Section 6. Promoting the Adoption and Use of Best Practices

• What is a best practice?

• Why promote the adoption and use of best practices?

• When should you promote the adoption and use of best practices?

• Who should be involved in promoting the adoption and use of best practices?

• Where do you find best practices?

• How do you promote the adoption and use of best practices?

The Parkville Heart Health Coalition was concerned. A community assessment showed that many elementary school children had limited opportunities for regular physical activity outside of school. Families and young people pointed to barriers that included limited access to safe recreation spaces, cost, transportation, and the amount of time spent on sedentary activities.

Research and community experience suggested that helping children find enjoyable forms of physical activity they can continue throughout life could support long-term health. Coalition members recognized this as a promising approach, but they also knew that success would require the participation of schools, families, young people, local officials, recreation organizations, and other community partners. How could they work together to determine whether the approach fit their community and, if so, put it into practice?

Best or promising practices can help you address community problems without having to start from scratch. If another community or organization has developed an approach with evidence of effectiveness, it makes sense to learn from it while also considering how well it fits your own community.

The first section of this chapter discussed how to recognize and choose promising practices for health and community development. Sometimes, however, those are only the preliminary steps. Once they're completed, there may remain the task of helping organizations and communities consider, adapt, adopt, and effectively use those practices. In this section, we explore how to do that, as well as what a "best practice" is and how to find one appropriate for your goals and circumstances.

What is a best practice?

A best practice may be a particular method, or it may be a whole program or intervention. "Best practice" status is sometimes conferred by a government body, professional association, research organization, funder, or other entity. In other cases, a practice gains recognition through research, evaluation, or consistent positive results in multiple settings. In general, a method or program considered a best practice is:

• Measurable. Its goals are clear enough that progress and outcomes can be assessed. A smoking cessation program, for instance, might examine how many participants reduce or stop tobacco use and how those outcomes change over time.
• Demonstrably effective. Evidence suggests that the method or program contributes meaningfully to the outcomes it is intended to achieve.
• Replicable or adaptable. The method or program is documented clearly enough that others can understand its essential components and use or adapt them in another setting.

Best practices, in short, are methods or programs that have evidence of success in accomplishing particular goals and that may be usable or adaptable in other settings. The standards for choosing a best practice vary greatly depending upon who is doing the choosing. Some organizations use broad criteria, while others require extensive research and evaluation evidence.

Where the standards are relatively loose, programs designated as best practices may have limited evidence. Where the standards are extremely strict, valuable community programs may be overlooked because they lack the funding or evaluation capacity to produce extensive research. When considering a best practice, pay attention to who designated it as such, what evidence was used, which communities were included in that evidence, and how recently the practice was evaluated.

Some other things to keep in mind when considering best practices:

• Fit with your community and the people involved. Does the method or program make sense given the realities, strengths, needs, languages, culture, and resources of your community? Can it be adapted appropriately?

• Appropriateness to your goals. Does the practice actually address the outcomes you want to achieve? A practice that works well for one part of an issue may not address the underlying conditions you are most concerned about.
• Fit with the structure and philosophy of the organization or initiative that will use it. A highly centralized program, for example, may not fit well with an organization committed to shared decision-making and community leadership unless it can be meaningfully adapted.
• Availability of resources. Make certain you understand what a practice requires in funding, staffing, training, partnerships, facilities, technology, time, and other resources before committing to it.
• Cost-effectiveness and sustainability. A highly effective program may still be difficult to sustain if it requires resources far beyond what most communities can provide. A somewhat less intensive approach that produces strong outcomes with available resources may ultimately have greater reach and sustainability.

Why promote the adoption and use of best practices?

One answer to this question is straightforward: using a method or program supported by credible evidence can increase the likelihood that an effort will achieve its goals and benefit participants and the community. There are, however, additional reasons why using a best or promising practice can be advantageous.

