Overview of the Translation, Dissemination, and Implementation of Public Health Preparedness and Response Research and Training Initiative

Abstract

We provide an overview of a Centers for Disease Control and Prevention–funded public health preparedness and response (PHPR) research and training initiative to improve public health practice. Our objectives were to accelerate the translation, dissemination, and implementation (TDI) of promising PHPR evidence-based tools and trainings developed by the Preparedness and Emergency Response Research Centers (PERRC) or the Preparedness and Emergency Response Learning Centers (PERLC) between 2008 and 2015.

Nine competitive awards were made to seven academic centers to achieve predetermined TDI objectives. The outputs attained by the initiative included: user-friendly online repositories of PERRC and PERLC tools and trainings; training courses that addressed topics; a community resilience manual to synthesize, translate, and implement evidence-based programs; and Web applications that supported legal preparedness, exercise evaluation, and immunization education. The evaluation identified several best practices and potential barriers to implementation.

As illustrated by the work in this supplement, the broader awareness and implementation of PERRC preparedness products and PERLC trainings and the continued evaluation of their impact could enhance the PHPR capacity and capability of the nation, which could lead to improved health security.

The Office of Public Health Preparedness and Response coordinates the preparedness and response activities at the Centers for Disease Control and Prevention (CDC). This Office works with state, tribal, local, territorial, national, and international public health partners to help the nation prepare for, respond to, and recover from natural- and human-caused disasters, as well as other threats to public health. CDC funded nine Preparedness and Emergency Response Research Centers (PERRCs) and 14 Preparedness and Emergency Response Learning Centers (PERLCs) in academic institutions throughout the nation.^1,2 The objectives were to improve all hazard emergency preparedness and response activities in the United States, as mandated in the 2006 Pandemic and All Hazards Preparedness Act.³ The federal investment in the PERRC and PERLC programs was $57 million from 2008 to 2014 and $34 million from 2009 to 2015, respectively.

The PERRC program intended to support applied public health systems research with the objectives of strengthening and improving national public health preparedness and emergency response capabilities.⁴ The PERLC program intended to improve workforce readiness and competence through the development, delivery, and evaluation of targeted learning programs designed to meet specific requirements of state, tribal, and local partners.² Both programs met their intended objectives and were highly productive. The PERRCs developed 30 ready-to-use preparedness toolkits to facilitate planning, evaluation, communication, and other activities. The funded institutions published more than 200 peer-reviewed scientific articles that presented findings from public health systems research on public health preparedness and response (PHPR) capabilities. Similarly, the PERLCs developed more than 800 learning products, inclusive of online webinars, in-person trainings, and exercises, intended to improve public health workforce readiness and competence in emergency preparedness and response. In addition, both the PERRCs and PERLCs established diverse practice partnerships with state, tribal, local entities, and nonprofit organizations across the nation. For example, Johns Hopkins University partnered with local health departments, state emergency planners, and Christian, Jewish, and Muslim faith-based organizations in urban and rural areas of Maryland, Illinois, and Iowa to develop a dual-intervention model of capacity building for public mental health preparedness and community resilience.⁵ Meanwhile, the University of Minnesota partnered with the Minnesota Department of Health to develop the “How to Assess Incident Commanders’ Leadership Skills” tool.⁶

After completion of the PERRC and PERLC programs, CDC sought to determine which products and trainings might be translated, disseminated, or implemented in other settings and announced the Translation, Dissemination, and Implementation (TDI) of Public Health Preparedness and Response Research and Training Initiative. This TDI initiative intended to move evidence-based practices and curricula from PERRC and PERLC programs to practice and to identify the challenges and best practices for implementation. We provide an overview of the TDI initiative, and this journal supplement showcases some of the work conducted by the selected investigators.

ESTABLISHMENT OF A COORDINATING CENTER

CDC selected the Association of Schools and Programs of Public Health (ASPPH) as the coordinating center for the TDI initiative, primarily because of their historical role in coordinating the activities of both the PERRC and PERLC programs. ASPPH had the required program infrastructure, level of expertise, and capacity to provide an organizational structure for a coordinating center of the TDI initiative. Following a CDC award of $7.6 million for establishing the coordinating center, ASPPH solicited proposals from all 18 accredited schools of public health that hosted PERRCs or PERLCs to work on three activities, namely: (1) synthesis and dissemination of research findings from PERRCs, (2) synthesis and dissemination of training products from PERLCs, and (3) moving new knowledge that resulted from public health preparedness response research and training into practice and policy. After an expert panel review, ASPPH selected nine applications for funding, one each for activities 1 and 2, and seven for activity 3 (Table 1). The funding amount for each project ranged from nearly $0.5 million to $1.1 million, and project work was conducted from January 2016 through August 2017. (The project periods for activities 1 and 2 were 12 months each, and activity 3 projects took 18 months.)

TABLE 1—

Accredited Schools of Public Health That Established a Preparedness and Emergency Response Research Center (PERRC) or a Preparedness and Emergency Response Learning Center (PERLC), and Their Participation in Translation, Dissemination, and Implementation (TDI) Activities

Academic Center	PERRC (2008–2014)	PERLC (2009–2015)	TDI Initiative Activitya (Jan. 2016–Aug. 2017)
Columbia University		X
Emory University	X		Activity 3
Harvard University	X	X	Activities 1 and 3
Johns Hopkins University	X	X
Texas A&M University		X
University of Alabama at Birmingham		X
University at Albany		X	Activity 3
University of Arizona		X	Activity 3
University of California, Berkeley	X
University of California, Los Angeles	X		Activity 3
University of Illinois		X
University of Iowa		X
University of Minnesota	X	X
University of North Carolina (Chapel Hill)	X	X
University of Oklahoma		X
University of Pittsburgh	X		Activity 3
University of South Florida		X
University of Washington (Seattle)	X	X	Activities 2 and 3

Note. TDI = Translation, dissemination, and implementation. This table shows participation in one or more activities of the TDI of Public Health Preparedness Response Research and Training Initiative.

^aActivities 1 and 2 focused on synthesis and dissemination of PERRCs and PERLCs research and training outputs, respectively. Activity 3 focused on moving those research outputs and trainings into practice and policy.

TDI INITIATIVE CONFIGURATION AND MANAGEMENT

CDC supported the TDI initiative by providing technical, programmatic, and scientific assistance. ASPPH, as the TDI initiative coordinating center, convened meetings, coordinated information sharing among grantees, coordinated dissemination opportunities for the project outputs, and monitored performance. ASPPH convened a Public Health Preparedness Advisory Group, which consisted of 20 state, tribal, local, and federal public health professionals, who informed the overall initiative’s approach to the work based on the Advisory Group members’ expertise in PHPR and experience in workforce development and public health training. ASPPH used the online community, a Web-based platform, for distributing information on the initiative and storing grantee progress reports. NORC at the University of Chicago (NORC, formerly the National Opinion Research Center) evaluated the TDI initiative (see Kelliher, p. S353).

Individual project structure included a core team of investigators and partnerships with local, regional, and national organizations, and experts selected based on project objectives. A major program advantage was that most grantees maintained continuity of staff from the PERRCs and the PERLCs to the TDI initiative. Depending on the project objectives and expertise of the core team, additional consultants and subject matter experts joined the project teams. This included curriculum designers, tribal liaisons, communication specialists, evaluation specialists, legal specialists, information technology experts, and Web site designers.

PROJECTS FOCUS AND MAIN OUTPUTS

The focus and selected outputs of all nine projects are summarized in Table 2. As recommended by the TDI initiative announcement, all the projects used the Interactive Systems Framework (ISF) in their design in some capacity. The ISF design incorporates aspects of both research-to-practice models and community-centered models to describe needs, barriers, and resources of principal stakeholders and systems engaged in the dissemination and implementation of evidence-based interventions.^8–12 ISF uses three systems to promote dissemination and translation of evidence-based practices to program. These are: (1) the prevention synthesis and translation system, which distills information about evidence-based innovations and translates it to user-friendly formats; 2) the prevention support system, which is the set of activities that provide information, training, technical assistance, or other support to practitioners for implementation of innovations in the field, and (3) the prevention delivery system, which is the set of activities that enable the implementation of innovations into practice. In the context of the TDI initiative, the ISF served as a guide for designing projects that could best address the research to practice gap at one or more of the three ISF system levels.

