A Delphi Study to prioritize implementation strategies to increase the adoption of screening and referral for brain injury among survivors of intimate partner violence and sexual assault within community-based organizations

A Delphi Study to prioritize implementation strategies to increase the adoption of screening and referral for brain injury among survivors of intimate partner violence and sexual assault within community-based organizations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Delphi Study to prioritize implementation strategies to increase the adoption of screening and referral for brain injury among survivors of intimate partner violence and sexual assault within community-based organizations Shireen S. Rajaram, Emiliane Lemos Pereira, Kathy Chiou, Peggy Reisher, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6925920/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Jan, 2026 Read the published version in BMC Public Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background Women who experience intimate partner violence (IPV) are at a high risk for injuries to the head, neck, and face that can result in a traumatic brain injury (BI). Despite increasing evidence of the high risk for BI in this vulnerable population, BI screenings remain critically under-implemented in community-based organizations (CBOs) serving IPV survivors. The aim of this community-engaged dissemination and implementation project was to co-identify implementation strategies to increase the adoption of brain injury (BI) screening and referral within intimate partner violence (IPV)-serving CBOs. Methods We used a modified Delphi method to prioritize 47 CBO relevant strategies from the Expert Recommendations for Implementation Change compendium to increase the adoption of BI screening and referral among IPV-serving CBOs. In Round-1, 14 Community-campus advisory board (CAB) members, including representatives from 10 CBOs prioritized relevant strategies in a virtual meeting. In Round-2, 62 CBOs staff members responded to a survey to refine a subset of prioritized strategies to 6–8 primary strategies that could be tested across the CBOs. Results CAB participants identified 21 strategies as particularly relevant to CBOs including 4 educational, 2 technical assistance, 5 staff and leadership, 4 management and evaluation, and 6 organizational workflow strategies. Survey responses indicated rated 7 of the 21 strategies were most consistently rated as relevant and feasible. The final list of 7 strategies included training opportunities, ongoing consultation, developing implementation plans, establishing local screening and referral protocols, soliciting survivor feedback, promoting adaptability, and tailoring strategies to CBOs contexts. Conclusions This study highlights the importance of creating tailored implementation strategies within IPV-serving CBOs to enhance the adoption of brain injury screening and referral protocols. The identified strategies offer valuable insights into optimizing support for IPV survivors and advancing public health interventions. brain injury screening intimate partner violence domestic violence community-based organizations Background Intimate partner violence (IPV) is a serious public health issue that affects millions of people in the U.S and worldwide. IPV is defined as violence or aggression that occurs within a close relationship, including with a current or former spouse, or a dating or sexual partner. Violence or aggression can include physical violence, sexual violence, stalking, and psychological abuse [ 1 – 3 ]. Statistics reveal that 1 in 2 women and 1 in 4 men have experienced sexual violence, physical violence, or stalking by an intimate partner in their lifetime and reported an IPV-related impact, including injury, fear, safety concerns, and/or need for supportive services [ 3 ]. While IPV affects all communities, it disproportionally affects women and racial/ethnic minorities [ 3 ]. IPV also extends beyond the immediate trauma to inflict profound and often hidden injuries, particularly on women. Studies have highlighted that women who experience IPV are at a high risk for injuries to the head, neck, and face that can result in a traumatic brain injury (TBI) [ 4 – 8 ]. These IPV-related TBIs can have lasting effects, leading to chronic symptoms such as headaches, memory and cognitive issues, concentration problems, dizziness and anxiety[ 9 – 14 ]. IPV survivors are also at high risk for an Acquired Brain Injury (ABI) resulting from strangulation that involves hypoxia and anoxia when the oxygen supply to the brain is restricted or completely cut off [ 4 , 5 , 15 ]. IPV-related brain injury (BI), which includes TBIs and ABIs is likely to be repeated, and women may experience multiple hits to the head in a short span of time [ 10 , 12 , 16 ]. A study by Rajaram and colleagues (2020), showed that of 171 IPV survivors screened, 92% experienced a hit to the head or strangulation [ 17 ]. Moreover, 52% reported that it occurred more than four times in their lives. People who experience repeated brain injuries before the brain recovers from the initial trauma are at high risk for neurological deficits, depression, suicide, and Alzheimer-like symptoms [ 18 , 19 ]. IPV survivors may not seek medical care following a BI. They may not trust medical providers [ 20 , 21 ] or have access or the autonomy to seek medical help for their injuries [ 9 , 22 ] .They may also be concerned about shame, fear, and stigma associated with IPV [ 23 , 24 ], and retaliation from their abusers resulting from the disclosure of abuse [ 25 ]. IPV-related BIs are hidden and, often, have no visible signs of physical trauma; thus these injuries can be missed or misdiagnosed by healthcare and social service providers [ 15 , 16 , 26 ], and may be minimized by survivors [ 27 ]. One study [ 28 ] showed that only 35% of IPV survivors who were at high risk for BI received medical treatment. We also found that IPV survivors may be more likely to reach out to community-based organizations (CBOs) that provide social services to survivors of IPV, sexual assault, and sex trafficking. Despite increasing evidence of the high risk for BI in this vulnerable population[ 4 – 6 , 10 , 29 – 31 ], there remains an inadequate focus on BI and BI screening among IPV survivors [ 12 , 32 ]. As BI continues to go unreported, undetected or misdiagnosed by mainstream healthcare and social service providers, other avenues, such as front line workers or CBOs, whom survivors may be more willing to disclose their needs to, have a unique opportunity to assist in the identification of a potential BI. Thus, it is imperative that IPV-serving CBOs integrate routine screening for possible BI and connect survivors to referral services, where evidence-based BI interventions may be available and accessible. Integrating BI screening approaches and referrals that are specifically tailored to IPV survivors holds great potential benefits. For example, a qualitative study [ 33 ] on screening for BI with a follow-up neuropsychological evaluation (NPE) showed the potential to be acceptable to IPV survivors and service providers. Understanding the facilitators and barriers to the use of evidence-based interventions by IPV-serving CBOs will help increase the chances for improved recovery through appropriate neurorehabilitation, particularly for disenfranchised groups who may lack the means to access, or have low trust in, medical care. Unfortunately, little is known about implementation strategies for screening by IPV-serving CBOs or how these organizations integrate screening and provide timely referrals – in routine practice – to aid women in the recovery process. A recent study in behavioral health settings found that only 25% of providers adopted BI screening post-training and suggested that implementation strategies that include additional training, leadership engagement, and state mandates may be needed to support widespread systematic uptake of BI screening [ 34 ]. This aligns with the Expert Recommendations for Implementing Change (ERIC) project that highlighted a range of strategies to support, primarily healthcare, implementation of evidence-based interventions [ 35 ]. That project identified 73 unique strategies that can be characterized as those that focus on education and training, staff and leadership activities, technical assistance, management and evaluation, and organization and workflow factors. However, outside of providing training, to date, no known studies have used these expert recommendations to improve the dissemination and implementation of BI screening and referrals to service provision among IPV-serving CBOs (or other behavioral health settings). Furthermore, while many CBOs participate in community-engaged research approaches, there is also a gap in understanding how community-engaged dissemination and implementation (CEDI) strategies [ 36 ] may be applied collaboratively with IPV-serving CBOs. This study aimed to co-identify appropriate BI screening and referral implementation strategies with IPV-serving CBOs and to develop guidance for broad adoption, implementation, and sustainment. Methods Setting and participants. This study used a community-academic partnership approach that involved a team of research scientists, a project manager, a non-profit community partner, and a community advisory board (CAB). Collaboratively, the project team identified 12 community-based programs (10 CBOs) from both rural and urban areas in a Midwestern state that served survivors of IPV and sexual assault to participate in a larger project focused on increasing BI screening and referral strategy implementation for women experiencing IPV. All CBOs involved in the project were participants in the study’s CAB and expressed an interest in conducting BI screening and referrals for IPV survivors who had used their services. Members of the CAB (n=14) participated in the modified Delphi process [37] described below and provided background information including organizational affiliation, role, profession, experience, demographics, and racial/ethnic backgrounds. This study was approved by the Institutional Review Board (IRB) at the University of Nebraska Medical Center (UNMC) under protocol number 0259-23-EX. Consent to participate was obtained from all participants. A summary of participants’ characteristics is in Table 1. Theoretical Approach The ERIC strategy list was reviewed through the lens of constructs from the Practical, Robust Implementation and Sustainability Model (PRISM) to ensure coverage of determinants at the organizational (e.g., leadership support, workflow fit), recipient (e.g., survivor readiness, staff training needs), external (e.g., funding or policy mandates), and infrastructure (e.g., availability of technical assistance) levels. This mapping informed the initial CAB discussions and selection process for the Round 1 Delphi. Table 1. Characteristics of participants Variables Round 1 (n=14) Round 2 (n=62) Sociodemographic characteristics Gender, n (%) Male 0 (0%) 2 (3%) Female 14 (100%) 56 (90%) Gender nonconforming 0 (0%) 3 (5%) Age 19-25 years 4 (29%) 11 (18%) 26-35 years 0 (0%) 9 (15%) 36-45 years 6 (43%) 18 (29%) 46-55 years 4 (29%) 16 (26%) Over 55 years 0 (0%) 6 (10%) Profession Experience < 1 year 1 (7%) 12 (19%) 1-5 years 4 (29%) 20 (32%) 6-15 years 4 (29%) 11 (18%) 16-25 years 5 (36%) 15 (24%) Above 25 years 0 (0%) 3 (5%) Education level High school/ GED 0 (0%) 6 (10%) Trade school 0 (0%) 0 (0%) Associate degree 3 (21%) 10 (16%) Some college 3 (21%) 11 (18%) College degree 4 (29%) 18 (29%) Post-graduate (Master and above) 4 (29%) 16 (26%) Race African American 0 (0%) 3 (5%) Asian American 0 (0%) 2 (3%) Mixed- racial background 1 (7%) 1 (2%) Native American 1 (7%) 1 (0%) White-Caucasian 12 (86%) 52 (84%) Ethnicity Hispanic/ Latinx 2 (14%) 7 (11%) Not Hispanic/ Latinx 12 (86%) 54 (87%) Missing 0 (0%) 3 (5%) Strategy identification process. During the initial planning phase, spanning two and a half months, community partners and researchers engaged in discussions and consensus-building to create a prioritized list of 47 possible ERIC evidence-based strategies from an initial pool of 73 strategies [35]. This process involved an iterative multi-round approach [37, 38], wherein the core team, including experts in dissemination and implementation science (PE and EP), as well as in intimate partner violence (SSR), closely examined the 73 strategies outlined in ERIC [35] (see Table 2). Table 2- Strategies considered for applicability with corresponding original and collaboratively adapted strategy definitions for CBO-based BI screening and referral. Strategy ERIC Definitions BI project definitions Access new funding Access new or existing money to facilitate the implementation Co-designed by community-academic partnership per protocol Alter incentive/allowance structures Work to incentivize the adoption and implementation of the clinical innovation Explore the possibility of offering incentives to clients who actively participate in brain injury screening. Alter patient/consumer fees Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments Not relevant to the project Assess for readiness and identify barriers and facilitators Assess 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 Assess the readiness of community-based organizations (CBOs) to implement brain injury screening. This includes considering factors like staff expertise, resources, and infrastructure and identifying barriers, such as staff resistance or resource constraints, that may impede the successful rollout Audit and provide feedback Collect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior Conduct regular audits of brain injury screening practices and provide feedback to community-based organizations (CBOs) to support quality improvement Build a coalition Recruit and cultivate relationships with partners in the implementation effort Co-designed by community-academic partnership per protocol Capture and share local knowledge Capture local knowledge from implementation sites on how implementers and clinicians made something work in their setting and then share it with other sites Co-designed by community-academic partnership per protocol Centralize technical assistance Develop and use a centralized system to deliver technical assistance focused on implementation issues Establish a centralized system to deliver technical assistance for brain injury screening implementation Change accreditation or membership requirements Strive to alter accreditation standards so that they require or encourage use of the clinical innovation. Work to alter membership organization requirements so that those who want to affiliate with the organization are encouraged or required to use the clinical innovation Not relevant to the project Change liability laws Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation Not relevant to the project Change physical structure and equipment Evaluate current configurations and adapt, as needed, the physical structure and/or equipment (e.g., changing the layout of a room, adding equipment) to best accommodate the targeted innovation Ensure that facilities are physically accessible and welcoming to clients and their families Change record systems Change records systems to allow better assessment of implementation or clinical outcomes Not relevant to the project Change service sites Change the location of clinical service sites to increase access Co-designed by community-academic partnership per protocol Conduct cyclical small tests of change Implement changes in a cyclical fashion using small tests of change before taking changes system-wide. Tests of change benefit from systematic measurement, and results of the tests of change are studied for insights on how to do better. This process continues serially over time, and refinement is added with each cycle Implement periodic changes using small tests of brain injury screening before taking changes system-wide Conduct educational meetings Hold meetings targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation Host educational meetings or seminars within the organization to inform staff about the importance of brain injury screening and the associated benefits. Conduct educational outreach visits Have a trained person meet with providers in their practice settings to educate providers about the clinical innovation with the intent of changing the provider’s practice Conduct outreach visits to other community-based organizations to share knowledge and best practices related to brain injury screening. Conduct local consensus discussions 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 Co-designed by community-academic partnership per protocol Conduct local needs assessment Collect and analyze data related to the need for the innovation Not relevant to the project Conduct ongoing training Plan for and conduct training in the clinical innovation in an ongoing way Offer continuous training opportunities to staff members to ensure they remain competent in conducting brain injury screenings. Create a learning collaborative Facilitate the formation of groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation Co-designed by community-academic partnership per protocol Create new clinical teams Change who serves on the clinical team, adding different disciplines and different skills to make it more likely that the clinical innovation is delivered (or is more successfully delivered) Establish dedicated teams or units specifically focused on brain injury screening and management Create or change credentialing and/or licensure standards Create an organization that certifies clinicians in the innovation or encourage an existing organization to do so. Change governmental professional certification or licensure requirements to include delivering the innovation. Work to alter continuing education requirements to shape professional practice toward the innovation Not relevant to the project Develop a formal implementation blueprint Develop a formal implementation blueprint that includes all goals and strategies. The blueprint should include the following: 1) aim/purpose of the implementation; 2) scope of the change (e.g., what organizational units are affected); 3) timeframe and milestones; and 4) appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time Develop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs) Develop academic partnerships Partner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project Co-designed by community-academic partnership per protocol Develop an implementation glossary Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change Create a local implementation glossary that defines key terms and concepts specific to brain injury screening and referral Develop and implement tools for quality monitoring Develop, test, and introduce into quality-monitoring systems the right input—the appropriate language, protocols, algorithms, standards, and measures (of processes, patient/consumer outcomes, and implementation outcomes) that are often specific to the innovation being implemented Create standardized protocols and tools for quality monitoring of brain injury screening that align with best practices Develop and organize quality monitoring systems Develop and organize systems and procedures that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement Set up an efficient system for tracking the progress of brain injury screening, including data collection, reporting, and analysis Develop disincentives Provide financial disincentives for failure to implement or use the clinical innovations Not relevant to the project Develop educational materials Develop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation Create locally tailored educational materials that explain the purpose and process of brain injury screening. Develop resource sharing agreements Develop partnerships with organizations that have resources needed to implement the innovation Collaborate with neighboring facilities to establish resource-sharing agreements that facilitate the exchange of expertise, equipment, or personnel Distribute educational materials Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically Disseminate educational materials to staff at community-based organizations, clients and their families through various channels, including reception area, websites, and community events. Facilitate relay of clinical data to providers Provide as close to real-time data as possible about key measures of process/outcomes using integrated modes/channels of communication in a way that promotes use of the targeted innovation Develop clear communication strategies to convey the potential risks and consequences of not participating in brain injury screening Facilitation A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship Employ facilitators who can help organizational teams navigate the complexities of brain injury screening implementation. Fund and contract for the clinical innovation Governments and other payers of services issue requests for proposals to deliver the innovation, use contracting processes to motivate providers to deliver the clinical innovation, and develop new funding formulas that make it more likely that providers will deliver the innovation Not relevant to the project Identify and prepare champions Identify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization Identify individuals who are passionate about the importance of brain injury screening and willing to champion the cause. Identify early adopters Identify early adopters at the local site to learn from their experiences with the practice innovation Identify and engage staff within the community-based organizations (CBOs) who are enthusiastic about implementing brain injury screening. Increase demand Attempt to influence the market for the clinical innovation to increase competition intensity and to increase the maturity of the market for the clinical innovation Not relevant to the project Inform local opinion leaders Inform providers identified by colleagues as opinion leaders or “educationally influential” about the clinical innovation in the hopes that they will influence colleagues to adopt it Identify and engage local opinion leaders and influential figures within the community who can help promote the benefits of brain injury screening Intervene with patients/consumers to enhance uptake and adherence Develop strategies with patients to encourage and problem solve around adherence Develop client support programs to address barriers to uptake and adherence, such as transportation issues or language barriers Involve executive boards Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes Not relevant to the project Involve patients/consumers and family members Engage or include patients/consumers and families in the implementation effort Engage clients and their family members as partners in the brain injury screening process from the outset Make billing easier Make it easier to bill for the clinical innovation Not relevant to the project Make training dynamic Vary the information delivery methods to cater to different learning styles and work contexts, and shape the training in the innovation to be interactive Use engaging and interactive training methods that encourage active participation and knowledge retention. Mandate change Have leadership declare the priority of the innovation and their determination to have it implemented Collaborate with regulators or policymakers to establish mandates or guidelines that require the integration of brain injury screening into standard practice for DVSA organizations. Model and simulate change Model or simulate the change that will be implemented prior to implementation Use simulation tools to illustrate the potential impact of brain injury screening on patient outcomes. Obtain and use patients/consumers and family feedback Develop strategies to increase patient/consumer and family feedback on the implementation effort Actively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening Obtain formal commitments Obtain written commitments from key partners that state what they will do to implement the innovation Co-designed by community-academic partnership per protocol Organize clinician implementation team meetings Develop and support teams of clinicians who are implementing the innovation and give them protected time to reflect on the implementation effort, share lessons learned, and support one another’s learning Schedule regular meetings of implementation teams to share progress, exchange ideas, and address challenges. Place innovation on fee for service lists/formularies Work to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable) Not relevant to the project Prepare patients/consumers to be active participants Prepare patients/consumers to be active in their care, to ask questions, and specifically to inquire about care guidelines, the evidence behind clinical decisions, or about available evidence-supported treatments Educate clients about the importance of their active involvement in the screening process. Promote adaptability Identify the ways a clinical innovation can be tailored to meet local needs and clarify which elements of the innovation must be maintained to preserve fidelity Encourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual clients needs and settings Promote network weaving Identify and build on existing high-quality working relationships and networks within and outside the organization, organizational units, teams, etc. to promote information sharing, collaborative problem-solving, and a shared vision/goal related to implementing the innovation Facilitate networking and collaboration among different community-based organizations (CBOs), departments, and organizations involved in brain injury screening Provide clinical supervision Provide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation Implement a system of supervision to oversee the quality and consistency of brain injury screening Provide local technical assistance Develop and use a system to deliver technical assistance focused on implementation issues using local personnel Establish local technical assistance teams within community-based organizations (CBOs) to provide on-site support and guidance during the implementation of brain injury screening Provide ongoing consultation Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation Offer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening. Purposely reexamine the implementation Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care Monitor progress and adjust community-based organizations (CBOs) practices and implementation strategies to continuously improve the quality of brain injury screening implementation Recruit, designate, and train for leadership Recruit, designate, and train leaders for the change effort Identify and train local leaders who can assume leadership roles within the implementation teams Remind clinicians Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation Implement regular reminders and notifications within the organization to conduct brain injury screenings when appropriate. Revise professional roles Shift and revise roles among professionals who provide care, and redesign job characteristics Redefine the roles and responsibilities of community-based organizations (CBOs) staff to incorporate brain injury screening as a standard practice Shadow other experts Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation Arrange for staff to shadow experienced experts in brain injury screening to gain hands-on experience and learn best practices. Stage implementation scale up Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout Start a dissemination organization Identify or start a separate organization that is responsible for disseminating the clinical innovation. It could be a for-profit or non-profit organization Not relevant to the project Tailor strategies Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection Customize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), client population, and local culture Use advisory boards and workgroups Create and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements Establish local advisory boards or workgroups composed of diverse stakeholders to provide input and guidance on the implementation process Use an implementation advisor Seek guidance from experts in implementation Seek guidance from an implementation advisor with expertise in brain injury screening. Use capitated payments Pay providers or care systems a set amount per patient/consumer for delivering clinical care Not relevant to the project Use data experts Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts Co-designed by community-academic partnership per protocol Use data warehousing techniques Integrate clinical records across facilities and organizations to facilitate implementation across systems Implement data warehousing techniques to efficiently store, manage, and analyze large volumes of screening data Use mass media Use media to reach large numbers of people to spread the word about the clinical innovation Not relevant to the project Use other payment schemes Introduce payment approaches (in a catch-all category) Not relevant to the project Use train-the-trainer strategies Train designated clinicians or organizations to train others in the clinical innovation Train a select group within community-based organizations as trainers who can then educate their peers on the principles and practices of brain injury screening. Visit other sites Visit sites where a similar implementation effort has been considered successful Visit other organizations that have successfully implemented brain injury screening. Work with educational institutions Encourage educational institutions to train clinicians in the innovation Not relevant to the project Modified Delphi Approach. A modified Delphi method was used to determine the most applicable strategies for increasing the adoption of BI screening and referral protocols among IPV-serving CBOs [37, 38] . We selected a modified Delphi technique due to its structured process for achieving expert consensus on priorities in areas where empirical evidence is limited and practice contexts are highly variable (McMillan 2016; Boulkedid 2011). This approach enabled broad participation across diverse CBOs and allowed us to systematically refine strategy priorities using community-engaged principles aligned with implementation science best practices. The Delphi process can be used to gather input virtually from a diverse group of people while maintaining anonymity which facilitates engagement and participation across different levels of an organization [37, 38]. Our approach aligns with other Delphi applications in implementation science [39, 40] by emphasizing context-sensitive strategy tailoring and extends this approach to CBOs providing IPV services. We constructed a QUALTRICS survey (see Appendix for survey questions) and organized the 47 ERIC-derived implementation strategies into five distinct categories: educational and training strategies, technical assistance strategies, staff and leadership development strategies, quality management strategies, and integration into organizational workflow. Delphi – Round 1 In the initial round of the Delphi process, we conducted an interactive consensus-building video-conference meeting with CAB members. A total of 14 CAB participants representing the 12 community-based programs and 4 research team members (SSR, PE, EP, CW) attended the meeting. First, participants were divided into three virtual sub-groups, and each group was assigned a subset of two ERIC categories. Moderators (SSR, PE, EP) facilitated discussions within each group, explained the categories, reviewed and clarified strategy definitions, and presented a rating process for participants to complete individually. Participants then rated around 17 strategies per group using a response set of "must-have," "nice-to-have," "don’t need," or "need more information" as the strategy related to improving the uptake of BI screening and referral within their respective organizations. Second, CAB members reconvened as a whole group to discuss the results from Round 1 ratings. The video conference moderator (EP) presented preliminary results, particularly focusing on strategies rated as "must-have" and those needing further clarification. Third, following the CAB meeting, the research team reviewed the results and refined the list of ERIC strategies based on participant ratings and discussions [35]. Delphi – Round 2 In Round 2 of the Delphi process, a QUALTRICS electronic survey included 21 ERIC-derived implementation strategies that were rated highest during Round 1. The strategies were organized into five distinct categories: 1) educational and training strategies; 2) technical assistance strategies; 3) staff and leadership development strategies; 4) quality management strategies; and 5) integration into organizational workflows. The survey was distributed via email to staff across the 12 CBO programs and respondents were instructed to rate each of the 21 strategies based on the predefined criteria: "must-have," "nice-to-have," "don’t need," or "need more information." Emails were sent to the CBOs liaisons requesting that they distribute the survey to all staff members. Two emails were sent to all CBOs with a 3 rd targeted reminder to CBOs with low response rates. Analyses. Round 1 survey responses were used to reduce the number of strategies reviewed by CBOs staff. The initial step included combining similar strategies based on CAB feedback. Consistent with recommendations for Delphi reporting (Diamond 2014), consensus for each stage was operationalized as ≥75% agreement across respondents, which served as the basis for final strategy selection. That is, strategies were included in Round 2 if they were: 1) designated as high-priority ("must-have") by at least 75% of participants or 2) strategies consistently regarded as a combination of high- ("must-have") or moderate-priority (“nice-to-have") by 75% of participants. This analysis resulted in a list of 21 strategies for review by CBOs staff in Round 2. Round 2 used the same process of inclusion of strategies (i.e., 75%) based on CBOs staff perceptions’ of potential effectiveness and relevance, resulting in the selection of 7 strategies for inclusion in the final list. Results The initial review of the ERIC strategies led to the removal of 26 strategies that were perceived as either irrelevant to the project (n=17) or redundant with other strategies that had been co-developed by our community-academic partnership as part of the study protocol (n=9). Subsequently, the remaining 47 strategy definitions were collaboratively adapted to better align with the multi-level perceptions and characteristics of BI screening recipients, CBOs implementation infrastructure, and potential external environmental factors that could influence BI screening reach, adoption, implementation, and maintenance in CBOs (see Table 2). Round 1 Fourteen CAB participants actively engaged in the Zoom interactive meeting, representing all 12 programs. Most participants (43%) were between 36-45 years old, all identified as female, with educational backgrounds ranging from college (29%) to postgraduate (29%). Of the 47 strategies reviewed, the CAB participants identified 21 strategies with a high level of agreement. Following our established statistical criterion—selecting strategies identified as a high priority by at least 75% of participants or as a moderate priority by 75% of participants—the following strategies were selected for inclusion in round 2: four from educational strategies (numbers 2, 4, 11, and 12); two from technical assistance (numbers 16 and 17); five related to building staff and leadership (numbers 18, 19, 20, 23, and 26); four concerning quality management (numbers 27, 28, 31, and 32); and six focused on organizational workflow (numbers 37, 38, 41, 42, 43, and 45). See table 3 for the list of strategies with the percentage of agreement (see Table 3). Strategies that were identified as similar included “Create locally tailored educational materials that explain the purpose and process of brain injury screening” (prioritized by 67% of participants; Strategy 7), and “Use engaging and interactive training methods that encourage active participation and knowledge retention” (prioritized by 78%; Strategy 9) and “Offer continuous training opportunities to staff members to ensure they remain competent in conducting brain injury screenings” (prioritized by 78%; Strategy 4). These strategies were merged, and the strategy was rephrased as follows: “Offer continuous training opportunities to staff members, including the creation of locally tailored educational materials and the use of engaging, interactive training methods to ensure they remain competent in conducting brain injury screenings”. See Table 4 for strategies included in Round 2. Round 2 Round 2 surveys were distributed to CBOs staff members (n=140). Sixty-two community partners completed an online survey that was distributed by email. Among them, 29% were aged between 36-45 years, 90% identified as female, and their educational backgrounds varied from college (29%) to postgraduate (26%). Of the 21 strategies considered, seven were consistently rated as high priority. Following our predetermined statistical criteria, selecting strategies identified as a high priority by at least 75% of participants or as a moderate priority by 75% of participants, the selected strategies included one educational strategy (#4); one technical assistance strategy (#17); one staff and leadership strategy (#19); two quality management strategies (#28, 31); and two organizational workflow strategies (#37, #38). See Table 5 for the final list of strategies. The final set of seven strategies are also aligned with PRISM constructs. Several strategies—such as providing training opportunities and developing formal implementation plans—address organizational characteristics by building staff capacity and creating structured processes to support adoption. Ongoing consultation and the establishment of local screening and referral protocols align with PRISM’s implementation and sustainability infrastructure domain, offering ongoing support and systematized procedures that promote routinization. Strategies like soliciting survivor feedback and promoting adaptability emphasize recipient characteristics and the importance of tailoring services to meet the needs, values, and preferences of those receiving care. Finally, tailoring strategies to CBO context represents a cross-cutting application of PRISM, underscoring the need to accommodate organizational culture, external demands, and contextual realities. Together, these findings highlight how co-identified strategies successfully addressed multilevel PRISM determinants, reinforcing its utility as a guiding framework for implementation strategy selection in community-based settings. Table 3. List of strategies rated in Round 1 and Round 2 ROUND 1 (n=9) ROUND 2 (n=55) MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO EDUCATE STRATEGIES 1- Develop an implementation glossary 44% 33% 0% 22% 2- Recruit, designate, and train for leadership 89% 0% 0% 11% 45% 35% 15% 5% 3-Visit other sites 22% 33% 33% 11% 4-Conduct ongoing training. 78% 22% 0% 0% 64% 76% 0% 2% 5- Conduct educational meetings. 44% 56% 0% 0% 6- Conduct educational outreach visits. 22% 44% 33% 0% 7- Develop educational materials. 67% 22% 0% 11% 8- Distribute educational materials. 22% 33% 22% 22% 9- Make training dynamic 78% 0% 11% 11% 10- Shadow other experts 11% 56% 22% 11% 11- Use train-the-trainer strategies 33% 71% 0% 11% 29% 56% 44% 44% 12-Prepare patients/consumers to be active participants 44% 44% 0% 11% 55% 31% 33% 56% ROUND 1 (n=5) ROUND 2(n=55) TECHNICAL ASSISTANCE STRATEGIES MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO 13- Centralize technical assistance 40% 20% 40% 0% 14- Facilitation 20% 60% 20% 0% 15- Provide local technical assistance 40% 0% 20% 40% 16-Use an implementation adviser 40% 60% 0% 0% 49% 45% 2% 4% 17- Provide ongoing consultation 80% 20% 0% 0% 73% 27% 0% 0% ROUND 1 (n=5) ROUND 2(n=54) BUILD STAFF AND LEADERSHIP STRATEGIES MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO 18- Assess for readiness and identify barriers and facilitators 80% 20% 0% 0% 52% 39% 6% 4% 19- Develop a formal implementation blueprint 100% 0% 0% 0% 76% 22% 2% 0% 20-Identify early adopters. 40% 60% 0% 0% 43% 6% 2% 21- Identify and prepare champions. 20% 80% 0% 0% 22- Inform local opinion leaders 0% 60% 20% 20% 23- Organize clinician implementation team meetings. 100% 20% 20% 0% 33% 61% 4% 2% 24-Promote network weaving 0% 60% 20% 20% 25- Use advisory boards and workgroups 0% 40% 20% 40% 26 Involve patients/consumers and family members 60% 20% 0% 20% 43% 37% 7% 13% ROUND 1 (n=5) ROUND 2(n=54) MANAGEMENT AND EVALUATION STRATEGIES MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO 27-Audit and provide feedback 60% 20% 0% 20% 24% 65% 7% 4% 28-Develop and implement tools for quality monitoring 80% 20% 0% 0% 70% 22% 4% 4% 29-Develop and organize quality monitoring systems 40% 60% 0% 0% 30-Purposely reexamine the implementation 60% 40% 0% 0% 46% 48% 2% 4% 31- Obtain and use patients/consumers and family feedback 60% 40% 0% 0% 65% 30% 6% 0% 32- Provide clinical supervision 0% 60% 0% 40% 33- Use data warehousing techniques 40% 40% 0% 20% 34- Conduct cyclical small tests of change 20% 40% 0% 40% 35-Stage implementation scale up 20% 60% 0% 20% 36- Model and simulate change. 0% 40% 20% 40% ROUND 1 (n=4) ROUND 2 (n=44) ORGANIZATIONAL AND WORKFLOW STRATEGIES MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO MUST HAVE NICE TO HAVE DON’T NEED NEED MORE INFO 37-Promote adaptability 75% 25% 0% 0% 75% 20% 2% 2% 38- Tailor strategies 75% 25% 0% 0% 68% 23% 7% 2% 39- Create new clinical teams 0% 50% 0% 50% 40- Develop resource sharing agreements 0% 75% 0% 25% 41- Remind clinicians 50% 50% 0% 0% 27% 59% 11% 2% 42- Revise professional roles 50% 50% 0% 0% 25% 57% 5% 14% 43- Intervene with patients/consumers to enhance uptake and adherence 75% 25% 0% 0% 45% 45% 2% 7% 44- Facilitate relay of clinical data to providers 25% 25% 25% 25% 45- Change physical structure and equipment 75% 0% 25% 0% 57% 32% 5% 7% 46-Alter incentive/allowance structures. 25% 25% 50% 0% 47-Mandate change 0% 25% 25% 50% Table 4. List of strategies included in Round 2 Educate Strategies Identify and train local leaders who can assume leadership roles within the implementation teams Offer continuous training opportunities to staff members, including the creation of locally tailored educational materials and the use of engaging, interactive training methods to ensure they remain competent in conducting brain injury screenings (combination of strategies 4,7,9 from the original survey) Train a select group within community-based organizations as trainers who can then educate their peers on the principles and practices of brain injury screening Educate clients about the importance of their active involvement in the screening process. Build Staff & Leadership Strategies Assess the readiness of community-based organizations (CBOs) to implement brain injury screening. This includes considering factors like staff expertise, resources, and infrastructure and identifying barriers, such as staff resistance or resource constraints, that may impede the successful rollout Develop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs) Identify and engage passionate individuals within community-based organizations (CBOs) who are enthusiastic about implementing and championing the importance of brain injury screening and referral (combination of strategies 20 and 21 and from the original survey). Schedule regular meetings of implementation teams to share progress, exchange ideas, and address challenges. Engage clients and their family members as partners in the brain injury screening process from the outset Technical Assistance Strategies Seek guidance from an implementation advisor with expertise in brain injury screening. Offer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening. Management And Evaluation Strategies Conduct regular audits of brain injury screening practices and provide feedback to community-based organizations (CBOs) to support quality improvement Create standardized protocols and tools for quality monitoring of brain injury screening that align with best practices Monitor progress and adjust community-based organizations (CBOs) practices and implementation strategies to continuously improve the quality of brain injury screening implementation Actively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening Organizational And Workflow Strategies Encourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual patient needs and settings Customize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), patient population, and local culture Implement regular reminders and notifications within the organization to conduct brain injury screenings when appropriate. Redefine the roles and responsibilities of community-based organizations (CBOs) staff to incorporate brain injury screening as a standard practice Develop client support programs to address barriers to uptake and adherence, such as transportation issues or language barriers Ensure that facilities are physically accessible and welcoming to clients and their families Table 5. Final list of strategies Educate Strategies Offer continuous training opportunities to staff members, including the creation of locally tailored educational materials and the use of engaging, interactive training methods to ensure they remain competent in conducting brain injury screenings. Build Staff & Leadership Strategies Develop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs) Technical Assistance Strategies Offer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening. Management And Evaluation Strategies Create standardized protocols and tools for quality monitoring of brain injury screening that align with best practices Actively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening Organizational And Workflow Strategies Encourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual clients needs and settings Customize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), client population, and local culture Discussion Our study extends previous dissemination and implementation science research by adding to modified Delphi techniques focused on system-level policy[ 39 ] or evidence grading[ 40 ] to the use of a Delphi process aimed to co-prioritize actionable strategies that align with the practice realities of under-resourced CBOs serving survivors of IPV. To the best of our knowledge, this is the first study to apply co-identification or ERIC strategies [ 35 ] in partnership with CBOs to increase the adoption of BI screening and referral protocols for IPV survivors. Using a modified Delphi approach and community-academic partnership with CBOs administrators and staff, we identified seven strategies that were considered both generalizable across all CBOs and rated as high priority to be implemented in their organizations. There are a number of promising outcomes of this collaborative project that include: (1) methods for an efficient approach to practically reduce ERIC strategies [ 36 ] down to those that have the highest likelihood of achieving broad impact, (2) suggestions for adaptation to strategy definitions for non-clinical settings, (3) demonstrating that CBOs are able to identify strategies across a variety of categories, including, but not limited to, training, and (4) there are still opportunities to better conceptualize dissemination and implementation strategies in CBOs outside of healthcare. The range of implementation strategies available to CBOs and other settings that can support the adoption, implementation, and sustainment of new evidence-based approaches can be overwhelming [ 41 ]. In addition, methods used to support the co-design or co-selection of strategies in partnership with organizational leaders and implementation teams focused on a new intervention can also be time consuming and impractical for community or clinical organizations to fit within limited time and resource constraints [ 42 ]. The use of the community-academic partnership to cull ERIC strategies from 73 to 47 greatly reduced the time needed to review strategies in the larger CAB. Further, the use of the CAB and facilitated discussions using video conferencing allowed for a relatively rapid reduction of the 46 strategies to 21 that could be reviewed in detail by CBOs staff and administrators. During the CAB discussion, members also expressed their appreciation of the selection scale options of ‘must have’ and ‘nice to have’ to support the prioritization of strategies. Finally, reduction of the 46 to 21 strategies using a survey prioritization approach allowed CBO staff to complete the process when and where it was most convenient for them. Our process also confirmed what others focusing on dissemination and implementation science outside of clinical settings have encountered with the ERIC strategies. That is, these strategies require modifications for use at the CBO-level, and many are not relevant outside of healthcare settings [ 43 , 44 ]. Financial strategies focused on consumers or reimbursements were seen as less relevant by the partnership. The seven prioritized strategies reflect consensus among practitioners working in IPV-focused CBOs, emphasizing pragmatic implementation features—such as local adaptation and survivor input—not typically emphasized in more generalized strategy sets such as ERIC. This illustrates how Delphi methods can surface implementation strategies that are both feasible and relevant within unique service contexts. Further, the prioritization of strategies like training, protocol development, and tailoring reflects PRISM-identified barriers and facilitators at both organizational and infrastructure levels. For example, limited screening capacity and lack of workflows aligned with BI screening and referral protocols underscore the need for structured implementation planning. The inclusion of survivor feedback and promotion of adaptability directly addresses the recipient and context domains of PRISM, signaling the value of community-defined fit over top-down approaches. The ongoing project will also provide opportunities for each CBOs to create additional strategies that may be more relevant locally while also being generalizable to other similar settings. Strengths and Limitations There were some limitations in the strategy selection process. First, community partners that are engaged in this process are all from one region in the Midwest which may not be generalizable to other locations. However, it is likely that IPV-serving CBOs have similar intake, assessment, and care processes regardless of location. Second, we used a convenience sample of 12 CBOs that identified BI screening and referral as an organizational priority which, may limit the generalizability of our findings. This is a consistent challenge in community-engaged research—the focus of the project is on locally identified priorities that may not be shared by other similar organizations. Third, the identification process used in this trial involves the identification of strategies that are likely to support sustained implementation. This is the first phase of our project and does not allow us to describe the actual utility of these strategies until they are tested. The next steps for this project include a stepped-wedge design whereby we will test a process of CBOs refinement of which strategies, and the order, will be used, operationalized, and enacted. Through this approach, we will provide additional opportunities for the co-design of defined strategies and co-creation of potential new strategies that will increase the reach of BI screening and referral for survivors of IPV. Conclusions This is the first known study to examine processes to select locally relevant implementation strategies for community implementation of BI screening and referral for IPV survivors. The modified Delphi approach appeared to be amenable to CBOs leadership and staff and allowed the reduction of strategies to those that are most needed and likely to have an impact on BI screening implementation. The identified strategies offer valuable insights for optimizing support to IPV survivors and advancing the implementation of public health interventions. Stakeholder-derived strategies that support comprehensive BI screening and referral in this vulnerable population and timely neurorehabilitation interventions have the potential to mitigate poor health outcomes and identify methods to achieve secondary prevention. Abbreviations BI: Brain Injury CAB: Community-campus advisory board CBOs: Community-based organizations ERIC: Expert Recommendations for Implementing Change IPV: Intimate partner violence TBI: Traumatic Brain Injury Declarations Ethics approval and consent to participate This study was approved as exempt by the Institutional Review Board (IRB) at the University of Nebraska Medical Center (UNMC) under protocol number 0259-23-EX. All procedures performed in this study were conducted in accordance with the Helsinki Declaration. Informed consent was obtained from all individuals participants included in the study. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interests. Funding This study was supported by grant number 1R01NS130574-01A1. Authors’ contributions SSR, PAE and ELP contributed to the study design. SSR, PAE, ELP and MNM contributed to moderation of the Delphi meetings and surveys development. ELP was responsible for data collection and analysis. All authors (SSR, ELP, KC, PR, CW, MNM and PAE) contributed to the data interpretation. ELP and SSR were responsible for manuscript writing. SSR and PAE provided feedback on revisions of the manuscript. All authors (SSR, ELP, KC, PR, CW, MNM and PAE) read and approved the final manuscript. Acknowledgements Not applicable. References Breiding, M., et al., Intimate partner violence surveillance : uniform definitions and recommended data elements. Version 2.0. 2015. 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Pérez Jolles, M., et al., Using Implementation Mapping to develop protocols supporting the implementation of a state policy on screening children for Adverse Childhood Experiences in a system of health centers in inland Southern California. Frontiers in Public Health, 2022. 10 . Balis, L.A.-O., B.A.-O. Houghtaling, and S.M. Harden, Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions. 2022(1613-9860 (Electronic)). Moore, S.A., et al., Specifying and Reporting Implementation Strategies Used in a School-Based Prevention Efficacy Trial. LID - 10.1177/26334895211047841 [doi] LID - 26334895211047841. 2021(2633-4895 (Electronic)). Additional Declarations No competing interests reported. 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Estabrooks","email":"","orcid":"","institution":"University of Utah","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"A.","lastName":"Estabrooks","suffix":""}],"badges":[],"createdAt":"2025-06-18 21:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6925920/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6925920/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25638-0","type":"published","date":"2026-01-24T15:59:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101151828,"identity":"c99e8dc0-2e34-4b04-82a9-978922bb577a","added_by":"auto","created_at":"2026-01-26 16:06:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1328636,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6925920/v1/ac696806-679f-4f53-9e49-49d700c87050.pdf"},{"id":86770898,"identity":"afb3f25a-22f1-4181-88f9-70a7b5e4419c","added_by":"auto","created_at":"2025-07-15 11:42:21","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19429,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6925920/v1/0bb98cf4c94724fc6ac6c538.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Delphi Study to prioritize implementation strategies to increase the adoption of screening and referral for brain injury among survivors of intimate partner violence and sexual assault within community-based organizations","fulltext":[{"header":"Background","content":"\u003cp\u003eIntimate partner violence (IPV) is a serious public health issue that affects millions of people in the U.S and worldwide. IPV is defined as violence or aggression that occurs within a close relationship, including with a current or former spouse, or a dating or sexual partner. Violence or aggression can include physical violence, sexual violence, stalking, and psychological abuse [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Statistics reveal that 1 in 2 women and 1 in 4 men have experienced sexual violence, physical violence, or stalking by an intimate partner in their lifetime and reported an IPV-related impact, including injury, fear, safety concerns, and/or need for supportive services [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While IPV affects all communities, it disproportionally affects women and racial/ethnic minorities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIPV also extends beyond the immediate trauma to inflict profound and often hidden injuries, particularly on women. Studies have highlighted that women who experience IPV are at a high risk for injuries to the head, neck, and face that can result in a traumatic brain injury (TBI) [\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These IPV-related TBIs can have lasting effects, leading to chronic symptoms such as headaches, memory and cognitive issues, concentration problems, dizziness and anxiety[\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. IPV survivors are also at high risk for an Acquired Brain Injury (ABI) resulting from strangulation that involves hypoxia and anoxia when the oxygen supply to the brain is restricted or completely cut off [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIPV-related brain injury (BI), which includes TBIs and ABIs is likely to be repeated, and women may experience multiple hits to the head in a short span of time [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A study by Rajaram and colleagues (2020), showed that of 171 IPV survivors screened, 92% experienced a hit to the head or strangulation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moreover, 52% reported that it occurred more than four times in their lives. People who experience repeated brain injuries before the brain recovers from the initial trauma are at high risk for neurological deficits, depression, suicide, and Alzheimer-like symptoms [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIPV survivors may not seek medical care following a BI. They may not trust medical providers [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] or have access or the autonomy to seek medical help for their injuries [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] .They may also be concerned about shame, fear, and stigma associated with IPV [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and retaliation from their abusers resulting from the disclosure of abuse [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. IPV-related BIs are hidden and, often, have no visible signs of physical trauma; thus these injuries can be missed or misdiagnosed by healthcare and social service providers [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and may be minimized by survivors [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. One study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] showed that only 35% of IPV survivors who were at high risk for BI received medical treatment. We also found that IPV survivors may be more likely to reach out to community-based organizations (CBOs) that provide social services to survivors of IPV, sexual assault, and sex trafficking.\u003c/p\u003e\u003cp\u003eDespite increasing evidence of the high risk for BI in this vulnerable population[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], there remains an inadequate focus on BI and BI screening among IPV survivors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. As BI continues to go unreported, undetected or misdiagnosed by mainstream healthcare and social service providers, other avenues, such as front line workers or CBOs, whom survivors may be more willing to disclose their needs to, have a unique opportunity to assist in the identification of a potential BI. Thus, it is imperative that IPV-serving CBOs integrate routine screening for possible BI and connect survivors to referral services, where evidence-based BI interventions may be available and accessible.\u003c/p\u003e\u003cp\u003eIntegrating BI screening approaches and referrals that are specifically tailored to IPV survivors holds great potential benefits. For example, a qualitative study [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] on screening for BI with a follow-up neuropsychological evaluation (NPE) showed the potential to be acceptable to IPV survivors and service providers. Understanding the facilitators and barriers to the use of evidence-based interventions by IPV-serving CBOs will help increase the chances for improved recovery through appropriate neurorehabilitation, particularly for disenfranchised groups who may lack the means to access, or have low trust in, medical care.\u003c/p\u003e\u003cp\u003eUnfortunately, little is known about implementation strategies for screening by IPV-serving CBOs or how these organizations integrate screening and provide timely referrals \u0026ndash; in routine practice \u0026ndash; to aid women in the recovery process. A recent study in behavioral health settings found that only 25% of providers adopted BI screening post-training and suggested that implementation strategies that include additional training, leadership engagement, and state mandates may be needed to support widespread systematic uptake of BI screening [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This aligns with the Expert Recommendations for Implementing Change (ERIC) project that highlighted a range of strategies to support, primarily healthcare, implementation of evidence-based interventions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. That project identified 73 unique strategies that can be characterized as those that focus on education and training, staff and leadership activities, technical assistance, management and evaluation, and organization and workflow factors. However, outside of providing training, to date, no known studies have used these expert recommendations to improve the dissemination and implementation of BI screening and referrals to service provision among IPV-serving CBOs (or other behavioral health settings). Furthermore, while many CBOs participate in community-engaged research approaches, there is also a gap in understanding how community-engaged dissemination and implementation (CEDI) strategies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] may be applied collaboratively with IPV-serving CBOs. This study aimed to co-identify appropriate BI screening and referral implementation strategies with IPV-serving CBOs and to develop guidance for broad adoption, implementation, and sustainment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eSetting and participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study used a community-academic partnership approach that involved a team of research scientists, a project manager, a non-profit community partner, and a community advisory board (CAB). Collaboratively, the project team identified 12 community-based programs (10 CBOs) from both rural and urban areas in a Midwestern state that served survivors of IPV and sexual assault to participate in a larger project focused on increasing BI screening and referral strategy implementation for women experiencing IPV. All CBOs involved in the project were participants in the study\u0026rsquo;s CAB and expressed an interest in conducting BI screening and referrals for IPV survivors who had used their services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMembers of the CAB (n=14) participated in the modified Delphi process [37] described below and provided background information including organizational affiliation, role, profession, experience, demographics, and racial/ethnic backgrounds. This study was approved by the Institutional Review Board (IRB) at the University of Nebraska Medical Center (UNMC) under protocol number 0259-23-EX. Consent to participate was obtained from all participants. \u0026nbsp;A summary of participants\u0026rsquo; characteristics is in Table 1.\u003c/p\u003e\n\u003cp\u003eTheoretical Approach\u003c/p\u003e\n\u003cp\u003eThe ERIC strategy list was reviewed through the lens of constructs from the Practical, Robust Implementation and Sustainability Model (PRISM) to ensure coverage of determinants at the organizational (e.g., leadership support, workflow fit), recipient (e.g., survivor readiness, staff training needs), external (e.g., funding or policy mandates), and infrastructure (e.g., availability of technical assistance) levels. This mapping informed the initial CAB discussions and selection process for the Round 1 Delphi. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1.\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eCharacteristics of participants\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 1 (n=14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2 (n=62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e14 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e56 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eGender nonconforming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e19-25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e26-35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e9 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e36-45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e6 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e18 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e46-55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e16 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eOver 55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession Experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e20 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e16-25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e5 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e15 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eAbove 25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eHigh school/ GED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eTrade school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eAssociate degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e3 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eSome college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e3 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eCollege degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e18 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003ePost-graduate (Master and above)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e16 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eAfrican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eAsian American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMixed- racial background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eNative American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eWhite-Caucasian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e52 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eHispanic/ Latinx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e7 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eNot Hispanic/ Latinx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e54 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eStrategy identification process.