• Using a recognized practice can help explain and justify the approach. Participants, community members, partners, and funders may reasonably want to know why a particular intervention was chosen. Evidence that the approach has worked elsewhere can provide useful support while still leaving room for local adaptation.
• Using recognized best practices can strengthen an organization's credibility. It shows that the organization has examined evidence and learned from the experience of others rather than relying only on assumptions or habit.
• Using best practices can strengthen funding proposals. Many funders want applicants to demonstrate that proposed approaches are informed by evidence or prior successful experience.

• Using a documented practice can reduce some of the uncertainty involved in planning. Having a clearly described structure, theory, and implementation process gives organizations a useful starting point.
• People with experience implementing the practice may be available to provide guidance. They may be able to explain what worked, what challenges arose, which components were essential, and how the practice has been adapted in other settings.
• Best practices provide evidence that an approach can work under particular conditions. That does not guarantee success in every community, but it provides a stronger starting point than using an approach with no supporting evidence or experience.

When should you promote the adoption and use of best practices?

Promoting the consideration and use of best practices can be an ongoing activity, but some times are especially appropriate.

• Before a new intervention or program begins. It is often easier to incorporate an evidence-supported practice while a program is being designed than to add it after structures and routines are already established.
• When a serious community issue requires a stronger response. Rising rates of domestic violence, child maltreatment, infectious disease, housing instability, or other concerns may prompt organizations and community members to examine approaches that have shown results elsewhere.
• When what's being done isn't working well. If a current intervention is not producing desired outcomes, it may be time to examine alternative or additional approaches.
• When community members or participants request change. People most directly affected may identify gaps in current services or call attention to approaches that appear to work elsewhere.
• When funders or officials encourage or require evidence-supported practices. Make sure, however, that requirements still allow appropriate adaptation to local circumstances and meaningful community input.

Who should be involved in promoting the adoption and use of best practices?

When considering whether to adopt a best practice, it's valuable to involve people who will be affected by, participate in, implement, or support the intervention. If they help identify, examine, and adapt possible practices, they are more likely to understand the evidence, identify potential problems, and help shape an approach that fits the community.

• Practitioners -- health and human service professionals, community development workers, educators, outreach staff, and others who may implement the practice.
• People who will participate in, be affected by, or benefit from the practice, including people with relevant lived experience.
• People and organizations that may be indirectly affected. These might include public agencies, social workers, businesses, property owners, schools, health systems, neighborhood organizations, or others whose work or responsibilities could change as a result of the intervention.
• Interested community members. Broader community participation can contribute local knowledge, strengthen transparency, and build support.
• Local and, when appropriate, regional, state, tribal, or other public officials. Their involvement may be important when policies, public funding, or government systems are connected to implementation.

Where do you find best practices?

To find best and promising practices, try:

• Online research. Search engines, research databases, government websites, university repositories, evidence clearinghouses, professional organizations, and program databases can provide research findings, evaluation reports, implementation guides, and descriptions of practices.
• Networking. Talk to colleagues, community partners, practitioners, researchers, and people with lived experience. They may know about practices that have worked elsewhere or connect you directly with organizations implementing them.
• Libraries. Public, academic, and specialized libraries can provide access to books, research databases, reports, journals, and professional guidance. Librarians can also help identify credible and relevant sources.
• State and national advocacy and professional organizations. These organizations may publish research, evidence reviews, implementation guidance, conference materials, or examples of successful programs.

• International, state, federal, tribal, and local agencies. Public agencies often publish evidence reviews, guidance, program evaluations, implementation resources, and descriptions of funded initiatives.
• Foundations and other private funders. Funders may publish evaluations, case studies, learning reports, and descriptions of projects they support.
• Colleges and universities. Researchers, faculty, students, extension programs, and research centers may be studying the issue you're concerned with or may know of relevant evidence and programs.
• Community knowledge and lived experience. Faith leaders, community organizations, service groups, businesses, advocates, participants, neighborhood leaders, and other community members may know about successful approaches that are not widely documented in academic or professional sources.

Using online sources to find best or promising practices

Online searching can provide access to an enormous amount of information, but finding reliable and relevant evidence requires more than simply entering a few words into a search engine. The goal is not only to find examples, but also to determine whether the source is credible, whether the evidence is current, and whether the practice has been used with communities or circumstances similar to yours.

General search engines can be useful starting points. Research databases, government websites, university repositories, professional associations, and evidence clearinghouses may be especially helpful when you need stronger evidence.

A few basic search strategies can make your search more useful:

• Be specific. Search for the issue, population or community, type of intervention, and outcome you're interested in. Instead of searching only for "child health best practices," for example, you might search for "school-based physical activity interventions elementary students" or another phrase that closely matches your question.
• Use several related terms. Different researchers and organizations may describe the same idea differently. Try terms such as "best practice," "promising practice," "evidence-based practice," "evidence-informed practice," "intervention," "program evaluation," or other issue-specific terms.

• Try different words and phrases if you don't immediately find what you're looking for. The terminology used in research, government, and community practice may differ, so testing several search terms can help uncover useful information.
• Search in relevant languages. When researching programs used in multilingual communities or in other countries, valuable information may be available in languages other than English. Translation tools may help with initial review, but important materials should be interpreted carefully.
• Use organizations' internal search tools and resource collections. Once you find a credible agency, university, professional association, foundation, or evidence clearinghouse, explore its reports, databases, toolkits, and related resources.

You can find an up-to-date list of Databases of Best Practices on the Community Tool Box. It contains web-based resources for exploring promising approaches to community health and development, as well as resources organized by issue.

Online sources are extremely useful, but they are not the only source of knowledge. Some strong community programs may have limited online visibility or may not yet have been formally evaluated. Talking with practitioners, researchers, participants, and community members can help you identify approaches that would otherwise be missed.

How do you promote the adoption and use of best practices?

Once you've brought together community members, practitioners, and other partners to consider best practices, the next steps are to define what you're trying to accomplish, identify approaches that fit your goals and circumstances, compare the available evidence, and decide together what should be adopted or adapted. Even then, you're not finished: successful implementation requires training, resources, ongoing learning, and evaluation.

Define your issue, priorities, and goals clearly, so that you can determine exactly what kind of best practice you're seeking.

As mentioned above, not every best practice related to your issue is necessarily aimed at the same outcomes you're working toward. To make sure that you're choosing a practice that fits your goals, begin by defining what you want to address and what success would look like.

• Define your issue. What exactly is it you want to address? If it's a broad issue, are you addressing the whole thing or one part of it? If the issue is community violence, for instance, are you focusing broadly on community safety, youth violence, intimate partner violence, firearm injury, or another specific concern? The answer will affect which practices are most relevant.
• Define the outcomes you intend to achieve. The practice you choose should aim at the outcomes you're interested in. If you're working to prevent intimate partner violence, for example, you may want an approach that combines survivor support and safety, healthy relationship education, prevention with young people, community norms change, economic and housing supports, accountability for people who cause harm, and appropriate policy or system changes. A program focused only on responding after violence occurs might be effective at that task but may not accomplish your broader prevention goals.

• Understand the people and communities involved. Who will participate in or be affected by the practice? What strengths, priorities, languages, cultures, experiences, access needs, and barriers should be considered? Involving people most affected can help determine whether a practice is likely to fit and what adaptations may be needed.
• Explore the context. Community history, geography, resources, systems, policies, relationships, transportation, housing, economic conditions, and other factors can influence whether a method or program will be effective.

This kind of analysis should help you identify practices that have produced outcomes similar to the ones you want and that appear compatible with your community's strengths, priorities, circumstances, and values.

Search for appropriate best practices.

Once you've defined what you're looking for, find several possible practices and compare them. Consider the quality of the evidence, who participated in the original programs, the settings in which they were tested, resources required, possible unintended effects, accessibility, cultural fit, and how much adaptation might be needed. Community members and people who would implement the practice should be involved in this review whenever possible.

Promote thoughtful consideration and adoption of best practices.

Sometimes organizations or communities are already using an approach they value. Even when evidence suggests that another method may produce stronger outcomes, simply telling people that their current work should be replaced is unlikely to build trust or collaboration.

A participatory process can help people examine current results, review alternatives, understand the evidence, identify strengths worth preserving, and decide whether a new or adapted approach would improve the work.

• Share evidence and community findings openly. Explain why particular practices appear promising and how they relate to local priorities, while also inviting questions and concerns.
• Engage funders as partners in implementation. Funders may be able to support training, evaluation, adaptation, staffing, or other resources needed to implement a practice effectively.
• Connect local participants and practitioners with people who have experience using the practice. Practical conversations about implementation, challenges, adaptations, and results can help everyone evaluate whether the approach is a good fit.

• Consider piloting or testing an approach before making a full transition. A limited pilot may allow the organization and community to compare approaches, identify needed adaptations, and learn whether the new practice actually improves outcomes in the local setting.

Ensure that anyone involved in implementing a best practice receives the training needed to carry it out effectively.

People should understand the assumptions, principles, and theory behind the program or method, as well as the specific skills needed to implement it. Even a strong practice can fail if staff members are asked to carry it out without adequate training, supervision, materials, or opportunities to practice.

Those implementing a practice should also understand why it was chosen and have opportunities to raise concerns, suggest adaptations, and learn from implementation. Commitment is more likely when people understand the evidence, see how the practice supports community priorities, and have a meaningful role in making it work.

Provide those who'll implement best practices with the necessary support.

You can't expect to reproduce the results of a successful practice without considering the resources and conditions that helped make the original successful. Those resources can include:

• Funding. Trying to implement a program with substantially fewer resources than it requires may undermine quality and outcomes. Understand the essential costs before beginning, and consider whether the model can be sustained over time.
• People and staffing. Some programs depend heavily on volunteers, peer leaders, community health workers, mentors, or other participants. Consider whether people have the time and resources to take on these roles and whether compensation may be appropriate. Volunteers and staff also need training, support, and supervision.
• Space and accessibility. Consider whether program locations are physically accessible, reachable by transportation, welcoming, appropriately sized, and suitable for the people using them. Virtual or hybrid participation may also be appropriate in some settings.
• Time. New programs need time to establish relationships, train staff, learn from implementation, make adjustments, and evaluate results. Accountability is important, but so is allowing enough time for responsible learning and improvement.
• Community and institutional support. Staff, participants, and partners are more likely to succeed when community leaders, public officials, funders, organizations, and other partners understand the work and support the conditions needed for it to succeed.

Keep making the best better, and maintain the community's commitment to effective practice.

Finally, remember that adopting a best practice is not the end of the work. Even a well-supported practice can be improved, and changing community conditions may require new adaptations over time.

Best practices are only as good as their implementation. Continue examining whether the practice is reaching the people it is intended to reach, whether participants experience it as respectful and useful, whether intended outcomes are being achieved, and whether changes are needed.

Community priorities, evidence, and available approaches will continue to change. Keep learning about promising practices, evaluating what you're already doing, listening to participants and community members, and strengthening approaches that support meaningful and lasting improvements.

In Summary

One way to strengthen community health and development efforts is to identify and thoughtfully use best or promising practices -- methods or programs that have evidence of effectiveness and that can be implemented or adapted in other settings. This doesn't guarantee success. No intervention works equally well everywhere, and communities may already have locally developed approaches that are effective. Evidence is most useful when it is combined with community knowledge, lived experience, thoughtful adaptation, and ongoing evaluation.

Considering a best practice should be a collaborative process. People most affected by the issue, practitioners, community organizations, public officials, funders, researchers, and other relevant partners can help examine the evidence, decide whether an approach fits, identify adaptations, and determine what resources are necessary for implementation.

Once a practice is adopted, continue learning. Provide the training and resources necessary to implement it well, evaluate both outcomes and participant experiences, and make improvements as evidence and community circumstances change. Even a practice labeled "best" should remain open to learning and improvement.