Community Academic Partnerships in Implementation Research

Abstract

Community-academic partnerships (CAP) are a critical component of implementing and sustaining evidence-based practices (EBPs) in community settings; however, the approaches used and mechanisms of change within CAPs have not been rigorously studied. The first step to advancing the science of CAP is to operationally define and contextualize the approaches used in CAP as part of the implementation process. Our research group has gleaned valuable lessons about the best ways to develop, support and nurture community partnerships within the context of implementation. In this paper we share these lessons learned and relate them to implementation strategies that are most relevant to community-partnered implementation endeavors. The implementation strategies most relevant to community academic partnerships include: (1) Building a coalition; (2) Conducting local consensus discussions; (3) Identifying barriers and facilitators to implementation; (4) Facilitating interactive problem solving; (5) Using an advisory board or workgroup; (6) Tailoring strategies; (7) Promoting adaptability; and (8) Auditing and providing feedback. We offer suggestions for future research to systematically evaluate these strategies with an eye towards advancing the science of CAP and implementation science, with the goal of guiding future research and improving the implementation of EBPs in community settings.

“Coming together is a beginning, staying together is progress, and working together is success.”

– Henry Ford

Despite the proliferation of evidence-based practices (EBPs) for psychiatric disorders (Weisz et al., 2013), these treatments continue to be under-used and poorly implemented in community settings (Brookman-Frazee, Taylor, & Garland, 2010; Morris, Wooding, & Grant, 2011; Schoenwald & Hoagwood, 2001). Typically, psychosocial intervention research is conducted in tightly controlled university-based research clinics using highly trained clinicians and rigorous methods to evaluate treatment outcomes (Breitenstein et al., 2010; Schoenwald et al., 2011). On the other hand, most mental health treatments in the community are conducted by masters-level clinicians employing an eclectic approach (Garland et al., 2010). Community clinicians rarely systematically monitor patient progress (Jensen-Doss, 2011) and community mental health agencies and systems often are not equipped to support the implementation of EBPs (Jensen-Doss & Hawley, 2010). Not surprisingly, efforts to implement EBP have been disappointing to date (Hemmelgarn, Glisson, & James, 2006; McHugh & Barlow, 2010). At the heart of this implementation problem is a fundamental disconnect between researchers who develop treatments in tightly controlled settings and community practitioners who continue to deliver services in ‘messy’ environments. Recently, scholars have identified partnership between researchers and community stakeholders as a key mechanism to bridge the research-to-practice gap, noting “the future of the field depends on the ability to utilize partnerships to conduct more rigorous and robust research” (Chambers & Azrin, 2013, p. 509). Guidelines about how to best engage in community partnered research and evidence of its effectiveness as an implementation approach are currently lacking. In this manuscript, we describe the lessons learned through our community partnered approach and map them onto a well-established taxonomy of implementation strategies as a first step in stimulating research to evaluate CAP.

What is Community Partnered Research?

Community-partnered research represents a paradigm shift from the traditional model of research, in which academic researchers conceptualize, develop, and carry out research with little input from community stakeholders (Drahota et al., 2016; Glasgow, Lichtenstein, & Marcus, 2003). Specifically, community-partnered research is driven by the view that the “trickledown model of how to translate research into practice” (Glasgow et al., 2003, p. 1262), characterized by the slow journey from efficacy trials to effectiveness trials and finally dissemination and implementation, is flawed and inadequate. Instead, community-partnered research includes community stakeholders in the decision-making process from the beginning, and aims to develop and test interventions that are feasible and sustainable in the settings for which they will ultimately be used (Drahota, Aarons, & Stahmer, 2012). Community-partnered research has been called by a number of names, including Community-Based Participatory Research (Israel, Schulz, Parker, & Becker, 1998), Community-Partnered Participatory Research (Jones & Wells, 2007; Wells & Jones, 2009), Participatory Action Research (Baum, MacDougall, & Smith, 2006), and most recently Community-Academic Partnership (Drahota et al., 2016). While these models have nuanced differences, their unifying theme is the adoption of an equal partnership among researchers and community stakeholders in the design, development and execution of research with the shared goal of improving community outcomes. In this paper, we describe our research using the term Community-Academic Partnership (CAP) because it emphasizes the bidirectional nature of the partnership.