TABLE 2—

Translation, Dissemination, and Implementation (TDI) of Public Health Preparedness Response Research (PHPR) and Training Initiative Projects—Main Outputs and Intended Knowledge Users (IKU) Organization Types

TDI Initiative Activity and Grantee	Activity Aim	Selected Outputs	IKU—Organization Type
1. Synthesis and dissemination of research findings from PERRC
Harvard T. H. Chan School of Public Health	To facilitate successful translation of PERRC research into practice by comprehensively synthesizing and disseminating research findings to knowledge users	Online inventory of PERRC tools. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1609/2017/03/PERRC-Toolkit-Inventory.pdf	State health department
		Systematic review of PHPR research literature (2009–2015) across identified priority areas. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594402	Local public health department National public health association
2. Synthesis and dissemination of training products from PERLC
University of Washington School of Public Health	To improve public health professionals’ access to PERLC-developed online trainings and other preparedness-related learning resources through the development of a user-friendly, searchable online catalog	Online catalog of PERRC and PERLC training resources. http://perlc.nwcphp.org	Local public health department
		Training quality assessment rubric	Tribal health department, state health department, university
3. Moving new knowledge resulting from PHPR research and training into practice and policy
Emory University Rollins School of Public Health	To enhance public health practitioners’ access to promising preparedness findings and tools focused on selected vulnerable populations: long-term care residents, pregnant women and inmates, through tool refinement and demonstration projects	Expanded and evaluated Web portal providing emergency preparedness planning, training, and response resources for long-term care providers; adoption and maintenance of the portal by the Florida Health Care Association. http://ltcprepare.org	State health care organization
		Developed a health department toolkit for preparedness partnering with jails	Local health department
		Published evidence and stimulated local, regional, and national dialogue about under-utilization of obstetric practice Web sites to distribute information to pregnant women about Zika virus and vaccines for influenza, and tetanus, diphtheria, and pertussis	Health providers
		Developed and expanded ReadyVax, an immunization education and tracking tool for patients, providers, pharmacists, and public health professionals. http://www.readyvax.com; https://itunes.apple.com/us/app/readyvax/id957851259?mt=8	Patients
Harvard T. H. Chan School of Public Health	To translate, disseminate and implement evidence-based preparedness tools and trainings into practice, while adding refinements and updates to specific components	On-line training “Learning from the experience of public health system responses to emergencies.” https://youtu.be/KbNG5NlGmwE	State health department
		Helped practitioners understand the public health system response to the Zika virus, using a prospective, evidence-based approach to improve critical incident analyses	Regional health department
		Process maps for the integration of PERRC products in rapid research mechanisms	Local public health department
		Guide to the Use of PERRC Online Toolkit Products in Exercise and Real-World Event Evaluation. http://www.preparednessevaluation.com/436952676	National public health association
		Exercise evaluation with Partners HealthCare. https://www.hsph.harvard.edu/preparedness/toolkits/perrcs-toolkit-inventory
		Risk communication during Public Health Emergencies training
		Social Media Learning Collaborative for the translation and dissemination of preparedness trainings and tools
University at Albany SUNY School of Public Health	To improve access to and sustainability of PFA training for New York HEPC members	Created a PFA Training Coordinator Guide to assist emergency preparedness coordinators in developing and implementing PFA policies and practices within their respective organizations https://www.albany.edu/sph/images/PFA_Training_Coordinator_Guide_August_14_2017.pdf	Regional medical center
		The guide lists available online PFA training courses enabling audience-appropriate course selection, and advice to promote program buy-in develop program sustainability, evaluate trainings, and build partnerships with local mental health providers for technical support	State health department
		A facilitator component provides instruction for conducting in-person, PFA skills practice sessions through role-playing, to build staff confidence and competence	State association of county health officials
		This project yielded a significant increase in PFA training activity across the HEPC agencies
University of Arizona Mel & Enid Zuckerman College of Public Health	To build a response network to strengthen and support collaboration, coordination, and communication around emergency preparedness and response practices between state, tribal, and local entities	Strategies Guidebook for Effectively Working with American Indians and Alaska Native Communities, focused on emergency preparedness and response efforts. https://mwperlc.arizona.edu/sites/default/files/Strategies_for_Effectively_Working_with_American_Indian_and_Alaskan_Native_Communities.pdf	Tribal health department
		Tribal and multijurisdictional PHPR needs assessment report	Local public health department
		Development of a Memorandum of Understanding template and checklist for regional partners for Point of Dispensing planning
		Building Block Approach Medical Counter Measures workshop
		Process Flow Mapping for Point of Dispensing Operations
		Developed a collection of regional case studies as a training resource to capture lessons learned, best practices, and identify further gaps in preparedness and response efforts
University of California Los Angles Jonathan & Karin Fielding School of Public Health	To increase the capacity of 3 greater Los Angeles area local health departments to implement evidence-based practices supporting community resilience, and build a practice improvement toolkit to guide health agencies in translating and implementing evidence-based practices promoting community resilience	Development of GTO—Community Resilience manual. https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL259/RAND_TL259.pdf	Local public health department
		Used GTO framework to train and help 3 local health departments identify, adapt, plan, implement, and evaluate evidence-based programs in disaster preparedness, improving the departments’ capacities to translate and implement programs (2 fielded household preparedness programs for senior communities; 1 implemented a program for emergency health staff preparedness)7
University of Pittsburgh Graduate School of Public Health	To create a searchable, online repository of emergency statutes and regulations applicable to volunteer response participation during a disaster or emergency	Developed ELI, designed to catalog laws addressing liability, license reciprocity, scope of practice, and worker’s benefits for emergency volunteers, areas requiring familiarity by volunteer responders https://www.legalinventory.pitt.edu	National organization for volunteer emergency responders
		The database helps individuals navigate through 1500 legal summaries impacting volunteer participation in disaster scenarios; the laws can be filtered by profession and jurisdiction so users can identify provisions that are most relevant to them	State health department
		ELI includes 4 legal topics relevant to volunteer preparation—liability, license reciprocity, scope of practice, and workers’ benefits	Local public health department
University of Washington School of Public Health	To improve public health agency communications during all phases of emergency events by supporting the translation of communications tools developed by the PERRCs and PERLCs	Inventoried, evaluated, and prioritized evidence-based PHPR communication tools and trainings	Local public health department
		Implemented evidence-based PHPR communication tools and trainings at 6 demonstration sites
		Demonstration project identified communication break-downs during public health emergency situations and strategies for incorporating evidence-based practices to address communication challenges in public health agencies
		Investigators characterized key organizational and tool-related factors that facilitate and hinder implementation
		Dissemination of outcomes from the implementation demonstration site projects in a national virtual Synthesis Symposium. www.nwcphp.org/docs/webinars/symposium20170627/index.html

Note. ELI = Emergency Law Inventory; GTO = Getting to Outcomes; HEPC = Health Emergency Preparedness Coalition; PERLC = Preparedness and Emergency Response Learning Centers; PERRC = Preparedness and Emergency Response Research Centers; PFA = Psychological First Aid; SUNY = State University of New York.

The activity 1 and 2 projects focused on the prevention synthesis and translation system in the ISF. These projects developed evidence-based methods for reviewing, evaluating, and cataloging PERRC and PERLC products. The synthesis and dissemination inventories of PERRC research and PERLC training resources serve as central repositories for preparedness program resources. They enable PHPR practitioners to easily locate information on evidence-based practices and high-quality training resources that might be able to be adapted to improve PHPR practice.

The activity 3 projects primarily focused on the prevention support system and the prevention delivery system of the ISF. Prevention support system activities focus on providing training, technical assistance, or other support to build the intervention implementation capacity and capability of practitioners in the field. The activities include conducting needs assessments, providing technical assistance and training, developing users guides, creating a program planning and implementation guide for community resilience programs meeting with advisory groups, rapid prototyping, conducting usability and feasibility testing, and establishing a public health stakeholder and partner forum. Prevention delivery system activities, implemented by five academic centers, were designed to actively implement innovations in the world of practice and included some form of needs assessment or baseline data collection followed by an assessment after implementation to evaluate the impact of delivered resources and activities. For example, to improve access to and sustainability of Psychological First Aid (PFA) training for New York Health Emergency Preparedness Coalition members, investigators from the University at Albany created a PFA training manual, facilitated collaboration between public health and mental health entities, supported the development of PFA training policies, and provided technical assistance to training coordinators who implemented the trainings at their agencies. To improve public health agency communications at all phases of emergency, the University of Washington investigators identified three high priority communication tools, worked with local health jurisdictions to implement them, and conducted an evaluation of the implementation of the tools. A summary of each project is provided in Appendix A (available as a supplement to the this article at http://www.ajph.org), and the accompanying articles in this supplemental issue describe the implementation of specific projects.