\u003c/p\u003e\n\u003cp\u003eDuring the initial planning phase, spanning two and a half months, community partners and researchers engaged in discussions and consensus-building to create a prioritized list of 47 possible ERIC evidence-based strategies from an initial pool of 73 strategies [35]. This process involved an iterative multi-round approach [37, 38], wherein the core team, including experts in dissemination and implementation science (PE and EP), as well as in intimate partner violence (SSR), closely examined the 73 strategies outlined in ERIC [35] (see Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2- Strategies considered for applicability with corresponding original and collaboratively adapted strategy definitions for CBO-based BI screening and referral.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eStrategy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eERIC Definitions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eBI project definitions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col\u003e\n \u003cli\u003eAccess new funding\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eAccess new or existing money to facilitate the implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003eAlter incentive/allowance structures\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eWork to incentivize the adoption and implementation of the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eExplore the possibility of offering incentives to clients who actively participate in brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eAlter patient/consumer fees\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eCreate fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eAssess for readiness and identify barriers and facilitators\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eAssess 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\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eAssess the readiness of community-based organizations (CBOs) to implement brain injury screening. This includes considering factors like staff expertise, resources, and infrastructure and identifying barriers, such as staff resistance or resource constraints, that may impede the successful rollout\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"5\"\u003e\n \u003cli\u003eAudit and provide feedback\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eCollect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eConduct regular audits of brain injury screening practices and provide feedback to community-based organizations (CBOs) to support quality improvement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"6\"\u003e\n \u003cli\u003eBuild a coalition\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eRecruit and cultivate relationships with partners in the implementation effort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"7\"\u003e\n \u003cli\u003eCapture and share local knowledge\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eCapture local knowledge from implementation sites on how implementers and clinicians made something work in their setting and then share it with other sites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"8\"\u003e\n \u003cli\u003eCentralize technical assistance\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop and use a centralized system to deliver technical assistance focused on implementation issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Establish a centralized system to deliver technical assistance for brain injury screening implementation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"9\"\u003e\n \u003cli\u003eChange accreditation or membership requirements\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eStrive to alter accreditation standards so that they require or encourage use of the clinical innovation. Work to alter membership organization requirements so that those who want to affiliate with the organization are encouraged or required to use the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"10\"\u003e\n \u003cli\u003eChange liability laws\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eParticipate in liability reform efforts that make clinicians more willing to deliver the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"11\"\u003e\n \u003cli\u003eChange physical structure and equipment\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eEvaluate current configurations and adapt, as needed, the physical structure and/or equipment (e.g., changing the layout of a room, adding equipment) to best accommodate the targeted innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eEnsure that facilities are physically accessible and welcoming to clients and their families\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"12\"\u003e\n \u003cli\u003eChange record systems\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eChange records systems to allow better assessment of implementation or clinical outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"13\"\u003e\n \u003cli\u003eChange service sites\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eChange the location of clinical service sites to increase access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"14\"\u003e\n \u003cli\u003eConduct cyclical small tests of change\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eImplement changes in a cyclical fashion using small tests of change before taking changes system-wide. Tests of change benefit from systematic measurement, and results of the tests of change are studied for insights on how to do better. This process continues serially over time, and refinement is added with each cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eImplement periodic changes using small tests of brain injury screening before taking changes system-wide\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"15\"\u003e\n \u003cli\u003eConduct educational meetings\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eHold meetings targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eHost educational meetings or seminars within the organization to inform staff about the importance of brain injury screening and the associated benefits.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"16\"\u003e\n \u003cli\u003eConduct educational outreach visits\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eHave a trained person meet with providers in their practice settings to educate providers about the clinical innovation with the intent of changing the provider\u0026rsquo;s practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eConduct outreach visits to other community-based organizations to share knowledge and best practices related to brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"17\"\u003e\n \u003cli\u003eConduct local consensus discussions\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eInclude 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\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"18\"\u003e\n \u003cli\u003eConduct local needs assessment\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eCollect and analyze data related to the need for the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"19\"\u003e\n \u003cli\u003eConduct ongoing training\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePlan for and conduct training in the clinical innovation in an ongoing way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eOffer continuous training opportunities to staff members to ensure they remain competent in conducting brain injury screenings.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"20\"\u003e\n \u003cli\u003eCreate a learning collaborative\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eFacilitate the formation of groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"21\"\u003e\n \u003cli\u003eCreate new clinical teams\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eChange who serves on the clinical team, adding different disciplines and different skills to make it more likely that the clinical innovation is delivered (or is more successfully delivered)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eEstablish dedicated teams or units specifically focused on brain injury screening and management\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"22\"\u003e\n \u003cli\u003eCreate or change credentialing and/or licensure standards\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eCreate an organization that certifies clinicians in the innovation or encourage an existing organization to do so. Change governmental professional certification or licensure requirements to include delivering the innovation. Work to alter continuing education requirements to shape professional practice toward the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"23\"\u003e\n \u003cli\u003eDevelop a formal implementation blueprint\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop a formal implementation blueprint that includes all goals and strategies. The blueprint should include the following: 1) aim/purpose of the implementation; 2) scope of the change (e.g., what organizational units are affected); 3) timeframe and milestones; and 4) appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eDevelop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"24\"\u003e\n \u003cli\u003eDevelop academic partnerships\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePartner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"25\"\u003e\n \u003cli\u003eDevelop an implementation glossary\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCreate a local implementation glossary that defines key terms and concepts specific to brain injury screening and referral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"26\"\u003e\n \u003cli\u003eDevelop and implement tools for quality monitoring\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop, test, and introduce into quality-monitoring systems the right input\u0026mdash;the appropriate language, protocols, algorithms, standards, and measures (of processes, patient/consumer outcomes, and implementation outcomes) that are often specific to the innovation being implemented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCreate standardized protocols and tools for quality monitoring of brain injury screening that align with best practices\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"27\"\u003e\n \u003cli\u003eDevelop and organize quality monitoring systems\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop and organize systems and procedures that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eSet up an efficient system for tracking the progress of brain injury screening, including data collection, reporting, and analysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"28\"\u003e\n \u003cli\u003eDevelop disincentives\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eProvide financial disincentives for failure to implement or use the clinical innovations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"29\"\u003e\n \u003cli\u003eDevelop educational materials\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Create locally tailored educational materials that explain the purpose and process of brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"30\"\u003e\n \u003cli\u003eDevelop resource sharing agreements\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop partnerships with organizations that have resources needed to implement the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCollaborate with neighboring facilities to establish resource-sharing agreements that facilitate the exchange of expertise, equipment, or personnel\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"31\"\u003e\n \u003cli\u003eDistribute educational materials\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDistribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eDisseminate educational materials to staff at community-based organizations, clients and their families through various channels, including reception area, websites, and community events.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"32\"\u003e\n \u003cli\u003eFacilitate relay of clinical data to providers\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eProvide as close to real-time data as possible about key measures of process/outcomes using integrated modes/channels of communication in a way that promotes use of the targeted innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eDevelop clear communication strategies to convey the potential risks and consequences of not participating in brain injury screening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"33\"\u003e\n \u003cli\u003eFacilitation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eA process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Employ facilitators who can help organizational teams navigate the complexities of brain injury screening implementation.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"34\"\u003e\n \u003cli\u003eFund and contract for the clinical innovation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eGovernments and other payers of services issue requests for proposals to deliver the innovation, use contracting processes to motivate providers to deliver the clinical innovation, and develop new funding formulas that make it more likely that providers will deliver the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"35\"\u003e\n \u003cli\u003eIdentify and prepare champions\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIdentify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Identify individuals who are passionate about the importance of brain injury screening and willing to champion the cause.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"36\"\u003e\n \u003cli\u003eIdentify early adopters\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIdentify early adopters at the local site to learn from their experiences with the practice innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Identify and engage staff within the community-based organizations (CBOs) who are enthusiastic about implementing brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"37\"\u003e\n \u003cli\u003eIncrease demand\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eAttempt to influence the market for the clinical innovation to increase competition intensity and to increase the maturity of the market for the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"38\"\u003e\n \u003cli\u003eInform local opinion leaders\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eInform providers identified by colleagues as opinion leaders or \u0026ldquo;educationally influential\u0026rdquo; about the clinical innovation in the hopes that they will influence colleagues to adopt it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eIdentify and engage local opinion leaders and influential figures within the community who can help promote the benefits of brain injury screening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"39\"\u003e\n \u003cli\u003eIntervene with patients/consumers to enhance uptake and adherence\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop strategies with patients to encourage and problem solve around adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Develop client support programs to address barriers to uptake and adherence, such as transportation issues or language barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"40\"\u003e\n \u003cli\u003eInvolve executive boards\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eInvolve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"41\"\u003e\n \u003cli\u003eInvolve patients/consumers and family members\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eEngage or include patients/consumers and families in the implementation effort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eEngage clients and their family members as partners in the brain injury screening process from the outset\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"42\"\u003e\n \u003cli\u003eMake billing easier\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMake it easier to bill for the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"43\"\u003e\n \u003cli\u003eMake training dynamic\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eVary the information delivery methods to cater to different learning styles and work contexts, and shape the training in the innovation to be interactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eUse engaging and interactive training methods that encourage active participation and knowledge retention.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"44\"\u003e\n \u003cli\u003eMandate change\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eHave leadership declare the priority of the innovation and their determination to have it implemented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCollaborate with regulators or policymakers to establish mandates or guidelines that require the integration of brain injury screening into standard practice for DVSA organizations.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"45\"\u003e\n \u003cli\u003eModel and simulate change\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eModel or simulate the change that will be implemented prior to implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Use simulation tools to illustrate the potential impact of brain injury screening on patient outcomes.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"46\"\u003e\n \u003cli\u003eObtain and use patients/consumers and family feedback\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop strategies to increase patient/consumer and family feedback on the implementation effort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eActively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"47\"\u003e\n \u003cli\u003eObtain formal commitments\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eObtain written commitments from key partners that state what they will do to implement the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"48\"\u003e\n \u003cli\u003eOrganize clinician implementation team meetings\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop and support teams of clinicians who are implementing the innovation and give them protected time to reflect on the implementation effort, share lessons learned, and support one another\u0026rsquo;s learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Schedule regular meetings of implementation teams to share progress, exchange ideas, and address challenges.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"49\"\u003e\n \u003cli\u003ePlace innovation on fee for service lists/formularies\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eWork to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"50\"\u003e\n \u003cli\u003ePrepare patients/consumers to be active participants\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePrepare patients/consumers to be active in their care, to ask questions, and specifically to inquire about care guidelines, the evidence behind clinical decisions, or about available evidence-supported treatments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Educate clients about the importance of their active involvement in the screening process.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"51\"\u003e\n \u003cli\u003ePromote adaptability\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIdentify the ways a clinical innovation can be tailored to meet local needs and clarify which elements of the innovation must be maintained to preserve fidelity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eEncourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual clients needs and settings\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"52\"\u003e\n \u003cli\u003ePromote network weaving\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIdentify and build on existing high-quality working relationships and networks within and outside the organization, organizational units, teams, etc. to promote information sharing, collaborative problem-solving, and a shared vision/goal related to implementing the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Facilitate networking and collaboration among different community-based organizations (CBOs), departments, and organizations involved in brain injury screening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"53\"\u003e\n \u003cli\u003eProvide clinical supervision\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eProvide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eImplement a system of supervision to oversee the quality and consistency of brain injury screening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"54\"\u003e\n \u003cli\u003eProvide local technical assistance\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop and use a system to deliver technical assistance focused on implementation issues using local personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eEstablish local technical assistance teams within community-based organizations (CBOs) to provide on-site support and guidance during the implementation of brain injury screening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"55\"\u003e\n \u003cli\u003eProvide ongoing consultation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eProvide ongoing consultation with one or more experts in the strategies used to support implementing the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Offer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"56\"\u003e\n \u003cli\u003ePurposely reexamine the implementation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eMonitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eMonitor progress and adjust community-based organizations (CBOs) practices and implementation strategies to continuously improve the quality of brain injury screening implementation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"57\"\u003e\n \u003cli\u003eRecruit, designate, and train for leadership\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eRecruit, designate, and train leaders for the change effort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eIdentify and train local leaders who can assume leadership roles within the implementation teams\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"58\"\u003e\n \u003cli\u003eRemind clinicians\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eDevelop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Implement regular reminders and notifications within the organization to conduct brain injury screenings when appropriate.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"59\"\u003e\n \u003cli\u003eRevise professional roles\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eShift and revise roles among professionals who provide care, and redesign job characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eRedefine the roles and responsibilities of community-based organizations (CBOs) staff to incorporate brain injury screening as a standard practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"60\"\u003e\n \u003cli\u003eShadow other experts\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eProvide ways for key individuals to directly observe experienced people engage with or use the targeted practice change/innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Arrange for staff to shadow experienced experts in brain injury screening to gain hands-on experience and learn best practices.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"61\"\u003e\n \u003cli\u003eStage implementation scale up\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePhase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003ePhase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"62\"\u003e\n \u003cli\u003eStart a dissemination organization\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIdentify or start a separate organization that is responsible for disseminating the clinical innovation. It could be a for-profit or non-profit organization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"63\"\u003e\n \u003cli\u003eTailor strategies\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Customize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), client population, and local culture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"64\"\u003e\n \u003cli\u003eUse advisory boards and workgroups\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eCreate and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;Establish local advisory boards or workgroups composed of diverse stakeholders to provide input and guidance on the implementation process\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"65\"\u003e\n \u003cli\u003eUse an implementation advisor\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSeek guidance from experts in implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eSeek guidance from an implementation advisor with expertise in brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"66\"\u003e\n \u003cli\u003eUse capitated payments\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePay providers or care systems a set amount per patient/consumer for delivering clinical care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"67\"\u003e\n \u003cli\u003eUse data experts\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eInvolve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eCo-designed by community-academic partnership per protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"68\"\u003e\n \u003cli\u003eUse data warehousing techniques\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIntegrate clinical records across facilities and organizations to facilitate implementation across systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eImplement data warehousing techniques to efficiently store, manage, and analyze large volumes of screening data\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"69\"\u003e\n \u003cli\u003eUse mass media\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eUse media to reach large numbers of people to spread the word about the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"70\"\u003e\n \u003cli\u003eUse other payment schemes\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eIntroduce payment approaches (in a catch-all category)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"71\"\u003e\n \u003cli\u003eUse train-the-trainer strategies\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTrain designated clinicians or organizations to train others in the clinical innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eTrain a select group within community-based organizations as trainers who can then educate their peers on the principles and practices of brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"72\"\u003e\n \u003cli\u003eVisit other sites\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eVisit sites where a similar implementation effort has been considered successful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eVisit other organizations that have successfully implemented brain injury screening.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003col start=\"73\"\u003e\n \u003cli\u003eWork with educational institutions\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eEncourage educational institutions to train clinicians in the innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNot relevant to the project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModified Delphi Approach.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA modified Delphi method was used to determine the most applicable strategies for increasing the adoption of BI screening and referral protocols among IPV-serving CBOs [37, 38] . We selected a modified Delphi technique due to its structured process for achieving expert consensus on priorities in areas where empirical evidence is limited and practice contexts are highly variable (McMillan 2016; Boulkedid 2011). This approach enabled broad participation across diverse CBOs and allowed us to systematically refine strategy priorities using community-engaged principles aligned with implementation science best practices. The Delphi process can be used to gather input virtually from a diverse group of people while maintaining anonymity which facilitates engagement and participation across different levels of an organization [37, 38]. Our approach aligns with other Delphi applications in implementation science [39, 40] by emphasizing context-sensitive strategy tailoring and extends this approach to CBOs providing IPV services. We constructed a QUALTRICS survey (see Appendix for survey questions) and organized the 47 ERIC-derived implementation strategies into five distinct categories: educational and training strategies, technical assistance strategies, staff and leadership development strategies, quality management strategies, and integration into organizational workflow.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDelphi \u0026ndash; Round 1\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the initial round of the Delphi process, we conducted an interactive consensus-building video-conference meeting with CAB members. A total of 14 CAB participants representing the 12 community-based programs and 4 research team members (SSR, PE, EP, CW) attended the meeting. First, participants were divided into three virtual sub-groups, and each group was assigned a subset of two ERIC categories. Moderators (SSR, PE, EP) facilitated discussions within each group, explained the categories, reviewed and clarified strategy definitions, and presented a rating process for participants to complete individually. Participants then rated around 17 strategies per group using a response set of \u0026quot;must-have,\u0026quot; \u0026quot;nice-to-have,\u0026quot; \u0026quot;don\u0026rsquo;t need,\u0026quot; or \u0026quot;need more information\u0026quot; as the strategy related to improving the uptake of BI screening and referral within their respective organizations. Second, CAB members reconvened as a whole group to discuss the results from Round 1 ratings. The video conference moderator (EP) presented preliminary results, particularly focusing on strategies rated as \u0026quot;must-have\u0026quot; and those needing further clarification. Third, following the CAB meeting, the research team reviewed the results and refined the list of ERIC strategies based on participant ratings and discussions [35].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDelphi \u0026ndash; Round 2\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Round 2 of the Delphi process, a QUALTRICS electronic survey included 21 ERIC-derived implementation strategies that were rated highest during Round 1. The strategies were organized into five distinct categories: 1) educational and training strategies; 2) technical assistance strategies; 3) staff and leadership development strategies; 4) quality management strategies; and 5) integration into organizational workflows.\u003c/p\u003e\n\u003cp\u003eThe survey was distributed via email to staff across the 12 CBO programs and respondents were instructed to rate each of the 21 strategies based on the predefined criteria: \u0026quot;must-have,\u0026quot; \u0026quot;nice-to-have,\u0026quot; \u0026quot;don\u0026rsquo;t need,\u0026quot; or \u0026quot;need more information.\u0026quot; Emails were sent to the CBOs liaisons requesting that they distribute the survey to all staff members. Two emails were sent to all CBOs with a 3\u003csup\u003erd\u003c/sup\u003e targeted reminder to CBOs with low response rates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalyses.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRound 1 survey responses were used to reduce the number of strategies reviewed by CBOs staff. The initial step included combining similar strategies based on CAB feedback. Consistent with recommendations for Delphi reporting (Diamond 2014), consensus for each stage was operationalized as \u0026ge;75% agreement across respondents, which served as the basis for final strategy selection. That is, strategies were included in Round 2 if they were: 1) designated as high-priority (\u0026quot;must-have\u0026quot;) by at least 75% of participants or 2) strategies consistently regarded as a combination of high- (\u0026quot;must-have\u0026quot;) or moderate-priority (\u0026ldquo;nice-to-have\u0026quot;) by 75% of participants. This analysis resulted in a list of 21 strategies for review by CBOs staff in Round 2. Round 2 used the same process of inclusion of strategies (i.e., 75%) based on CBOs staff perceptions\u0026rsquo; of potential effectiveness and relevance, resulting in the selection of 7 strategies for inclusion in the final list.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe initial review of the ERIC strategies led to the removal of 26 strategies that were perceived as either irrelevant to the project (n=17) or redundant with other strategies that had been co-developed by our community-academic partnership as part of the study protocol (n=9). Subsequently, the remaining 47 strategy definitions were collaboratively adapted to better align with the multi-level perceptions and characteristics of BI screening recipients, CBOs implementation infrastructure, and potential external environmental factors that could influence BI screening reach, adoption, implementation, and maintenance in CBOs (see Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cu\u003eRound 1\u003c/u\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFourteen CAB participants actively engaged in the Zoom interactive meeting, representing all 12 programs. Most participants (43%) were between 36-45\u0026nbsp;years old, all identified as female, with educational backgrounds ranging from college (29%) to postgraduate (29%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 47 strategies reviewed, the CAB participants identified 21 strategies with a high level of agreement. Following our established statistical criterion\u0026mdash;selecting strategies identified as a high priority by at least 75% of participants or as a moderate priority by 75% of participants\u0026mdash;the following strategies were selected for inclusion in round 2: four from educational strategies (numbers 2, 4, 11, and 12); two from technical assistance (numbers 16 and 17); five related to building staff and leadership (numbers 18, 19, 20, 23, and 26); four concerning quality management (numbers 27, 28, 31, and 32); and six focused on organizational workflow (numbers 37, 38, 41, 42, 43, and 45). See table 3 for the list of strategies with the percentage of agreement (see Table 3).\u003c/p\u003e\n\u003cp\u003eStrategies that were identified as similar included \u0026ldquo;Create locally tailored educational materials that explain the purpose and process of brain injury screening\u0026rdquo; (prioritized by 67% of participants; Strategy 7), and \u0026ldquo;Use engaging and interactive training methods that encourage active participation and knowledge retention\u0026rdquo; (prioritized by 78%; Strategy 9) and \u0026ldquo;Offer continuous training opportunities to staff members to ensure they remain competent in conducting brain injury screenings\u0026rdquo; (prioritized by 78%; Strategy 4). These strategies were merged, and the strategy was rephrased as follows: \u0026ldquo;Offer continuous training opportunities to staff members, including the creation of locally tailored educational materials and the use of engaging, interactive training methods to ensure they remain competent in conducting brain injury screenings\u0026rdquo;. See Table 4 for strategies included in Round 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cu\u003eRound 2\u003c/u\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRound 2 surveys were distributed to CBOs staff members (n=140). Sixty-two community partners completed an online survey that was distributed by email. Among them, 29% were aged between 36-45 years, 90% identified as female, and their educational backgrounds varied from college (29%) to postgraduate (26%).\u003c/p\u003e\n\u003cp\u003eOf the 21 strategies considered, seven were consistently rated as high priority. Following our predetermined statistical criteria, selecting strategies identified as a high priority by at least 75% of participants or as a moderate priority by 75% of participants, the selected strategies included one educational strategy (#4); one technical assistance strategy (#17); one staff and leadership strategy (#19); two quality management strategies (#28, 31); and two organizational workflow strategies (#37, #38). See Table 5 for the final list of strategies. The final set of seven strategies are also aligned with PRISM constructs. Several strategies\u0026mdash;such as providing training opportunities and developing formal implementation plans\u0026mdash;address organizational characteristics by building staff capacity and creating structured processes to support adoption. Ongoing consultation and the establishment of local screening and referral protocols align with PRISM\u0026rsquo;s implementation and sustainability infrastructure domain, offering ongoing support and systematized procedures that promote routinization. Strategies like soliciting survivor feedback and promoting adaptability emphasize recipient characteristics and the importance of tailoring services to meet the needs, values, and preferences of those receiving care. Finally, tailoring strategies to CBO context represents a cross-cutting application of PRISM, underscoring the need to accommodate organizational culture, external demands, and contextual realities. Together, these findings highlight how co-identified strategies successfully addressed multilevel PRISM determinants, reinforcing its utility as a guiding framework for implementation strategy selection in community-based settings.\u003c/p\u003e\n\u003cp\u003eTable 3.\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eList of strategies rated in Round 1 and Round 2\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 1 (n=9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 2 (n=55)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;DON\u0026rsquo;T NEED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;NEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;MUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;NICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;DON\u0026rsquo;T NEED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;NEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEDUCATE STRATEGIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1- Develop an implementation glossary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2- Recruit, designate, and train for leadership\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e3-Visit other sites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4-Conduct ongoing training.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e64%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e5- Conduct educational meetings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e6- Conduct educational outreach visits.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e7- Develop educational materials.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e8- Distribute educational materials.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e9- Make training dynamic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e10- Shadow other experts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e11- Use train-the-trainer strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e71%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e12-Prepare patients/consumers to be active participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 1 (n=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 2(n=55)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTECHNICAL ASSISTANCE STRATEGIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e13- Centralize technical assistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e14- Facilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e15- Provide local technical assistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e16-Use an implementation adviser\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e17- Provide ongoing consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e73%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 1 (n=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 2(n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUILD STAFF AND LEADERSHIP STRATEGIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e18- Assess for readiness and identify barriers and facilitators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e19- Develop a formal implementation blueprint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e20-Identify early adopters.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e21- Identify and prepare champions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e22- Inform local opinion leaders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e23- Organize clinician implementation team meetings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e24-Promote network weaving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e25- Use advisory boards and workgroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e26 Involve patients/consumers and family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 1 (n=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 2(n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMANAGEMENT AND EVALUATION STRATEGIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e27-Audit and provide feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e28-Develop and implement tools for quality monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e29-Develop and organize quality monitoring systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e30-Purposely reexamine the implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e31- Obtain and use patients/consumers and family feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e32- Provide clinical supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e33- Use data warehousing techniques\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e34- Conduct cyclical small tests of change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e35-Stage implementation scale up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e36- Model and simulate change.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 1 (n=4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROUND 2 (n=44)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eORGANIZATIONAL AND WORKFLOW STRATEGIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eMUST HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNICE TO HAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eDON\u0026rsquo;T NEED\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eNEED MORE INFO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e37-Promote adaptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e38- Tailor strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e39- Create new clinical teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e40-\u0026nbsp;Develop resource sharing agreements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e41- Remind clinicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e42- Revise professional roles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e43- Intervene with patients/consumers to enhance uptake and adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e44- Facilitate relay of clinical data to providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e45- Change physical structure and equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e46-Alter incentive/allowance structures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e47-Mandate change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4.\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003eList of strategies included in Round 2\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"720\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eEducate Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eIdentify and train local leaders who can assume leadership roles within the implementation teams\u003c/li\u003e\n \u003cli\u003eOffer continuous training opportunities to staff members, including the creation of locally tailored educational materials and the use of engaging, interactive training methods to ensure they remain competent in conducting brain injury screenings (combination of strategies 4,7,9 from the original survey)\u003c/li\u003e\n \u003cli\u003eTrain a select group within community-based organizations as trainers who can then educate their peers on the principles and practices of brain injury screening\u003c/li\u003e\n \u003cli\u003eEducate clients about the importance of their active involvement in the screening process.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eBuild Staff \u0026amp; Leadership Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAssess the readiness of community-based organizations (CBOs) to implement brain injury screening. This includes considering factors like staff expertise, resources, and infrastructure and identifying barriers, such as staff resistance or resource constraints, that may impede the successful rollout\u003c/li\u003e\n \u003cli\u003eDevelop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs)\u003c/li\u003e\n \u003cli\u003eIdentify and engage passionate individuals within community-based organizations (CBOs) who are enthusiastic about implementing and championing the importance of brain injury screening and referral (combination of strategies 20 and 21 and from the original survey).\u003c/li\u003e\n \u003cli\u003eSchedule regular meetings of implementation teams to share progress, exchange ideas, and address challenges.\u003c/li\u003e\n \u003cli\u003eEngage clients and their family members as partners in the brain injury screening process from the outset\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eTechnical Assistance Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSeek guidance from an implementation advisor with expertise in brain injury screening.\u003c/li\u003e\n \u003cli\u003eOffer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eManagement And Evaluation Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eConduct regular audits of brain injury screening practices and provide feedback to community-based organizations (CBOs) to support quality improvement\u003c/li\u003e\n \u003cli\u003eCreate standardized protocols and tools for quality monitoring of brain injury screening that align with best practices\u003c/li\u003e\n \u003cli\u003eMonitor progress and adjust community-based organizations (CBOs) practices and implementation strategies to continuously improve the quality of brain injury screening implementation\u003c/li\u003e\n \u003cli\u003eActively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eOrganizational And Workflow Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eEncourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual patient needs and settings\u003c/li\u003e\n \u003cli\u003eCustomize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), patient population, and local culture\u003c/li\u003e\n \u003cli\u003eImplement regular reminders and notifications within the organization to conduct brain injury screenings when appropriate.\u003c/li\u003e\n \u003cli\u003eRedefine the roles and responsibilities of community-based organizations (CBOs) staff to incorporate brain injury screening as a standard practice\u003c/li\u003e\n \u003cli\u003eDevelop client support programs to address barriers to uptake and adherence, such as transportation issues or language barriers\u003c/li\u003e\n \u003cli\u003eEnsure that facilities are physically accessible and welcoming to clients and their families\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. Final list of strategies\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"720\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;Educate Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOffer continuous training opportunities to staff members, including the creation of locally tailored educational materials and the use of engaging, interactive training methods to ensure they remain competent in conducting brain injury screenings.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eBuild Staff \u0026amp; Leadership Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDevelop a detailed implementation plan that outlines the steps, responsibilities, and timelines for implementing brain injury screening throughout the community-based organizations (CBOs)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eTechnical Assistance Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOffer ongoing consultation and support to organization teams as they encounter challenges during the implementation of brain injury screening.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eManagement And Evaluation Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eCreate standardized protocols and tools for quality monitoring of brain injury screening that align with best practices\u003c/li\u003e\n \u003cli\u003eActively seek feedback from survivors of intimate partner violence regarding their experiences with brain injury screening\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eOrganizational And Workflow Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 571px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eEncourage adaptability within the implementation process, allowing community-based organizations (CBOs) teams to tailor the screening approach to individual clients needs and settings\u003c/li\u003e\n \u003cli\u003eCustomize implementation strategies to align with the unique characteristics of the community-based organizations (CBOs), client population, and local culture\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study extends previous dissemination and implementation science research by adding to modified Delphi techniques focused on system-level policy[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] or evidence grading[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] to the use of a Delphi process aimed to co-prioritize actionable strategies that align with the practice realities of under-resourced CBOs serving survivors of IPV. To the best of our knowledge, this is the first study to apply co-identification or ERIC strategies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] in partnership with CBOs to increase the adoption of BI screening and referral protocols for IPV survivors. Using a modified Delphi approach and community-academic partnership with CBOs administrators and staff, we identified seven strategies that were considered both generalizable across all CBOs and rated as high priority to be implemented in their organizations. There are a number of promising outcomes of this collaborative project that include: (1) methods for an efficient approach to practically reduce ERIC strategies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] down to those that have the highest likelihood of achieving broad impact, (2) suggestions for adaptation to strategy definitions for non-clinical settings, (3) demonstrating that CBOs are able to identify strategies across a variety of categories, including, but not limited to, training, and (4) there are still opportunities to better conceptualize dissemination and implementation strategies in CBOs outside of healthcare.\u003c/p\u003e\u003cp\u003eThe range of implementation strategies available to CBOs and other settings that can support the adoption, implementation, and sustainment of new evidence-based approaches can be overwhelming [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In addition, methods used to support the co-design or co-selection of strategies in partnership with organizational leaders and implementation teams focused on a new intervention can also be time consuming and impractical for community or clinical organizations to fit within limited time and resource constraints [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The use of the community-academic partnership to cull ERIC strategies from 73 to 47 greatly reduced the time needed to review strategies in the larger CAB. Further, the use of the CAB and facilitated discussions using video conferencing allowed for a relatively rapid reduction of the 46 strategies to 21 that could be reviewed in detail by CBOs staff and administrators. During the CAB discussion, members also expressed their appreciation of the selection scale options of \u0026lsquo;must have\u0026rsquo; and \u0026lsquo;nice to have\u0026rsquo; to support the prioritization of strategies. Finally, reduction of the 46 to 21 strategies using a survey prioritization approach allowed CBO staff to complete the process when and where it was most convenient for them.\u003c/p\u003e\u003cp\u003eOur process also confirmed what others focusing on dissemination and implementation science outside of clinical settings have encountered with the ERIC strategies. That is, these strategies require modifications for use at the CBO-level, and many are not relevant outside of healthcare settings [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Financial strategies focused on consumers or reimbursements were seen as less relevant by the partnership. The seven prioritized strategies reflect consensus among practitioners working in IPV-focused CBOs, emphasizing pragmatic implementation features\u0026mdash;such as local adaptation and survivor input\u0026mdash;not typically emphasized in more generalized strategy sets such as ERIC. This illustrates how Delphi methods can surface implementation strategies that are both feasible and relevant within unique service contexts. Further, the prioritization of strategies like training, protocol development, and tailoring reflects PRISM-identified barriers and facilitators at both organizational and infrastructure levels. For example, limited screening capacity and lack of workflows aligned with BI screening and referral protocols underscore the need for structured implementation planning. The inclusion of survivor feedback and promotion of adaptability directly addresses the recipient and context domains of PRISM, signaling the value of community-defined fit over top-down approaches. The ongoing project will also provide opportunities for each CBOs to create additional strategies that may be more relevant locally while also being generalizable to other similar settings.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThere were some limitations in the strategy selection process. First, community partners that are engaged in this process are all from one region in the Midwest which may not be generalizable to other locations. However, it is likely that IPV-serving CBOs have similar intake, assessment, and care processes regardless of location. Second, we used a convenience sample of 12 CBOs that identified BI screening and referral as an organizational priority which, may limit the generalizability of our findings. This is a consistent challenge in community-engaged research\u0026mdash;the focus of the project is on locally identified priorities that may not be shared by other similar organizations. Third, the identification process used in this trial involves the identification of strategies that are likely to support sustained implementation. This is the first phase of our project and does not allow us to describe the actual utility of these strategies until they are tested.\u003c/p\u003e\u003cp\u003eThe next steps for this project include a stepped-wedge design whereby we will test a process of CBOs refinement of which strategies, and the order, will be used, operationalized, and enacted. Through this approach, we will provide additional opportunities for the co-design of defined strategies and co-creation of potential new strategies that will increase the reach of BI screening and referral for survivors of IPV.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis is the first known study to examine processes to select locally relevant implementation strategies for community implementation of BI screening and referral for IPV survivors. The modified Delphi approach appeared to be amenable to CBOs leadership and staff and allowed the reduction of strategies to those that are most needed and likely to have an impact on BI screening implementation. The identified strategies offer valuable insights for optimizing support to IPV survivors and advancing the implementation of public health interventions.\u003c/p\u003e\u003cp\u003eStakeholder-derived strategies that support comprehensive BI screening and referral in this vulnerable population and timely neurorehabilitation interventions have the potential to mitigate poor health outcomes and identify methods to achieve secondary prevention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBI: Brain Injury\u003c/p\u003e\n\u003cp\u003eCAB: Community-campus advisory board\u003c/p\u003e\n\u003cp\u003eCBOs: Community-based organizations\u003c/p\u003e\n\u003cp\u003eERIC: Expert Recommendations for Implementing Change\u003c/p\u003e\n\u003cp\u003eIPV: Intimate partner violence\u003c/p\u003e\n\u003cp\u003eTBI: Traumatic Brain Injury\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved as exempt by the Institutional Review Board (IRB) at the University of Nebraska Medical Center (UNMC) under protocol number 0259-23-EX. All procedures performed in this study were conducted in accordance with the Helsinki Declaration. Informed consent was obtained from all individuals participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by grant number 1R01NS130574-01A1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSSR, PAE and ELP contributed to the study design. SSR, PAE, ELP and MNM contributed to moderation of the Delphi meetings and surveys development. ELP was responsible for data collection and analysis. All authors (SSR, ELP, KC, PR, CW, MNM and PAE) contributed to the data interpretation. ELP and SSR were responsible for manuscript writing. SSR and PAE provided feedback on revisions of the manuscript. \u0026nbsp;All authors (SSR, ELP, KC, PR, CW, MNM and PAE) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBreiding, M., et al., \u003cem\u003eIntimate partner violence surveillance : uniform definitions and recommended data elements. Version 2.0.\u003c/em\u003e 2015.\u003c/li\u003e\n\u003cli\u003eSmith, S.G., et al., \u003cem\u003eNational intimate partner and sexual violence survey (NISVS): 2010-2012 state report.\u003c/em\u003e 2017.\u003c/li\u003e\n\u003cli\u003eLeemis, R.W., et al., \u003cem\u003eThe National Intimate Partner and Sexual Violence Survey Report on Intimate Partner Violence The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence Acknowledgment Background and Definition.\u003c/em\u003e 2022.\u003c/li\u003e\n\u003cli\u003eValera, E.M., et al., \u003cem\u003eUnderstanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions.\u003c/em\u003e Journal of Head Trauma Rehabilitation, 2021. \u003cstrong\u003e36\u003c/strong\u003e(1): p. 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Montayre, \u003cem\u003e\u0026ldquo;There was no-one I could turn to because I was ashamed\u0026rdquo;: Shame in the narratives of women affected by IPV.\u003c/em\u003e Women\u0026apos;s Studies International Forum, 2019. \u003cstrong\u003e74\u003c/strong\u003e: p. 218-223.\u003c/li\u003e\n\u003cli\u003eMiller, E., et al., \u003cem\u003eIntegrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach.\u003c/em\u003e 2015(1931-843X (Electronic)).\u003c/li\u003e\n\u003cli\u003eAnguzu, R., et al., \u003cem\u003eHealthcare provider experiences interacting with survivors of intimate partner violence: a qualitative study to inform survivor-centered approaches.\u003c/em\u003e 2023(1472-6874 (Electronic)).\u003c/li\u003e\n\u003cli\u003eHaag, H.L., et al., \u003cem\u003eBattered and Brain Injured: Assessing Knowledge of Traumatic Brain Injury Among Intimate Partner Violence Service Providers.\u003c/em\u003e (1931-843X (Electronic)).\u003c/li\u003e\n\u003cli\u003ePatch, M., J.C. 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Campbell, \u003cem\u003eInjuries of Women Surviving Intimate Partner Strangulation and Subsequent Emergency Health Care Seeking: An Integrative Evidence Review.\u003c/em\u003e Journal of Emergency Nursing, 2018. \u003cstrong\u003e44\u003c/strong\u003e(4): p. 384-393.\u003c/li\u003e\n\u003cli\u003eRajaram, S.S., et al., \u003cem\u003eIntimate Partner Violence and Brain Injury Screening.\u003c/em\u003e Violence Against Women, 2021. \u003cstrong\u003e27\u003c/strong\u003e(10): p. 1548-1565.\u003c/li\u003e\n\u003cli\u003eToccalino, D.A.-O., et al., \u003cem\u003eExploring the Relationships Between Rehabilitation and Survivors of Intimate Partner Violence: A Scoping Review.\u003c/em\u003e 2024(1552-8324 (Electronic)).\u003c/li\u003e\n\u003cli\u003eIvany, A.S., et al., \u003cem\u003eLiving in Fear and Prioritizing Safety: Exploring Women\u0026apos;s Lives After Traumatic Brain Injury From Intimate Partner Violence.\u003c/em\u003e 2018(1049-7323 (Print)).\u003c/li\u003e\n\u003cli\u003eIverson, G.L., \u003cem\u003eNetwork Analysis and Precision Rehabilitation for the Post-concussion Syndrome.\u003c/em\u003e Frontiers in Neurology, 2019. \u003cstrong\u003e10\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eValera, E.M., \u003cem\u003eIncreasing Our Understanding of an Overlooked Public Health Epidemic: Traumatic Brain Injuries in Women Subjected to Intimate Partner Violence.\u003c/em\u003e Journal of Women\u0026apos;s Health, 2018. \u003cstrong\u003e27\u003c/strong\u003e(6): p. 735-736.\u003c/li\u003e\n\u003cli\u003eRajaram, S.S., et al., \u003cem\u003eIPV survivors\u0026rsquo; and service providers\u0026rsquo; perspectives on brain injury screening/evaluation process and impact.\u003c/em\u003e Neuropsychological Rehabilitation, 2024: p. 1-23.\u003c/li\u003e\n\u003cli\u003eHyzak, K.A., et al., \u003cem\u003eImplementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation.\u003c/em\u003e Implementation Science, 2023. \u003cstrong\u003e18\u003c/strong\u003e(1): p. 35.\u003c/li\u003e\n\u003cli\u003ePowell, B.J., et al., \u003cem\u003eA refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.\u003c/em\u003e Implementation Science, 2015. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 21.\u003c/li\u003e\n\u003cli\u003eShea, C.M., et al., \u003cem\u003eResearcher readiness for participating in community-engaged dissemination and implementation research: a conceptual framework of core competencies.\u003c/em\u003e Translational Behavioral Medicine, 2017. \u003cstrong\u003e7\u003c/strong\u003e(3): p. 393-404.\u003c/li\u003e\n\u003cli\u003eOkoli, C. and S.D. 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Proctor, \u003cem\u003eDissemination and Implementation Research in Health: Translating Science to Practice\u003c/em\u003e. 2023: Oxford University Press.\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez Jolles, M., et al., \u003cem\u003eUsing Implementation Mapping to develop protocols supporting the implementation of a state policy on screening children for Adverse Childhood Experiences in a system of health centers in inland Southern California.\u003c/em\u003e Frontiers in Public Health, 2022. \u003cstrong\u003e10\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eBalis, L.A.-O., B.A.-O. Houghtaling, and S.M. Harden, \u003cem\u003eUsing implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions.\u003c/em\u003e 2022(1613-9860 (Electronic)).\u003c/li\u003e\n\u003cli\u003eMoore, S.A., et al., \u003cem\u003eSpecifying and Reporting Implementation Strategies Used in a School-Based Prevention Efficacy Trial. LID - 10.1177/26334895211047841 [doi] LID - 26334895211047841.\u003c/em\u003e 2021(2633-4895 (Electronic)).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"brain injury, screening, intimate partner violence, domestic violence, community-based organizations","lastPublishedDoi":"10.21203/rs.3.rs-6925920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6925920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWomen who experience intimate partner violence (IPV) are at a high risk for injuries to the head, neck, and face that can result in a traumatic brain injury (BI). Despite increasing evidence of the high risk for BI in this vulnerable population, BI screenings remain critically under-implemented in community-based organizations (CBOs) serving IPV survivors. The aim of this community-engaged dissemination and implementation project was to co-identify implementation strategies to increase the adoption of brain injury (BI) screening and referral within intimate partner violence (IPV)-serving CBOs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe used a modified Delphi method to prioritize 47 CBO relevant strategies from the Expert Recommendations for Implementation Change compendium to increase the adoption of BI screening and referral among IPV-serving CBOs. In Round-1, 14 Community-campus advisory board (CAB) members, including representatives from 10 CBOs prioritized relevant strategies in a virtual meeting. In Round-2, 62 CBOs staff members responded to a survey to refine a subset of prioritized strategies to 6\u0026ndash;8 primary strategies that could be tested across the CBOs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCAB participants identified 21 strategies as particularly relevant to CBOs including 4 educational, 2 technical assistance, 5 staff and leadership, 4 management and evaluation, and 6 organizational workflow strategies. Survey responses indicated rated 7 of the 21 strategies were most consistently rated as relevant and feasible. The final list of 7 strategies included training opportunities, ongoing consultation, developing implementation plans, establishing local screening and referral protocols, soliciting survivor feedback, promoting adaptability, and tailoring strategies to CBOs contexts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study highlights the importance of creating tailored implementation strategies within IPV-serving CBOs to enhance the adoption of brain injury screening and referral protocols. The identified strategies offer valuable insights into optimizing support for IPV survivors and advancing public health interventions.\u003c/p\u003e","manuscriptTitle":"A Delphi Study to prioritize implementation strategies to increase the adoption of screening and referral for brain injury among survivors of intimate partner violence and sexual assault within community-based organizations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 11:42:17","doi":"10.21203/rs.3.rs-6925920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-18T08:31:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T14:03:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T03:50:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198931472316193993253676224845533896938","date":"2025-08-12T23:28:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267309497305141973276797678147375232745","date":"2025-08-07T14:10:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-09T08:22:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T08:00:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-27T18:09:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T17:43:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-27T17:39:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"53a0d2ca-2fec-488a-8192-570f41240d17","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:02:30+00:00","versionOfRecord":{"articleIdentity":"rs-6925920","link":"https://doi.org/10.1186/s12889-025-25638-0","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-01-24 15:59:05","publishedOnDateReadable":"January 24th, 2026"},"versionCreatedAt":"2025-07-15 11:42:17","video":"","vorDoi":"10.1186/s12889-025-25638-0","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25638-0","workflowStages":[]},"version":"v1","identity":"rs-6925920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6925920","identity":"rs-6925920","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}