Benefits and Barriers to Community-Academic Partnerships

A partnership between researchers and community stakeholders offers many advantages, and is indeed foundational to implementation science, which is the scientific study of methods to promote the uptake of research findings into routine health and mental health care (Eccles & Mittman, 2006). First, these partnerships improve the quality of the research questions by engaging community stakeholders from the onset of the research design and ensuring that the research questions are relevant to community needs (Baker, Homan, Schonhoff, & Krueter, 1999). Ideally, all parties iteratively generate research questions until they arrive at a set of questions of interest and importance to all. Community stakeholder participation in the scientific process increases the potential to design studies that produce information that is readily useful and relevant to community partners (Benoit, Jansson, Millar, & Phillips, 2005; Kasari & Smith, 2013). Second, these partnerships create local expertise to sustain implementation beyond the study period (Glasgow et al., 2003). Third, community partnerships keep researchers accountable for producing tools that are useful in day-to-day practice. This type of research also poses many challenges. For example, even in situations in which genuine efforts are made to partner, there may be an inequitable distribution of power, leading community stakeholders to feel marginalized and inferior (Wells & Jones, 2009). Additionally, community stakeholders may hesitate to lead research activities due to the additional demands on their time (Weinberg & Erickson, 1996). Last, timelines associated with CAP also pose challenges. Developing such a partnership takes time because of the need to build trust, identify questions, and train and educate researchers and community stakeholders (Hanney et al., 2015). These timelines differ from those of funders and university promotion processes and can create conflict and burden for both researchers and community partners. Each of these challenges to forming and maintaining CAP can serve as barriers to implementation of EBPs in community settings.

In addition to the challenges of successfully building and maintaining CAP, the approaches used and mechanisms of change (i.e., how they work) have not been empirically tested, which presents a barrier to the scientific process and replicability of findings. Describing the process of forming and maintaining a CAP in one research group and mapping them on to a taxonomy of implementation strategies is a first step towards an empirical research agenda related to CAP. The purpose of this paper is to 1) describe the lessons our group has learned through the CAP process while studying the implementation of EBPs in public community settings including schools and specialty mental health clinics, and 2) map the lessons learned onto the refined compilation of implementation strategies identified by Powell and colleagues (2015). We hope that these lessons serve as a blueprint for future work that will empirically test the effectiveness of forming a CAP as an implementation strategy, and initiate dialogue between researchers and community stakeholders.

Implementation Strategy Selection

In the sections that follow we describe the lessons we have learned while engaged in CAP and the implementation strategies that align with these lessons (see Table 1). Implementation strategies that focus on CAP were selected from the Powell et al (2015) comprehensive summary of implementation strategies. These implementation strategies were identified as a post-hoc exercise upon reflection of the lessons learned through our CAP work. The lessons learned were mapped onto relevant implementation strategies using content analysis and group consensus to identify the implementation strategy that best aligned with each of our lessons learned. Implementation strategies aligned with each lesson were selected from the Powell et al. (2015) taxonomy of implementation strategies by three independent raters, and checked for agreement by a leading expert in implementation science research.

Table 1.