DEMONSTRATION SITES

As required by the TDI initiative announcement, grantees collaborated with PHPR practice and system partners associated with the type of tool or output being translated to facilitate the translation and implementation of innovations into PHPR practice (Table 3). Collaborative activities included needs assessments, piloting and feedback, using a product or resource, or serving as a demonstration or implementation site. Active involvement of practitioners in the projects nurtured relationships with the research community that fostered greater understanding and appreciation of each other’s perspectives and preparedness needs. The mutually beneficial partnerships facilitated the development and use of practical, useful, and user-friendly products, resources, and trainings for public health practitioners. As an example, an online toolkit used for evaluation of a disaster exercise was developed and field-tested in collaboration with public health and health care agencies from several states.¹³ Ninety-three percent of the 14 exercise planners reported that they found the toolkit appropriate for the creation of exercise evaluation forms and plan to use it again for future exercises. A brief description of other tools and trainings is available at https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1609/2017/03/PERRC-Toolkit-Inventory.pdf and http://perlc.nwcphp.org. The NORC evaluation of the TDI initiative indicated that practitioners appreciated the collaboration opportunities and were excited about the skills and lessons they gained through the experience.¹⁴

TABLE 3—

Translation, Dissemination, and Implementation (TDI) of Public Health Preparedness and Response Research and Training Initiative Grantees and Partners Engagement

	Project Partners
Grantee and the TDI Initiative Activity	State HDs	Tribal Local/Territorial HDs	Tribe/Tribal Organization	Professional Associationa	Other Not-for-Profit or Government Entitiesb	Health Care Organization	Academic (Other Than ASPPH)
Harvard Universityc	X			X		X
University of Washingtond	X	X
Emory Universitye	X	X		X	X	X	X
Harvard Universitye	X	X		X		X	X
University at Albanye	X	X				X
University of Arizonae	X	X	X
University of California, LAe		X			X
University of Pittsburghe		X	X	X	X
University of Washingtone		X					X

Note. ASPPH = Association of Schools and Programs of Public Health; HD = health department.

^aFor example, National Association of County and City Health Officials, Association of State and Territorial Health Officials.

^bFor example, RAND Corporation, jails.

^cSynthesis and dissemination of research findings from Preparedness and Emergency Response Research Centers.

^dSynthesize and dissemination of training products from Preparedness and Emergency Response Learning Centers.

^eMoving new knowledge resulting from public health preparedness response research and training into practice and policy.

The grantees implemented project activities at various sites, including state and local health departments, medical provider offices, and tribal health organizations. Demonstration site activities included serving as participants in project activities and processes (e.g., exercises, trainings, after-action reports, and improvement planning processes), informing development of grantee’s tools or resources, providing feedback on a grantee’s in-development tool or resource, identifying barriers to tool or resource implementation, assisting with tool or resource adaptation to local settings, and providing the grantee with progress reports and evaluation data.

STEERING COMMITTEE OR ADVISORY GROUP

Each project convened its steering committee or advisory group, which typically consisted of emergency preparedness and response representatives from health departments, academic institutions, humanitarian organizations, medical center preparedness programs, professional associations, and federal agencies, among other entities. The steering committee or advisory group functions included providing general feedback on the tools and resources developed by grantees, assisting with the recruitment of demonstration sites, publicizing grantees’ efforts during the project period, and assisting with dissemination of project tools to end users.

In addition to direct-knowledge users with whom they collaborated, the grantees identified several intended knowledge users, including emergency management leadership, national emergency response associations, public health emergency preparedness and hospital preparedness program grantees, and administrators, managers, or directors of health care facilities.

DISSEMINATION ACTIVITIES

To facilitate dissemination activities, grantees used various specific strategies, both direct (e.g., development and distribution of training guides, technical assistance, conference presentations, and online publishing) and indirect (e.g., using partners, including the National Association of County and City Health Officials, the Association of State and Territorial Health Officials workforce development and emergency preparedness groups, public health practice listservs, regional steering committees, and the ASPPH newsletter and community of practice Web site). In addition, this special issue of AJPH highlights work from each of the projects.

EVALUATION AND IDENTIFICATION OF BEST PRACTICES

NORC used mixed methods to evaluate (1) the overall structures, processes, and outputs of the TDI initiative; (2) the extent to which the grantees effectively translated, disseminated, and supported the implementation of evidence-based PHPR tools and resources among public health practitioners; and (3) use of the ISF in development and implementation of the projects. Through interviews, focus groups (one with grantees and others with intended knowledge users), and document review, NORC explored grantees’ programmatic outputs, effectiveness of program and project structures, grantee evaluation methods, grantee partnerships with public health practitioners and other organizations, the reach of grantees’ products, best practices and program models emerging from the initiative, project challenges, and recommendations for CDC and ASPPH in effectively facilitating the dissemination and implementation of grantee products.¹⁴

The evaluation by NORC identified some best practices for translation, dissemination, and implementation of PHPR tools and resources, as reported by grantees, partners, intended and potential knowledge users, and members of the ASPPH Advisory Committee (Table 4).¹⁵ Several intended knowledge users and grantees felt that tools and products developed through the TDI initiative were appropriate models for future use in PHPR practice (e.g., the detailed processes established for creating inventories of existing tools and resources, the rating tool used to assess PHPR communications tools and trainings, the strategies document for working with tribal entities, the coding methodology for PHPR-related laws, the PFA training program, and so on) (Table 2). Effective strategies to facilitate communication included an existing relationship with the target audience, brief and timely messages and materials about existing tools and resources, and messages tailored differently depending on the primary, secondary, and tertiary audiences.

