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Healy E, Means AR, Knudtson K, Frank N, Juarez A, Prohaska S, McKnight C, Des Jarlais D, Asher A, Glick SN. Facilitators and barriers to monitoring and evaluation at syringe service programs. Harm Reduct J 2024; 21:157. [PMID: 39192340 DOI: 10.1186/s12954-024-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Syringe services programs (SSPs) provide harm reduction supplies and services to people who use drugs and are often required by funders or partners to collect data from program participants. SSPs can use these data during monitoring and evaluation (M&E) to inform programmatic decision making, however little is known about facilitators and barriers to collecting and using data at SSPs. METHODS Using the Consolidated Framework for Implementation Research (CFIR), we conducted 12 key informant interviews with SSP staff to describe the overall landscape of data systems at SSPs, understand facilitators and barriers to data collection and use at SSPs, and generate recommendations for best practices for data collection at SSPs. We used 30 CFIR constructs to develop individual interview guides, guide data analysis, and interpret study findings. RESULTS Four main themes emerged from our analysis: SSP M&E systems are primarily designed to be responsive to perceived SSP client needs and preferences; SSP staffing capacity influences the likelihood of modifying M&E systems; external funding frequently forces changes to M&E systems; and strong M&E systems are often a necessary precursor for accessing funding. CONCLUSIONS Our findings highlight that SSPs are not resistant to data collection and M&E, but face substantial barriers to implementation, including lack of funding and disjointed data reporting requirements. There is a need to expand M&E-focused funding opportunities, harmonize quantitative indicators collected across funders, and minimize data collection to essential data points for SSPs.
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Affiliation(s)
- Elise Healy
- Division of Allergy and Infectious Disease, School of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA, 98195, USA
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kelly Knudtson
- Division of Allergy and Infectious Disease, School of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA, 98195, USA
| | - Noah Frank
- Division of Allergy and Infectious Disease, School of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA, 98195, USA
- Office of Infectious Disease, Washington State Department of Health, Olympia, Washington, USA
| | - Alexa Juarez
- Division of Allergy and Infectious Disease, School of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA, 98195, USA
| | | | - Courtney McKnight
- School of Global Public Health, Department of Epidemiology, New York University, New York, New York, USA
| | - Don Des Jarlais
- School of Global Public Health, Department of Epidemiology, New York University, New York, New York, USA
| | - Alice Asher
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sara N Glick
- Division of Allergy and Infectious Disease, School of Medicine, University of Washington, 325 9th Ave, Box 359777, Seattle, WA, 98195, USA.
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Ledgerwood DM, Stott MC, Quesada S, Sontag M, Beck RM, McDonell MG, Johnson D, DePhilippis D, Donnelly S, Hartzler B, Nauts T, Novak MD, Peck JA, Rash CJ. Implementing contingency management into rural recovery housing: recommendations of a professional advisory expert panel. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-10. [PMID: 39172119 DOI: 10.1080/00952990.2024.2387725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
Background: Rural areas in the United States have been severely impacted by recent rises in substance use related mortality and psychosocial consequences. There is a dearth of treatment resources to address substance use disorder (SUD). Rural recovery houses (RRH) are important services that provide individuals with SUD with an environment where they can engage in recovery-oriented activities, but dropout rates are unacceptably high, and evidence-based interventions such as contingency management (CM) may reduce dropout and improve outcomes for RRH residents. In this paper, we describe the results of a national convening of experts that addressed important issues concerning the implementation of CM within the context of RRHs.Methods: Twelve experts (five female) in the areas of CM, RRH and rural health participated in a one-day facilitated meeting that used nominal group technique to identify expert consensus in three areas as they pertain to RRH: (a) facilitators and barriers to CM implementation, (b) elements necessary for successful program building based on group feedback, and (c) recommendations for future implementation of CM.Results: Several RRH- and system-level barriers and facilitators to implementing CM were identified by the panel, and these were categorized based on the level of importance for and ease of implementation. CM funding, staff and resident buy-in, set policies, education on CM, and consistent fidelity to CM procedures and tracking were identified as important requirements for implementing CM in RRH.Conclusions: We provide recommendations for the implementation of CM in RRH that may be useful in this context, as well as more broadly.
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Affiliation(s)
- David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | | | | | - Marci Sontag
- Center for Public Health Innovation, Evergreen, CO, USA
| | - Rachel M Beck
- Department of Psychology, Washington State University, Spokane, WA, USA
| | | | | | - Dominick DePhilippis
- Office of Mental Health, U.S. Department of Veterans Affairs and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bryan Hartzler
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Matthew D Novak
- Department of Psychology, University of Maryland, Baltimore, MD, USA
| | - James A Peck
- Integrated Substance Abuse Programs, University of California - Los Angeles, Los Angeles, CA, USA
| | - Carla J Rash
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, USA
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Lu TT, Parent SC, Chaytor N, Amiri S, Palmer K, McPherson S, Jett J, Ries R, McDonell MG, Murphy SM. Budget Impact Tool for Implementing Contingency Management for Co-occurring Alcohol Use Disorders and Serious Mental Illness. Psychiatr Serv 2024; 75:326-332. [PMID: 37855102 PMCID: PMC10984796 DOI: 10.1176/appi.ps.20220547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Contingency management (CM) is a behavioral intervention in which tangible incentives are provided to patients when they achieve a desired behavior (e.g., reducing or abstaining from alcohol use). The authors sought to describe the resource requirements and associated costs of various CM versions (usual, high magnitude, and shaping) tailored to a high-risk population with co-occurring serious mental illness and severe alcohol use disorder. METHODS A microcosting analysis was conducted to identify the resource requirements of the different CM versions. This approach included semistructured interviews with site investigators, who also staffed the intervention. The resource costing method-multiplying the number of units of each resource utilized by its respective unit cost-was used to value the resources from a provider's perspective. All cost estimates were calculated in 2021 U.S. dollars. RESULTS The cost of setting up a CM program was $6,038 per site. Assuming full capacity and 56% of urine samples meeting the requirement for receipt of the CM incentive, the average cost of 16 weeks of usual and shaping CM treatments was $1,119-$1,136 and of high-magnitude CM was $1,848-$1,865 per participant. CONCLUSIONS A customizable tool was created to estimate the costs associated with various levels of treatment success and CM design features. After the trial, the tool will be updated and used to finalize per-participant cost for incorporation into a comprehensive economic evaluation. This costing tool will help a growing number of treatment providers who are interested in implementing CM with budgeting for and sustaining CM in their practices.
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Affiliation(s)
- Thanh T Lu
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina
| | - Sara C Parent
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Naomi Chaytor
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Solmaz Amiri
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle
| | - Katharine Palmer
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Julianne Jett
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City
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Hartzler B, Hinde J, Lang S, Correia N, Yermash J, Yap K, Murphy CM, Ruwala R, Rash CJ, Becker SJ, Garner BR. Virtual Training Is More Cost-Effective Than In-Person Training for Preparing Staff to Implement Contingency Management. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-10. [PMID: 36246531 PMCID: PMC9553630 DOI: 10.1007/s41347-022-00283-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022]
Abstract
Behavior therapy implementation relies in part on training to foster counselor skills in preparation for delivery with fidelity. Amidst Covid-19, the professional education arena witnessed a rapid shift from in-person to virtual training, yet these modalities' relative utility and expense is unknown. In the context of a cluster-randomized hybrid type 3 trial of contingency management (CM) implementation in opioid treatment programs (OTPs), a multi-cohort design presented rare opportunity to compare cost-effectiveness of virtual vs. in-person training. An initial counselor cohort (n = 26) from eight OTPs attended in-person training, and a subsequent cohort (n = 31) from ten OTPs attended virtual training. Common training elements were the facilitator, learning objectives, and educational strategies/activities. All clinicians submitted a post-training role-play, independently scored with a validated fidelity instrument for which performances were compared against benchmarks representing initial readiness and advanced proficiency. To examine the utility and expense of in-person and virtual trainings, cohort-specific rates for benchmark attainment were computed, and per-clinician expenses were estimated. Adjusted between-cohort differences were estimated via ordinary least squares, and an incremental cost effectiveness ratio (ICER) was calculated. Readiness and proficiency benchmarks were attained at rates 12-14% higher among clinicians attending virtual training, for which aggregated costs indicated a $399 per-clinician savings relative to in-person training. Accordingly, the ICER identified virtual training as the dominant strategy, reflecting greater cost-effectiveness across willingness-to-pay values. Study findings document greater utility, lesser expense, and cost-effectiveness of virtual training, which may inform post-pandemic dissemination of CM and other therapies.
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Affiliation(s)
- Bryan Hartzler
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631 USA
| | - Jesse Hinde
- Research Triangle Institute International, Research Triangle Park, NC 27709 USA
| | - Sharon Lang
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Nicholas Correia
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Julia Yermash
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Kim Yap
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Cara M. Murphy
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Richa Ruwala
- Research Triangle Institute International, Research Triangle Park, NC 27709 USA
| | | | - Sara J. Becker
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Bryan R. Garner
- Research Triangle Institute International, Research Triangle Park, NC 27709 USA
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Bloom EL, Japuntich SJ, Pierro A, Dallery J, Leahey TM, Rosen J. Pilot trial of QuitBet: A digital social game that pays you to stop smoking. Exp Clin Psychopharmacol 2022; 30:642-652. [PMID: 34110881 PMCID: PMC10259805 DOI: 10.1037/pha0000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is an effective treatment for cigarette smoking cessation but feasibility and acceptability concerns have been barriers to implementation. We conducted a pilot test of QuitBet, a commercial, digital (smartphone) social game for smoking cessation during which participants earned financial incentives for abstinence. QuitBet included a social feed for posting messages and entirely participant-funded incentives in the form of a deposit contract (the "bet"). QuitBet had a bet of $30 and lasted for 28 days. After a week to prepare for quitting, the quit day was Day 8. Between Day 9-28 (a 20-day period), participants earned back $1 of their $30 bet for each day of carbon monoxide (CO)-verified abstinence (≤ 6 ppm). Remaining bet money was pooled into a "grand prize" pot. Participants who were abstinent on at least 19 of the 20 days (1 "lapse" day allowed) were declared "winners" and split the grand prize pot equally. A game host posted a daily message containing evidence-based education about smoking cessation or a discussion topic. Recruitment goals were met. Among the players (N = 50 U.S. adults, 78% female), 17 (34%) were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erika Litvin Bloom
- Behavioral and Policy Sciences, RAND Corporation, Boston, Massachusetts, United States
| | - Sandra J. Japuntich
- