randomized outcome studies; practitioners usually opt for a more participatory, less controlled approach. In this way, science is cumulative and slow-moving; practitioners frequently want more immediate action on pressing problems. Slow-moving science is especially evident when scientists adopt a linear approach to application of scientific findings to community problems, moving methodically from basic to applied research (Price & Behrens, 2003).
Contributing greatly to tensions about goals and methods are the different reward structures for scientists and community practitioners. Among the key rewards for community practitioners is local recognition for successes in community action efforts, which often follows from focus on immediate outcomes and not on longer-term implementation systems change. Scientists are usually rewarded for activity that leads to publishable findings. Further, scientists often are rewarded for more basic or traditional scientific work rather than applied work (also see Boyer, 1990; Kellogg Commission on the Future of State and Land Grant Universities, 1999).
ADDRESSING PRACTITIONER-SCIENTIST TENSIONS--TOWARD MORE EFFECTIVE PARTNERSHIPS AND LARGER-SCALE BENEFITS TO HEALTH AND WELL-BEING
Practitioner-scientist tensions have generated motivation for creative solutions. Numerous approaches have been proposed for the resolution of practitioner-scientist tensions; a number of strategies have been suggested to generate mutually-beneficial and productive relationships. Various approaches and strategies are presented in the American Journal of Community Psychology special issue, and in earlier literature, as well. For example, to address differences in goals, the American Journal of Community Psychology special section authors recommend that scientists and community practitioners can start with definition of common ground or identification of interrelated goals of interest to community stakeholders early in the collaborative process, such as those suggested by community or school surveys of adolescent risk behaviors (Price & Behrens, 2003; Wandersman, 2003). To address differences between scientist and practitioner methods in community-based intervention implementation, Kelly (2003) recommends social norms that foster active, ongoing dialogues between scientist and community practitioners, consistent with earlier recommendations from action research projects (Spoth & Molgaard, 1999). Price and Behrens (2003) promote an approach that dynamically integrates community action with theory development, using a community leadership development project as an illustration. Wandersman (2003) suggests emphasis on the community delivery process (rather than just proven intervention content delivered with fidelity), with careful consideration of infrastructure development and capacity-building, plus local participation oriented toward accountability.
One illustration of the literature outlining recommendations of relevance to effective scientist-practitioner collaboration is that on university engagement with communities. This emerging literature recommends changes in the reward structures for university-based scientists in a way that encourages collaborative projects with communities (Kellogg Commission on the Future of State and Land Grant Universities, 1999; Lerner & Simon, 1998; Spanier, 1999; Spoth, 2004; Tierney, 1998). There also are emerging literatures of relevance that address community-based participatory research in public health (Minkler & Wallerstein, 2002) and other community-based approaches specific to prevention research, participatory or collaborative and otherwise. One illustration of the latter is Weissberg and Greenberg (1998), who contrast two approaches to community prevention research: prevention science and collaborative community action research (Coie et al., 1993; Rappaport, 1990).
Although it is clear that prevention science and collaborative community action research each have great strengths, their utility differs according to the research question(s) being addressed and the phase in the prevention research cycle. Weissberg and Greenberg (1998) state that preventive intervention and competence-enhancement research must meet the challenge of combining the strengths of prevention science and collaborative community action research approaches. On the one hand, clinical trial methodologies, including random assignment, are needed to provide a clearer foundation for identifying the effects of programs on risk and protective factors and desired intervention outcomes. In addition, clinical trials may inform collaborative researchers about variables to address as they work with school and community settings to design ecologically-valid, contextually-responsive programs. On the other hand, collaborative community action research is likely to provide rich accounts of how culture, context, and local decision-making and history influences both model development and implementation of programs and policies. Clearly, there is a need for synthesis and further cross-learning between scientists and practitioners (also see Green, 2001; Spoth & Molgaard, 1999).
The reviewed solutions to the challenge of practitioner-scientist tensions highlight two joint priorities for the fields of prevention and community psychology. The first is to expand the knowledge base on processes and outcomes of practitioner-scientist partnerships that implement prevention-oriented community programs. The focus of this expanded knowledge base is primarily about collaboration within communities and supports for such collaboration. Additional work is required to address larger-scale organization of partnership efforts that stretch across communities, within states and beyond. Hence, the second, related priority is to learn how to increase capacity for diffusion of effective practitioner-scientist partnerships on a larger scale to achieve, in turn, larger-scale benefits in health and well-being for communities and their residents. The remainder of this paper will be devoted to consideration of each of these two priorities.
THE BACKDROP--GROWTH IN COMMUNITY PARTNERSHIPS AND EMERGENT RESEARCH
Community-based preventive interventions implemented through locally-based partnerships and coalitions have become increasingly popular in recent years (Butterfoss, Goodman, & Wandersman, 1993; Kumpfer, Turner, Hopkins, & Librett, 1993; Minkler & Wallerstein, 2002). Many of these community-based approaches were originally developed within the agent/host/environment public health model to address cardiovascular disease (e.g., Puska et al., 1985), but then extended to other health problems as diverse as cancer, HIV infection, lead poisoning, low birth weight, and injury, as well as behavioral health problems such as violence, alcohol and substance abuse, and teenage pregnancy (Roussos & Fawcett, 2000). In part, these shifts reflect disenchantment with categorical funding, isolated and poorly coordinated social service agencies, high service costs, and observation of ineffective intervention.