Implementation Strategies and CAP Lessons Learned by Stage in Partnership

Implementation Strategy(s)	CAP Lesson Learned	Stage in Partnership
Building a coalition (while engaged in implementation research)	Building and maintaining trust is foundational to all other aspects of CAP.	Throughout
Conducting local consensus discussions	Including community partners in research planning improves the acceptability and feasibility of the research	Before
Identifying barriers and facilitators to implementation	Providing foundational resources or support to our partners is essential for sustaining newly implemented programs.	Before
Using an advisory board or workgroup Using facilitation	Respecting organizational culture along with open and frequent communication among researchers and community stakeholders prevent challenges from becoming barriers to implementation.	During
Tailoring strategies Promoting adaptability	Being flexible and adapting research plans to fit with partners’ needs	During
Auditing and providing feedback	Supporting our community partners beyond the scope of the research project	After

Community Academic Partnered Implementation Strategies

The foundation for our approach to conducting CAP-centric implementation research is broadly represented by the implementation strategy ‘develop academic partnerships,’ in which a university or academic group and community stakeholders develop a partnership for the purposes of shared training and bringing research skills to an implementation project (Powell et al., 2015).

We begin our description of the lessons we have learned while engaged in this research by discussing the foundational components of implementation-focused CAP that must occur continuously throughout the partnership to facilitate the uptake and sustainment of clinical innovations. We then describe sequential steps in CAP as actions that occur before the research, during the research, and after the research, with the understanding that many steps may be fluid and dynamic. This multi-phase process is parallel to the multi-phase nature of implementation, which is similarly described as iterative and dynamic (Aarons, Sommerfeld, & Willging, 2011). Figure 1 depicts our conceptual model illustrating the sequential and interwoven relationships among these lessons.

Figure 1.

Conceptual model illustrating implementation strategies across phases of the CAP research process.

Throughout the Partnership

Building a Coalition

A hallmark of CAP is the bidirectional nature of the partnership and mutual sense of trust among partners, which lays the foundation for all subsequent research activities. This active partnership between groups is captured in the implementation strategy, ‘building a coalition’ and is defined as recruiting and cultivating relationships with partners in the implementation effort (Powell et al., 2015). Building a coalition or an alliance with community stakeholders is thought to lead to better implementation outcomes (Drahota et al., 2016); however, research that directly evaluates implementation efforts developed through a coalition with community partners is needed to validate the effectiveness of this strategy. Throughout our CAP we have learned that building and maintaining trust is foundational to our ability to effectively form an alliance with our community partners, and that all other aspects of the CAP are contingent upon this alliance.

We make concerted efforts to gain and maintain the trust of our community partners. We build trust with our partners through frequent communication, actively listening to their needs and concerns, and tailoring our approach to meet their needs in order to create a partnership that actively supports the implementation of EBPs in community settings. In an effort to promote an egalitarian relationship among researchers and community partners, faculty and postdoctoral fellows in our center go by their first names during all interactions, rather than by ‘Dr.’ Further, one of the most central tenets of our work is that research participants have a positive experience with the research process, particularly ethnic minority participants (Scharff et al., 2010), who are typically underrepresented in research and may be mistrustful of the research process (Wells & Jones, 2009; Wells, Miranda, Bruce, Alegria, & Wallerstein, 2004). Researchers also may make mistakes that lead to unpleasant experiences for participants (Clark & Mulligan, 2011). When mistakes happen, we attempt to turn the experience into a learning opportunity for our team members, but more importantly, we acknowledge and correct the mistake.

Here we share a story that illustrates this lesson. We were conducting assessments in community mental health clinics for a study on implementation of evidence-based treatment for trauma (Beidas et al., 2016). The principal investigator (PI) received a phone call from a research assistant telling her that an interview had not gone well. Debriefing revealed that the research assistant had not been sensitive to the needs of the legal guardian of the youth receiving treatment. The guardian had not understood the questions and the interviewer did not adequately explain them. To remediate the situation, the PI visited the community mental health agency during the youth’s next appointment (with the consent of the legal guardian) to apologize and learn more about the participant’s interview experience. Before leaving the session, the participant stated that although she did not want to continue in the study, she was grateful that the PI had spoken with her. The family’s therapist shared that she was more likely to enroll future clients in the evaluation because she thought the team had “righted a wrong.”

We also maintain our community partners’ trust by valuing our partnership above collecting data. Doing this is ethically advisable and enriches the research program in the long run. For example, in another project, we collected fidelity data regarding teachers’ use of EBPs. Despite our best efforts to accommodate teachers’ schedules during visits, many teachers viewed them as burdensome and stressful. They reported that the researchers “only care about the data.” We quickly acknowledged our mistake and changed our data collection approach to be entirely based on the teachers’ preferences. For example, before commencing data collection on a particular day, researchers would double check with teachers that the day still suited them, as many unforeseen last minute changes to scheduling and crises can make data collection practically or emotionally unsuitable for a teacher. This process resulted in obtaining data that may have been considered less rigorous, but was more complete because teachers were more likely to participate and were appreciative of our efforts to reduce burden. The lessons related to building a coalition and maintaining trust highlight the importance of a nonhierarchical relationship among partners that embraces efforts to acknowledge and fix mistakes as they occur.

Before the Research

Conducting Local Consensus Discussions

Research should be based upon community needs, and partners should have a voice in the research design (Beidas et al., 2015). Sometimes researchers’ questions of interest and those of community partners are at odds. Similarly, designs that researchers consider best suited to answer a particular question may conflict with the pragmatic and ethical concerns of community partners. Listening to community partners’ priorities and incorporating their views into the research questions and design are likely to improve implementation outcomes. This type of active community involvement in the research design can be described as aligning with the implementation strategy of ‘conducting local consensus discussions.’ When using the implementation strategy of conducting local consensus discussion, researchers include local providers and other stakeholders in discussions that address whether the chosen problem is important and whether the clinical innovation to address it is appropriate (Powell et al., 2015).

Several examples from our community partnerships highlight the critical importance of including community partners in the research planning. First, when designing an implementation study, we planned to randomize therapists within agencies to different implementation strategies. During our customary visit with agency leadership prior to the study launch, we learned that this was not acceptable because it could create discontent among therapists. We listened to their concerns about randomization and presented alternative study designs. Based upon their feedback, we modified the study design to a crossover design (i.e., all participants received a sequence of implementation strategies), which agency stakeholders preferred. Ultimately, despite requiring more resources, this approach strengthened scientific rigor and maintained partner acceptability. At the end of the study, qualitative interviews reflected that the flexibility demonstrated by the research team was welcomed by agency stakeholders and enhanced the trust developed between the research team and partners.

Next, to highlight the process of developing research goals that meet our partner’s needs, we discuss conversations we have had with the school district about how to improve education for children with autism spectrum disorder. These conversations began the way many of our partnerships do, with one of the authors asking administrators about the district’s most pressing challenges. Of particular concern was that children with autism were not successfully transitioning from early intervention services to kindergarten, which resulted in family dissatisfaction and increased district costs as families demanded more expensive services. The researchers proposed a small-scale observational study to follow children and families through the transition process to learn more about challenges faced and gaps in services. Months into planning the study, our district partner expressed dismay at the timeline for this study and for the subsequent intervention. They proposed that, instead of an observational study, we conduct an intervention study. Their proposal led to lengthy discussions about whether the district had the infrastructure to implement an intervention program, whether there was enough preliminary evidence to support large-scale implementation, and what the research design would be. The study was dramatically changed based on our community partners’ needs and timetable, once again ultimately resulting in better implementation of classroom EBPs for autism and a more sound partnership. Throughout these experiences using the implementation strategy of conducting local consensus discussions we have learned that including community partners in the research planning improves the feasibility and acceptability of the research. Additional implementation science studies that evaluate the effects of including local providers and other stakeholders in the decision-making process for selecting research questions and research strategies would offer support for the utility of these practices, which are often viewed as fundamental to a community-partnered approach.

Identifying Barriers and Facilitators to Implementation

Understanding contextual barriers in the community is essential to building and maintaining a strong CAP that supports the implementation of EBPs. Implementation researchers engaged in CAP may benefit from formally assessing for readiness and identifying potential barriers and facilitators to implementation before engaging in implementation efforts. Powell et al. (2015) describe this implementation strategy as assessing various aspects of an organization to determine its degree of readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort. Formally assessing barriers to implementation will enable researchers to systematically provide foundational resources for implementation of EBPs when they are needed, rather than waiting until the implementation fails to provide the needed resources. Additionally, evaluating current configurations of the implementation setting and adapting the physical structure and/or equipment to best accommodate the targeted innovation (Powell et al., 2015) can help ensure the environment is ready for implementation. We have learned that providing foundational resources or support to our partners is essential for sustaining newly implemented programs.

One example that highlights the use of this strategy stems from our work in public schools. During classroom visits in autism support classrooms, one of the authors noticed that the teacher did not have access to the materials needed to implement common EBPs in her classroom. When designing the intervention to improve parent-teacher implementation of EBPs, the team did not plan to supply (nor did they budget for) materials. So, the team began traveling with a printer, laminator, Velcro, and a variety of child-friendly materials. Our group has repeatedly observed that providing resources for implementation has been a key facilitator in building partnerships with community stakeholders, especially those operating in under-resourced settings, and in beginning the implementation process. Future implementation researchers should systematically evaluate the benefits of providing foundational resources to implementers as a basic process in the implementation of new practices, especially within under-resourced community settings.

During the Research

Facilitation

We have found that open and frequent communication among researchers and community partners is critical for preventing barriers to implementation of EBPs. Open and frequent communication with active problem solving to improve implementation is aligned with the implementation strategy of ‘facilitation’, the process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship (Powell et al., 2015). Through our use of facilitation we have learned that open and frequent communication among researchers and community stakeholders is likely to prevent challenges from becoming barriers to implementation. For example, whenever we start a new study with partners at community mental health agencies, we engage in brief check-ins with agency leadership. The PI communicates via phone or email to ask if everything is going smoothly and we quickly adapt to agency feedback. This ensures that we can be responsive to the needs of our partners and that we are aware of any logistical challenges that arise immediately, thus avoiding a situation where leadership reaches out to us to report a problem. Our group’s frequent and open communication with community partners led to a deeper understanding of our partners’ preferences and priorities for research. This communication and understanding has strengthened our partnerships and likely contributed to continued opportunities for research collaboration. An open dialogue with interactive problem solving in the context of a supportive relationship is likely a foundational component of a successful CAP. Research that operationalizes this strategy and evaluates its effect on implementation outcomes within a CAP is needed.

Use an Advisory Board or Workgroup

The use of an advisory board or workgroup is an implementation strategy in which the research team creates and engages a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements (Powell et al., 2015). We work closely with community partners to integrate our research goals with the existing mission of the organization. One example of this integration is our autism workgroup, which was formed in response to repeated challenges to research in the school district. The monthly workgroup is comprised of administrators, educators, and researchers. Initially, the research team set the agenda, but quickly that became collaborative. After several meetings, trust and common purpose were established, and the school administrators began bringing programmatic issues to our workgroup to get feedback. The research team used this venue to disseminate current research that was of interest to the group. We also modeled transparency in decision-making within our own research team. This frequent communication, mutual respect, and transparency have been essential to a successful workgroup and has led to continued problem solving related to observed barriers to implementation of EBPs in classrooms. Each monthly meeting led to a deeper understanding of the district’s mission and how the mission related to the classrooms and students we served. Consistent attendance and active participation by both researchers and community partners to these workgroup meetings were indicators of the success of this forum. The workgroup has been a positive experience that has shaped the way we align our research goals with the school district’s mission in order to support the implementation of EBPs in public school settings. Our experience with the autism workgroup highlights the benefits of engaging a workgroup in the implementation process. Future research is needed to systematically evaluate the implementation outcomes associated with the use of such an advisory board or workgroup during the implementation process.

