Natalie Wilkins

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, “siloed” approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

Putting program evaluation to work: a framework for creating actionable knowledge for suicide prevention practice

ABSTRACTThe economic and human cost of suicidal behavior to individuals, families, communities, and society makes suicide a serious public health concern, both in the US and around the world. As research and evaluation continue to identify strategies that have the potential to reduce or ultimately prevent suicidal behavior, the need for translating these findings into practice grows. The development of actionable knowledge is an emerging process for translating important research and evaluation findings into action to benefit practice settings. In an effort to apply evaluation findings to strengthen suicide prevention practice, the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) supported the development of three actionable knowledge products that make key findings and lessons learned from youth suicide prevention program evaluations accessible and useable for action. This paper describes the actionable knowledge framework (adapted from the knowledge transfer literature), the three products that resulted, and recommendations for further research into this emerging method for translating research and evaluation findings and bridging the knowledge–action gap.

Injury prevention as social change

We will not solve the public health problem of injury simply by educating individuals about the nature of injury risk, improving their risk assessment and providing these individuals with information to enable them to reduce the level of risk to which they are exposed. Substantial improvement in the societal injury burden will occur only when changes are made at the societal level that focus on reducing the population-level indicators of injury.1 ,2 The shift from an individual to a population perspective has substantial implications for the way we perceive, direct, undertake, and evaluate injury prevention research and practice. The analogy of ‘the population as patient’ provides a clear illustration of the foundational truths that underpin the preferred public health approach to the prevention of injury. Society is the system within which populations exist. Sustained change made at the societal level to reduce population-level indicators of injury morbidity and mortality involves systemic change. In this paper, we consider a shift from the contemporary systematic approach to unintentional injury and violence prevention,3 to a systemic approach4 more consistent with the principles of ecological public health.5 We consider the extent to which the logic of the systematic model, and the related misconceptions about the role of uncertainty in science, limit local, national and global efforts to minimise injury-related harm. We explore the implications of a systemic perspective for the field of injury prevention and conclude by delineating a new programme of work that could be of considerable benefit to the injury-related health of populations. ### Individual risk versus population frequency Should there be a perceived benefit of engaging in a risky driving behaviour, a person on a given day could double her or his risk of death without noticing the change in their likelihood of dying on the road. If, on that day, the …

Adverse Childhood Experiences and Suicide Risk: Toward Comprehensive Prevention

Division of Violence Prevention, National Center for Injury and Control, Centers for Disease Control and Prevention, orgia; Division of Analysis, Research, and Practice Integration, enter for Injury Prevention and Control, Centers for Disease d Prevention, Atlanta, Georgia; and Education Development ., Suicide Prevention Resource Center, Waltham, Massachusetts correspondence to: Katie A. Ports, PhD, Division of Violence Centers for Disease Control and Prevention, 4770 Buford ailstop F-63, Atlanta GA 30341. E-mail: kports@cdc.gov. 97/

Mind the Gap: Approaches to Addressing the Research-to-Practice, Practice-to-Research Chasm

36.00 oi.org/10.1016/j.amepre.2017.03.015 The field of suicide prevention has had numerous promising advances in recent decades, including the development of evidence-based prevention strategies, the National Suicide Prevention Lifeline (1-800-273-TALK), the Suicide Prevention Resource Center, and a revised National Strategy for Suicide Prevention. Despite these important advances, suicide prevention still lacks the breadth and depth of the coordinated response truly needed to reduce suicide morbidity and mortality. Suicide prevention requires a comprehensive approach that spans systems, organizations, and environments, combining treatment and intervention with primary prevention efforts beginning in childhood so they can set the stage for future health and well-being. Adverse childhood experiences (ACEs), including exposure to child abuse and neglect, are welldocumented risk factors for suicidality, and a viable suicide prevention target; however, suicide prevention efforts seldom focus here. The following provides an overview of suicide prevention and intervention, and suggestions for comprehensive suicide prevention programs that address ACE prevention. The context for suicide prevention in the U.S. is sobering. In 2015, a total of 44,193 individuals died by suicide, and between 1999 and 2015, suicide rates increased more than 25%. Emergency departments recorded 1.4 million discharges for self-inflicted injuries, and acute care hospitals recorded an additional 758,000 discharges in 2013. These numbers represent only a fraction of individuals experiencing suicidal ideation. According to self-report survey data, 1.3 million adults attempted suicide, 2.7 million made plans for suicide, and 9.7 million adults seriously considered suicide in 2015. These events exact a large emotional and human cost on families, friends, workplaces, and communities. Based on conservative estimates, death by suicide totals

Systemic approach for injury and violence prevention: what we can learn from the Harlem Children’s Zone and Promise Neighborhoods

50.8 billion in lifetime medical and work-loss costs, and nonfatal self-harm injuries treated in U.S. emergency departments accounted for more than

The Power of Academic-Practitioner Collaboration to Enhance Science and Practice Integration: Injury and Violence Prevention Case Studies.