The growing popularity of community-based approaches is a natural outgrowth of developments in relevant theory and practice. Theorists and researchers have come to recognize the several layers of overlapping contextual influences on individual behavior problems (Bronfenbrenner, 1989; Catalano & Hawkins, 1996; Conner, Tanjasiri, Dempsey, & Robles, 1999). Individual behavior problems, including violence, substance abuse, and risky sexual behaviors, can be positively or negatively influenced by family structure and interaction, the quality and nature of school systems and health care systems, and the faith community. These factors are influenced by community norms, attitudes, laws, and law enforcement. Further, policy makers recognize that discrete programs are rarely sufficient to alter community-wide problem prevalence rates (Butterfoss et al., 1993) and that community approaches often are necessary to positively impact those rates.
As a result of the rapid growth of community prevention/health promotion partnerships and coalitions in the last two decades, there has been greater opportunity and interest in studying their dynamics and outcomes (Backer, 2003). Indeed, many of the scientist-practitioner tensions described in the American Journal of Community Psychology special section are cited in a broader literature that addresses challenges in the conduct of research on the effectiveness of community partnerships or coalitions (Green, 2001; Green & Kreuter, 2002; Hallfors, Cho, Livert, & Kadushin, 2002; Kreuter, Lezin, & Young, 2000; Roussos & Fawcett, 2000). Most studies in this area have been qualitative case studies of one, or at most, a handful of coalitions (Farquhar, 1978; Francisco, Paine, & Fawcett, 1993; Goodman, Wheeler, & Lee, 1995; Jacobs et al., 1986; Mittelmark et al., 1987; Rindskopf & Saxe, 1998). Recently, however, several studies have been conducted with a sample size of 10 or more community coalitions (Butterfoss, Goodman, & Wandersman, 1996; COMMIT, 1995; Kegler, Steckler, Malek, & McLeroy, 1998; Kumpfer et al., 1993; Saxe, Reber, Hallfors, & Kadushin, 1997; Yin, Kaftarian, Yu, & Jansen, 1997). The limited evaluation of partnership outcomes overall reflects, in part, the difficulty of evaluating comprehensive, community-based prevention and health promotion interventions, as will be discussed in detail subsequently.
Recently, Hallfors and colleagues (Hallfors et al., 2002) examined the effectiveness of the Fighting Back Against Substance Abuse coalitions funded by the Robert Wood Johnson Foundation. Using a quasi-experimental design with comparison sites, the study examined alcohol and other drug use outcomes and attitudes in 14 intervention and comparison communities. These coalitions were developed at the grassroots level, attempting to bring diverse stakeholders together for decision-making. They included community education and awareness, prevention, and treatment--for both children and youth--and used schools, community agencies and police to alter a variety of policies, norms and behaviors. Regarding youth substance abuse there were no positive effects of the coalitions; for coalitions that primarily targeted adults there were mild negative effects. The authors derive a number of tentative conclusions for the discouraging findings, including (a) many competing agendas that may have paralyzed the process and reduced efficiency and quality, (b) the lack of requirements for coalitions to use tested and effective programs--(thus programs that were implemented may have had no impact), and (c) the coalitions may have been poorly organized and implemented.
In consideration of their findings, Hallfors et al. (2002) suggest that coalitions have limited and clearly focused goals, outcomes, and benchmarks. They stated these indicators should be well-defined and use effective measurement strategies from the preintervention phase onward, as well as ongoing measurement to assess outcomes. In addition, communities should be strongly encouraged to use evidence-based programs and policies and should carefully monitor dosage and quality of implementation of programs. To do so requires careful program choice, program implementation, program evaluation, and ongoing technical assistance (TA). Although the Hallfors et al. (2002) evaluation was not a randomized trial, it was well constructed. The findings clearly call into question the general efficacy of broad coalitions that use grass-roots models in which there is little TA or use of current evidence in the field of substance abuse prevention. They also suggest the need for more delimited and carefully designed studies of partnership and coalition processes and outcomes.
The practitioner-scientist partnership model illustrated in the next section is designed to address the issues raised by Hallfors and colleagues (2002) and others (El Ansari, Phillips, & Hammick, 2001; Kreuter et al., 2000) in a number of ways. Most importantly, it focuses on structuring effective practitioner-scientist collaborations in which local teams have focused intervention goals, implement interventions that already have a strong evidence base, and have proactive technical assistance focused on implementation, evaluation and sustainability. Methods for longitudinal study of the model will be described subsequently. There also is potential for application of the partnership model to community collaboration in the pilot testing of new interventions and in evaluation of promising interventions with a limited evidence base.
AN ILLUSTRATIVE APPROACH TO EFFECTIVE PARTNERSHIPS
Land Grant System Support for Practitioner-Scientist Collaboration
An important type of practitioner-scientist partnership encompasses those that are supported by Land Grant Universities. Historically, the "land grant" university mission has encouraged partnerships with communities, with the explicitly stated purpose of benefiting the local citizenry. This mission was inspired by the "land grant idea." Bonnen (1998) has noted that this idea evolved across centuries, consolidating a unique set of social role beliefs over time. Central to the idea is the belief that various science-based fields within the university should work "to improve the welfare and social status of the largest groups in society" (Bonnen, 1998, p. 29). Consistent with this idea, the Cooperative Extension Service (CES) was established in the early 1900s. It has created the infrastructure needed to become "the largest informal education system in the world" (Coward, Van Horne, & Jackson, 1986, quoted in Molgaard, 1997), designed to transfer a wide range of research-based information to the general public. In their informal educational capacity, CES personnel have served as linking change agents, connecting university-based innovators with the general public who could benefit from their innovations (Rogers, 1995).
The CES has thousands of local agents that reach all U.S. counties and thus has enormous potential for outreach to the general public (Spoth, 2004). It operates the outreach mission of the land grant universities in each state and...
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