Tailor Strategies and Promote Adaptability

Conducting implementation research with community partners requires greater flexibility than other types of research. Tailoring strategies to address barriers to implementation and promoting adaptability by identifying the ways an innovation can be tailored to meet local needs can improve the long-term sustainability of EBPs and clarify which elements of the innovation must be maintained to preserve fidelity (Powell et al., 2015). Throughout our CAP we have learned that being flexible and adapting research plans to fit with our partners’ needs are critical for implementation of EBPs. Our research team learned this lesson in the first year of a five-year randomized controlled trial. After careful, collaborative planning with our school partners, we began to train a group of teachers in a packaged program for young students with autism. The program consisted of three instructional strategies paired with a curriculum. We relied heavily on the curriculum developers to provide the training. The program developers, however, did not have experience in under-resourced urban schools. There were serious problems with the program roll out. Teachers were being trained in an instructional strategy that required intensive individualized instruction; however, the classrooms lacked the infrastructure to provide students with intensive individualized instruction. We observed classrooms and interviewed teachers about why they were having difficulty with the program. We learned that our teachers did not have the classroom resources, foundational training, and incentive for the change needed to implement this program.

Based on our findings, we worked with the program developers to change the training strategy. First, we created a team of local expert trainers that took over classroom-based consultation. Second, we rearranged the sequence of training to ensure that foundational strategies related to classroom structure and management were implemented first. We found that teachers responded immediately to local experts who understood their challenges. Teachers wanted to learn the foundational strategies because they thought these skills would improve their classrooms more than the individualized instructional components of the intervention. Once teachers experienced success with the foundational strategies, they were much more likely to buy into the idea that a comprehensive program could work in their classroom. Evidence of the success of our efforts was apparent in the second year of the study, when newly enrolled teachers achieved program fidelity much more quickly than teachers in the first year. Our approach to training was flexible and evolved over time to appropriately meet teachers’ needs. Future research is needed to evaluate how a flexible and tailored approach to the use of implementation strategies can support practitioners’ successful implementation of new EBPs.

After the Research

Audit and Provide Feedback

Our community partners have taught us that implementation research participation is often time-consuming. We are grateful for their partnership and try to support them in meaningful ways whenever possible. We have learned that supporting our community partners beyond the scope of the research project is an important strategy to support long-term partnerships and sustainment of EBP. One way we have tried to support our community partners is through the use of the implementation strategy ‘audit and provide feedback’, the process of collecting and summarizing clinical performance data over a specified time period and sharing it with clinicians and administrators to monitor, evaluate, and modify provider behavior (Powell et al., 2015).

For example, in a pilot study with therapists delivering EBPs, we recorded and then coded treatment sessions to determine whether a therapist demonstrated fidelity to the treatment model. We realized that coding therapy tapes offered an opportunity to provide therapists with individual feedback about their use of the EBP. We gave the therapists brief feedback reports including information about their use of the EBP with a focus on identifying areas of strength and areas for growth. During follow-up interviews we learned that therapists appreciated the feedback and found it very useful.

We also provide feedback to agency leadership. For example, during a five-year study of the impact of a policy on the use of EBP (Beidas et al., 2015), we provided aggregated reports to leadership and study participants based upon the data that we collected. Each report included recommendations to improve elements of EBP implementation. Providing individual and organizational level feedback has been mutually beneficial as our team is able to keep the agencies engaged in our study during non-data collection years, maintain personal relationships, and provide agencies with helpful recommendations to improve ongoing implementation efforts. Although we did not measure the effects of this implementation strategy, future research that evaluates the acceptability and effectiveness of providing performance feedback to clinicians implementing new EBPs will provide valuable insight into the utility of this implementation strategy.

Conclusion

Many strategies have been developed to support the implementation of EBP into community practice (Powell et al., 2012; Powell et al., 2015); however, most of these strategies do not explicitly describe how a CAP approach informs the design of these strategies. Although partnerships with the community are complex and can be difficult to manage, CAP has the potential to reduce the research-to-practice gap and improve the successful implementation of EBP into community practice (Drahota et al., 2016). Our research group has partnered with a variety of community stakeholders to improve the implementation of EBP in community settings. In implementation science, the unit of analysis and therefore the necessary partner, are the individuals implementing the innovation. As a result, our focus in CAP is in building partnerships with agencies, schools, and practitioners to improve the implementation of EBP in community settings.

The field of implementation science offers a systematic method to evaluate the success of methods to promote the uptake of research findings into routine health and mental health care. A wide-range of implementation strategies have been described and used to support the transfer of research findings into daily practice, many of which include community-partnered components (Powell et al., 2015). However, the processes involved in developing and sustaining a CAP to support implementation of EBPs into practice have not been formally operationalized and evaluated using an implementation science framework. The implementation strategies described in this paper are not an exhaustive list of CAP focused implementation strategies. Rather, the strategies described are those that best align with the lessons we have learned through our CAP. We present these lessons as a first step in operationalizing implementation strategies used within CAP in an effort to excite more empirical research that evaluates the use of CAP in implementation science.

Successful CAP involve a series of carefully planned steps to build and maintain the partnership during multiple phases of the research process. Our intention in providing this proposed order is to share the lessons we have learned during distinct phases of our CAP and the actions that we have taken based on these lessons throughout the research process. The most important lesson here is not our order of steps, but that CAP should involve a systematic series of thoughtfully planned and executed actions during all phases of the research process and throughout the partnership, much like the multi-phased nature of implementation science (Aarons et al., 2011). We view the steps needed to form a successful CAP as continuous, and much like Henry Ford’s quote listed at the beginning of this paper, care must be taken to nurture the partnership across all phases so that researchers and community stakeholders can successfully come together, stay together, and work together.

Perhaps the most important lesson we have learned throughout our CAP is that successful implementation of EBP in community settings requires careful listening to and consideration of our partners’ needs. Academic researchers often have preconceived ideas regarding research questions, goals, and design strategies to disseminate and implement EBP in the community. Yet, our most successful attempts at implementing EBP with our community partners occurred when we actively involved our community partners in the research planning, or when we adapted our research protocols to better meet our partners’ needs. Willingness to be flexible in the design and execution of research strategies has been critical to the success of our partnerships.

The lessons we share here are not based on data; rather they are based on anecdotes, observations, and careful reflection of our experiences engaging in community-partnered research. While we have data to support the success of our research projects, we acknowledge that we do not have data regarding the success and effectiveness of our CAP. As a field, we lack systematic methods to effectively measure the success of CAP beyond the success of our research agendas and whether or not the relationships are maintained. The science of CAP warrants further study characterization in order to identify and measure its success. Researchers are beginning to systematically develop and evaluate strategies to improve CAP (Wallerstein, 2015). However, implementation research that specifically evaluates whether or not including stakeholders as part of the participatory design results in better outcomes, and if any observed improvements sustain as the innovation is taken to scale are needed. We hope the lessons we learned, which we believe mirror other centers’ experiences, spark continued interest in the development of scientific tools (such as measures to evaluate effective CAP) to support successful community-academic partnerships and ultimately improve the implementation of EBP in community settings.

The development of observational or survey methods can help us better understand and evaluate the scientific process of CAP and how this process relates to implementation science. One possible way may be to borrow from the field of team science, which draws on diverse disciplinary perspectives to better understand and enhance scientific collaboration (Hall, Feng, Moser, Stokols, & Taylor, 2008; Vogel, Hall, Fiore, Klein, & Bennett, 2013), to develop useful and novel measures to evaluate the effectiveness of the CAP process. Furthermore, use of randomized trials evaluating different partnership models that systematically develop CAP processes aligned with implementation strategies would improve our understanding of the CAP characteristics and processes that lead to better implementation of EBP (Drahota et al., 2012). The field of implementation science stands to benefit greatly from the use of CAP; however, we have great strides to make regarding the science and rigor of CAP in implementation science.