11.9 billion in lifetime medical and work-loss costs. Although informative, these estimates are considerable underestimates of the true cost of suicidality. Many additional costs, such as psychological care, costs to family members, and the broader impacts on children, schools, and communities are not included in these cost estimations. Despite these limitations, these estimates demonstrate the significant public health burden of suicidality, and make a strong case for increased investments in comprehensive prevention programs that include evidence-based, primary prevention strategies. What suicidologists have recommended for quite some time, but has yet to be systematically achieved, is a truly comprehensive approach to suicide prevention— one that occurs across the social ecology (i.e., at the individual, family/relationship, school/community, and societal levels) in schools, workplaces, and healthcare settings, and includes both “downstream” prevention efforts (i.e., secondary and tertiary prevention efforts that focus on treatment and interventions for at-risk individuals or groups to decrease the likelihood of future suicide attempts) and “upstream” prevention efforts (i.e., primary prevention efforts that focus on preventing suicidal ideation, behavior, and risk before they occur). Suicide prevention strategies are being implemented in many settings, communities, and states, but these strategies often involve only one level of the social ecology— typically the individual or family/relational level. These models tend to focus on downstream prevention, and occur in isolation from other relevant suicide prevention strategies. Downstream prevention activities at the individual level include safety planning, screening for suicide,

Injury prevention: achieving population-level change

The 4-step public health model has been welltouted and applied as an approach toward improving population-level health. It outlines a 4-step sequential process that moves from studying a health problem epidemiologically (ie, defining the problem and identifying risk and protective factors) to empirically developing and testing effective interventions to address that problem and ending in widespread dissemination and adoption of evidence-based, effective interventions in practice and community-based settings (see the Figure). While public health has for the most part developed and successfully applied the first 2 steps in this model, which often take place in controlled, scientifictechnical environments (eg, developing surveillance systems, etiological studies), there is a conceptual “leap of faith” that occurs between the third (development of effective interventions) and the fourth (widespread adoption) steps. Specifically, we continue to struggle as a field to ensure widespread adoption of interventions that have been studied and found to be effective—often described as the research-topractice gap. There has also been concern around the “practice-to-research gap” or the relevance of research to the needs of decision makers and community stakeholders. To address this concern, there have been continuous calls for knowledge to flow from practice to the academic domain to inform more relevant research and transferrable science and ensure that important practice-based knowledge is included as evidence (or “what is known”), is valued, and disseminated.

Injury Deaths Among U.S. Females: CDC Resources and Programs

An escalating volume of injury prevention research over the past half century has dramatically increased our understanding of the risk and protective factors associated with injury and violence, and the efficacy of interventions for addressing these risk factors across the social ecology.1 2 However, this increased understanding has not resulted in widespread adoption and implementation of evidence-based and evidence-informed interventions, and countries such as the USA are still experiencing increased rates of injury and violence morbidity and mortality.3 The disassociation between our knowledge of injury causation and effectiveness of our efforts to reduce injury has been discussed in the injury prevention literature as the ‘research to practice gap’ and has focused primarily on the disconnect between evidence-based programmes and their wide-scale adoption.4 This research to practice gap evident in injury prevention is simply a special case of the more generic challenge evident throughout the public health field. Disciplines and approaches such as translation research and implementation science have emerged to help bridge this gap and facilitate the spread of evidence-based prevention programmes.4–7 This has included the development of tools, resources and methods to support and engage communities in the implementation of evidence-based injury and violence prevention programmes.7–10 However, translation research and implementation science have been developed largely within the existing paradigms of laboratory and clinical research.11 Some in the field of public health have begun to question whether the ‘research to practice gap’ is truly limited to the uptake of evidence-based programmes or if it may actually be a much broader disconnect requiring more integrated, multifaceted approaches to knowledge generation and application.3 Similarly, population health research is now recognising that efforts to achieve community-level well-being are more likely to be effective when they focus on systems change, and when they are not limited …

35 Achieving population level changes in health: a dialogue on pathways to progress

One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention–funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap.