A fortnight of articles about the difficulties of embedding programs based on good research in sound everyday practice, and the big divide between the two conditions has roughly coincided with the publication by Newsweek of a feature about equivalent problems that continue to plague medicine.

Prevention Science has chosen the term Type 2 translation research to encapsulate the emerging area of activity. The source of the Newsweek account, Greg Simon, has taken several bold steps toward the picturesque by choosing the epithet Valley of Death to describe the terrain.

Simon is president of FasterCures, a US Center devoted to closing the gap in the medical field. The author of the Newsweek piece, Science Editor Sharon Begley, explains: “The valley of death is why many promising discoveries genes linked to cancer and Parkinson’s disease; biochemical pathways that ravage neurons in Lou Gehrig’s disease – never move forward”.

Program designers recognize the medical predicament and the feeling. They know there is a store of reliable knowledge to draw on; they know just as surely that very little of it is being used in practice.

Participants at the seminar on Type 2 issues at Dartington in the UK, which prompted this run of articles, were able to list at least 100 articles on the subject that had informed their thinking, including about 20 that they would describe as essential reading for anyone seeking to introduce a prevention innovation to a mainstream audience.

Questions about the dissemination and application of science are consequently to the fore again – with a dozen lessons learned. Among them is the the need to link program development with policy change, highlighted by Mark Greenberg. [See: "We pay for disorders; why don’t we pay to prevent them?" ]

The value of systematic methods such as PROSPER and the approach being trialed in the health world by the Peninsula Medical School in the south-west of the UK is another. [See: Willing the science of translation to prosper]

The change that occurs when government officials recognize that models like Nurse Family Partnership have to be implemented with care and fidelity to the model is another. [See: True partnership brings down the battle flag ]

Two of the most important contributions have come from people outside the prevention world. Sandra Nutley’s exhaustive search of the literature reminds us that application of evidence to policy and practice is about human relationships. It is therefore complex, messy and hard to measure. [See: Plug-and-play programs – ready for the Christmas tree?]

Roy Parker started with a meditation not on what worked, rather on what probably does not work but is all the same popular with policy makers and practitioners. There are many more examples in that second, “popular but unsuccessful” category than in the first.

Another lesson is about the need for good descriptive data. Estimates about the widespread implementation of proven prevention models are based on idealized pictures of children’s services. How many people work in these systems? What kinds of intelligence do they bring to their work? How happy are they? What do they do? How much time do they spend in direct contract with children and families? What incentives do they have to stop what they are doing and do something different – and therefore threatening?

Much more remains to be learned about communication and contagion. More than 20,000 people work in a typical integrated children’s services department in England. But communication arrangements rest on the otherwise defunct silos in which people used to work. Getting any message, never mind one as complex as the careful implementation of evidence based programs, to 20,000 or more people is a difficult and specialized task. But government agencies employ specialists to do just such a job.

It is often said that there is a “tipping point” in big communication exercises. But is it really sufficient to focus on getting a quarter of the workforce to understand what is happening and expect the others to follow suit?

Reference: Sharon Begley, “Where Are the Cures?”, Newsweek, 10th November 2008