A Solution to the 17-Year Science-to-Practice Gap? Clinical-Psychological Scientists and Multidisciplinary Collaborations

Multidisciplinary Partnerships as an Implementation Strategy

It was in response to the failure of health-care systems to effectively implement empirically supported treatments (Lockwood & Ivers, 2023) and a desire to address the challenges of implementing these interventions (Nilsen, 2015) that led to the development of implementation science as a formal discipline. Over the past 2 decades, implementation scientists have developed frameworks, models, and theories for classifying and understanding the barriers that impede implementing empirically supported treatments and strategies meant to target those barriers to improve implementation outcomes (Nilsen, 2015). These frameworks provide a sort of “blueprint” for clinical scientists to use to more effectively translate interventions from controlled lab settings to real world points of service delivery.

Two frameworks that have been widely used to build out these blueprints are the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2022), which provides a classification of contextual barriers that are relevant to implementation, and Expert Recommendations for Implementing Change (ERIC; Powell et al., 2015), which provides a “menu” of more than 70 strategies that have been developed via consensus by implementation scientists for addressing the kinds of barriers described above. These frameworks have helped to enumerate the enormously complex factors at play when an organization is implementing an evidence-based intervention.

Of the many contextual barriers that have been identified as relevant to implementation, several are related to the degree to which there is a highly functioning team facilitating implementation. Specifically, teaming is defined in the CFIR as “joining together, intentionally coordinating and collaborating on interdependent tasks, to implement the innovation” (Damschroder et al., 2022). Multiple strategies have been put forth by implementation scientists to promote teaming. In the ERIC framework, these strategies are represented by building coalitions, creating new clinical teams, developing academic partnerships (for community-based organizations), and promoting network weaving (Powell et al., 2015). This last strategy emphasizes the importance of building partnerships both within and outside of the organization to promote information sharing and collaborative problem-solving, drawing on the expertise of people with different skill sets and professional backgrounds.

The specific mechanisms through which these strategies lead to implementation outcomes of interest (e.g., adoption, reach, maintenance) are less well defined (Lewis et al., 2020), and in fact, efforts are currently underway to create a database of known strategy-mechanism links (Lewis et al., 2022). However, findings indicate that multidisciplinary teams offer greater potential for developing innovative ideas (Post et al., 2009), creating more effective interventions for addressing complex public-health problems (Hall et al., 2012), and reducing health disparities (Warnecke et al., 2008).

Building coalitions across disciplines can also be a powerful way of redistributing power across scientists and practitioners (Stokols et al., 2008) and potentially serve as a framework for engaging the public in participatory team science (Tebes & Thai, 2018). This framework does not begin at the implementation process; in fact, it can be particularly important from the start of intervention development to promote real-world feasibility and effectiveness among communities who will actually be served by this intervention. In the case example to follow, we describe how we used multidisciplinary teaming as both an intervention development and implementation strategy. First, we provide some additional context on our intervention (a curriculum designed to reduce IPV) and the service-delivery setting (community corrections agencies).

Case Example: An Acceptance-and-Commitment-Therapy-Based Intervention to Reduce IPV

IPV is a serious public-health issue that affects millions of individuals each year. In the United States, the Centers for Disease Control and Prevention estimated that lifetime prevalence rates of sexual violence, physical violence, or stalking by an intimate partner are approximately 41% for women and 26% for men (Leemis et al., 2022). In addition, the same report estimated that more than 61 million women and 53 million men have experienced psychological aggression by an intimate partner in their lifetime (Leemis et al., 2022). IPV is associated with myriad negative health outcomes (Jack et al., 2018) and mental-health problems (Niolon et al., 2017), which tend to be more severe for individuals from marginalized communities (Stockman et al., 2015).

When individuals in the United States are convicted of a domestic-violence offense and released on probation or supervision, they are typically court-mandated to complete a state-sanctioned community-based domestic-violence program. These programs are offered to individuals living in the community (not in jail). Programs range from 15 weeks to 52 weeks depending on the state. These programs are offered either by probation officers and other employees through departments of corrections or by behavioral-health providers or trained clinicians in community agencies who have contracts with the county or state departments of corrections to offer these programs.

Two models have been adopted over the last 50+ years and disseminated nationwide. The first is known as the Duluth model, which emphasizes systemic, patriarchal cultural norms as the primary causal mechanism for IPV perpetration. The intervention is primarily psychoeducational and focuses on changing men’s beliefs about traditional gender norms and the role of male power and privilege in exerting control over women (J. Babcock et al., 2016). The second program is based on principles of cognitive-behavioral therapy (CBT; Murphy & Eckhardt, 2005) and focuses on the role of thoughts and emotions in abusive behavior. Clients learn behavioral skills (e.g., time outs, relaxation techniques, communication skills) and cognitive strategies (e.g., challenging thoughts, reframing to alternative thoughts) that are thought to be useful in moments when someone is at risk for engaging in IPV (Eckhardt et al., 2013). In practice, most programs for IPV perpetrators are a blend of these approaches (Babcock et al., 2004; Babcock et al., 2016).

Unfortunately, across approach and theoretical orientation, IPV interventions have been found to be highly ineffective at reducing violence and criminal recidivism (Wilson et al., 2021). Across hundreds of outcome studies and five meta-analyses, existing interventions (Duluth, CBT, or a hybrid) did not yield significant reductions in IPV or recidivism compared with no treatment at all (Babcock et al., 2016; Graham-Kevan et al., 2024; Travers et al., 2021).

In response to the clear need for more effective intervention, a study team led by E. Lawrence proposed using the framework of acceptance-and-commitment therapy (ACT) to target IPV. ACT is a third-wave CBT that focuses on increasing psychological flexibility using strategies targeting mindfulness, acceptance, committed action, and values-based behavior. In contrast to traditional Duluth or CBT approaches, the goal of the ACT approach is to help individuals change their relationship to the thought and “defuse” or unhook from it rather than attempt to fix or change the thought itself. In addition, ACT emphasizes building willingness to experience uncomfortable thoughts, feelings, and urges rather than engaging in experiential avoidance (i.e., trying to control or avoid uncomfortable thoughts, feelings, and urges). It has been theorized that IPV is the result of experiencing uncomfortable internal experiences (e.g., anger, jealousy, anxiety) during conflict and engaging in physical or psychological violence toward a partner to avoid and escape those unwanted thoughts and feelings (Langer & Lawrence, 2010a, 2010b). This relief then reinforces IPV as a strategy for a short-term reduction in painful emotional experiences, which continues a cycle of violence as a strategy for managing emotional arousal. Thus, practicing willingness to experience these unwanted internal experiences may help to disrupt this cycle.

ACT had already been demonstrated to be effective at treating several mental-health conditions and maladaptive behaviors (Brown et al., 2016; Gaudiano et al., 2023; Hayes et al., 2006; Viskovich & Pakenham, 2020), and experiential avoidance had already been proposed as a theoretical framework for conceptualizing psychopathology and maladaptive behavior (Hayes et al., 2004). However, this was the first time ACT was being proposed to target “other harm” specifically. For a detailed explanation of this new intervention, please see (Langer & Lawrence, 2010a, 2010b; Reardon et al., 2020).

Leveraging Expertise Across Disciplines: Intervention-Development Phase

Efforts to develop an intervention began as a partnership between E. Lawrence, a clinical psychologist, and the Iowa Department of Corrections (IDOC). Individuals convicted of a domestic assault are typically sentenced to complete a court-ordered “batterers’ intervention program” (BIP). In this state, these programs are typically offered through community-based corrections.

In 2009, the IDOC conducted an internal evaluation of its own BIP programming and found that the programs being offered did little to reduce recidivism compared with no treatment at all and that there was little consistency in program content across the state. In an effort to develop a new, more effective BIP program, a multidisciplinary team was established comprising administrators, probation officers, clinical-psychology and public-health faculty, judges, and victim advocates.

Clinical psychologists on the team provided expertise in ACT principles, adapting traditional ACT concepts and strategies to specifically target IPV, and developing aspects of the intervention focused on increasing value-based behavior, cognitive defusion, and decreasing experiential avoidance. Criminal-justice practitioners provided expertise in shaping language to be more in line with community corrections, developing training protocols, and adding modules related to relevant topics for community-corrections clients (e.g., parenting, substance use). Individuals in corrections-administrative roles were integral in providing input to ensure that the intervention met state guidelines for number of sessions, hours completed, and required content. Victim advocates provided input on topics and themes that should be included based on their work with survivors.

These early conversations demonstrated challenges inherent in working on a multidisciplinary team. Developing a common language and common concern to address across disciplines takes time and patience. For example, early in the development of our partnership, clients were alternately referred to as “clients,” “participants,” “offenders,” or “batterers,” depending on the team member’s discipline. These differences in preferred language also highlighted the different perspectives on how to approach programming targeting IPV. For example, corrections-affiliated team members emphasized accountability and more explicit focus on the crime that resulted in a referral to group, and clinical psychologists on the team emphasized more general strategies that could be used moving forward to change group members’ relationship to their thoughts, feelings, and behaviors. Further discussion of some of these early challenges is reported in Zarling and Scheffert (2021).

Clinical psychologists met with various members of the multidisciplinary team monthly to discuss the possible adaptation of ACT to target IPV and its concomitants and discuss concerns raised by members of each discipline. After 2 years, members of all disciplines on the team participated in the drafting of early versions of the treatment manual, collaborative decisions regarding what content to include and how to present it, and determining best practices in programming targeting IPV within corrections. The development of the resulting intervention, known as Achieving Change Through Value-Based Behavior (ACTV; Lawrence et al., 2013), demonstrates success of the multidisciplinary team in collaboratively developing an intervention that met the specific needs of corrections agencies while incorporating strategies that have been shown to be effective in changing behaviors.

One of the strategies we employed in the intervention-development phase was to conduct a “proof-of-concept”/promise-of-efficacy study. In this lab-based study with 101 community volunteers, male-identifying and female-identifying clients in committed relationships who self-reported engaging in at least two acts of physical aggression toward their partner in the previous 3 months were randomly assigned to a 12-week ACT group or a 12-week attention/support group. Participants in the ACT condition had significantly greater declines in psychological and physical aggression from pretreatment to posttreatment and from pretreatment to follow-up compared with participants in the support/attention placebo condition. Group differences in 6-month treatment outcomes were partially mediated by increases in ACT skills after treatment. Given that participants were volunteers and that multiple potentially confounding influences were able to be controlled (e.g., who the group facilitators were, close weekly supervision of facilitators), this study was not an ideal reflection of the eventual clients who would be receiving treatment in community corrections or their context. However, these initial findings were necessary to first demonstrate clinical efficacy to our stakeholders, which, in turn, led to getting necessary buy-in from agencies who were interested in using this intervention. For further details about the methodology and results of this study, see Zarling et al. (2015).

Leveraging Expertise Across Disciplines: Intervention-Implementation Phase

Once the content of the intervention was developed, team members collaborated on a series of feasibility and pilot trials to determine whether nonclinicians (i.e., the community-corrections staff who facilitate treatment groups) could be effectively trained in and deliver ACT. Clients in these trials were all male-identifying, convicted of a domestic-violence offense, and court-mandated to complete a BIP. Results demonstrated that corrections staff (mostly probation officers) were able to learn the new conceptual model and successfully employ the therapeutic techniques in the context of IPV as facilitators. In addition to successfully adhering to treatment content and demonstrating competence, facilitators also reported liking the new intervention and finding facilitating BIPs more rewarding. Likewise, clients learned new skills and shared how they implemented them in their own lives. They demonstrated engagement during sessions and reported experiencing the sessions as helpful and rewarding. Finally, the trials suggested comparability and generalizability of facilitators and clients and commitment and willingness to implement the ACT-based intervention among both facilitators and administrators (for details of the methodology and results from these feasibility and pilot studies, see Collison et al. (2025).

The feasibility and pilot trials served two functions. First, they demonstrated the promise of effectiveness of ACTV. Second, they were critical to solidifying the investment of team members across disciplines and the maintenance of our partnership across the subsequent phases of dissemination and implementation (i.e., conducting randomized controlled trials [RCTs], statewide dissemination).

The Promise and Challenges of Multidisciplinary Work

There were many points at which multidisciplinary collaboration was crucial to develop and implement an effective IPV intervention in community-corrections agencies. We argue that beyond the scope of just this case study, these types of partnerships can be fruitful for all clinical psychologists regardless of where their research falls in the clinical-intervention pipeline. Clinical psychologists’ work often shares borders with fields such as medicine, neuroscience, public health, economics, and mathematics, to name a few. Leveraging knowledge from these neighboring and overlapping areas of expertise strengthens the field’s science and allows clinical psychologists to build on what clinical psychology alone can offer. We argue that expanding the field’s work to include theories and frameworks from other disciplines and the simple process of brainstorming and talking through ideas with researchers from other backgrounds help clinical psychologists become more creative and generative as scientists. In our case, these partnerships also allowed us to translate an intervention from bench to bedside in a far more efficient time frame than is typical of clinical science. This last point is perhaps the most compelling one and makes a strong case for the need for these partnerships to bring research from the ivory tower into the hands of the communities who need it.

The promise offered by these types of partnerships is not without its share of challenges. One of the biggest challenges was determining with whom to partner. For all of our partnerships, we waited for agencies to approach us. We presented the intervention and the opportunities for collaboration at various relevant conferences and to agencies when invited. The agencies with whom we partnered all indicated that they were looking for a new approach or for something “evidence-based.” Although this approach can take more time on the front end compared with approaching agencies directly, we have found that when agencies approached us first, this led to much stronger buy-in and trust early on.

Inviting experts from other fields into our research process (and vice versa) means a loss of some degree of control in the design and execution of the work. Different stakeholders may have different priorities or goals for the study. In our IPV-intervention work, an example of this early on during the development of the treatment arose regarding differences in perspective on the content the program should emphasize (i.e., the behavior that led a client to the program vs. how to promote future change; the specific behaviors of a specific argument vs. behaviors across arguments and relationships) and the therapeutic style in which to frame the intervention (sanction-based vs. growth-oriented). Other examples include how outcomes are measured and how various disciplines may define success. For example, a health economist may be more focused on the cost-effectiveness of an intervention, whereas criminal-justice staff or advocates may prioritize administrative criminal records (e.g., recidivism), and clinical psychologists may be interested in observable changes in behavior. Reconciling these differences and making space for compromise takes time—for this reason, we argue for transparent communication and collaboration to begin at the earliest stages of the study-design process as possible and continue throughout the process of developing and implementing an intervention.

Consistent and clear communication have been vital in maintaining our partnerships and sustaining the implementation of ACTV. One of the biggest challenges of maintaining these partnerships is turnover in leadership, which happens often in the settings of our team members. When new individuals take on leadership roles, there can be a shift in terms of agency goals, initiatives, and allocation of resources. These shifts have also meant needing to build new relationships and trust, which are not necessarily inherited from predecessors. Without trust and strong interpersonal relationships, a previously established partnership with an organization can quickly fall apart. This also includes ongoing communication with the frontline staff who are actively implementing the intervention, providing functional support wherever we can. We have found much greater success in maintaining our multidisciplinary partnerships when we make concerted efforts to invest in these relationships via regular check-ins, offers of support with whatever resources we can offer, and letting partners take the lead with respect to implementation.

Finally, in our translational work with community partners, there is often a tension between delivering interventions with fidelity and needing to adapt to make the program workable in the real world. These modifications have included shifting between offering treatment sessions once versus twice per week depending on facilitator and client availability, offering programming online versus on ground and adapting session content and activities for each format, and creating a modified manual for community agencies versus probation settings and a modified manual for open groups versus closed groups. These adaptations have often required us to use a more flexible approach than we typically would for clinical-efficacy studies while still adhering to principles of rigorous scientific design.

Conclusion

In summary, the success and effectiveness of a multidisciplinary team when conducting intervention science requires engaging stakeholders from the different disciplines during both the intervention-development and -implementation phases. The most effective teams are developed early in the process—before research questions are identified and before interventions are developed. Communication and contributions need to be bidirectional between disciplines and dynamic and longitudinal through the multiple phases of intervention development and implementation. Relationships with collaborators need to be cultivated and nurtured regularly and over time. Finally, attention must be paid to maintaining equity among multidisciplinary team members. Power must be balanced across disciplines, and hierarchies need to be rejected.

In the case example presented above, we argue that our ability to first develop and then adapt and implement an empirically supported treatment required input from multiple disciplines. We hypothesize that developing and implementing an intervention in close collaboration with a multidisciplinary team is perhaps one reason for the intervention’s effectiveness at reducing violence and criminal recidivism, particularly given the historical lack of effectiveness of traditional IPV interventions in those settings.

Clinical psychologists are uniquely positioned to engage in multidisciplinary teams. First, clinical psychologists receive rigorous training in research methodology, study design, and statistical analyses, ranging from basic science to evaluating the effectiveness and implementations of interventions, which can be an asset to a broad range of team-science efforts. Second, clinical psychologists are trained as not just scientists but also clinicians. Clinical psychologists’ advanced training in effective communication and (ideally) humility when working with clients can also foster collaboration on multidisciplinary research teams and help them view their skills as complementary to others’ rather than being the experts in the room. This approach is fundamental when approaching team science and a necessary component to community-based work. Third, collaborating across disciplines is in line with the broader values and current initiatives in psychological science. This is no more evident than in the current vision statement for the Association for Psychological Science (APS), which states, “APS will be the global leader in catalyzing psychological science, promoting the field as a hub discipline, and serving as the nexus for scientists and students across domains and employment sectors to share knowledge” (APS, 2021). We argue that serving as this nexus and creating opportunities for multidisciplinary collaboration is the key to increasing access to interventions that work.