TABLE 4—

Best Practices for the Translation, Dissemination, and Implementation of Public Health Preparedness and Response (PHPR) Tools and Resources as Identified by Grantees, Partners, Knowledge Users, and the Advisory Committee Members During Evaluation

Areas	Best Practices
Translation	End-user engagement (i.e., public health practice community) from the start of the activity, to ensure that tools and products are appropriate and relevant
	Interrater reliability to review and assess existing tools and products for usability
	Training webinars to acquaint PHPR staff with new skills or processes to improve performance
	Real-world and local community scenarios and examples to demonstrate how to use practices, processes, tools, and resources
Dissemination	Word of mouth/personal recommendations
	Conferences and national meetings
	Radio stations (especially for tribes)
	In-person meetings providing opportunity for direct communication
	Internet, e-mail newsletters, gaming techniques, distribution lists, and social media
	Trusted public health agencies and organizations, including CDC, state health departments, American Public Health Association, Assistant Secretary for Preparedness and Response, National Network of Public Health Institutes, Association of State and Territorial Health Officials, and NACCHO
	Peer-to-peer learning through existing networks (e.g., the NACCHO Public Health Preparedness Committee and other Workgroups)
	Local and regional health care coalitions
Implementation	Ensure products and tools can be implemented by different agency and organization types (i.e., health care, public health, emergency management agencies, and others), such as by providing guidance for adaptation of interventions or designing modular tools to facilitate customized use
	Provide implementation support for public health agencies to implement new tools or resources
	Identify an advocate within the health department ensure the tool remains a priority during planning and implementation
	Provide support to convene staff for review and practice with tools and resources selected for implementation in PHPR program
	Develop products and tools that are clear and concise (i.e., 1- or 2-page checklists, rather than dense reports or binders)
	Create ready-to-use products for health department staff with limited time to review, modify, and adapt resources for local use
	Build in-person trainings into existing grant structures
	Schedule in-person trainings on back-to-back days, to improve participation
	Create tools and products that integrate easily into staff everyday workflow and existing processes

Note. CDC = Centers for Disease Control and Prevention; NACCHO = National Association of County and City Health Official.

Source. NORC.¹⁴

CHALLENGES

The TDI initiative evaluation revealed several challenges to translation of research to practice (e.g., slow progress of the project, understanding the tool and its relevance to practice), and investigators’ efforts to overcome those obstacles.¹⁴ The evaluation results highlighted the need to anticipate and build into project timelines commonly encountered implementation barriers (e.g., competing priorities, time constraints, and staff turnover). It also underscored the importance of engaging practitioners early and often to identify practice-based research questions, conduct high-quality applied research, and move research outputs into practice.

CONCLUSIONS

The TDI initiative intended to apply ISF to determine how selected PERRC and PERLC program outputs could be delivered to the practice community, based on their identified needs. It fostered active and mutually beneficial engagement of state, tribal, local, and territorial health departments, tribal organizations, professional associations, academia, and health care organizations in translation, dissemination, and implementation activities. There remains a need to evaluate the relevance and effectiveness of PERRC- and PERLC-developed tools and products for wider implementation. Maintaining the accessibility of these tools will enable their broader dissemination and implementation across the PHPR practice community but will require resource investment to provide implementation support and technical assistance. The National Association of County and City Health Officials Toolbox (http://toolbox.naccho.org/pages/index.html), Assistant Secretary for Preparedness and Response’s Technical Resources, Assistance Center, and Information Exchange (https://asprtracie.hhs.gov), TrainingFinder Real-time Affiliate Integrated Network (TRAIN) (www.phf.org/programs/TRAIN/Pages/default.aspx), ASPPH, or CDC could also serve as host sites for the tools and trainings. Although enhanced availability and user-friendliness of PERRC and PERLC products resulting from the TDI initiative are likely to improve the preparedness and response systems capacities and capabilities, further initiatives are needed to promote the translation and implementation of PHPR research and training products to policy and practice.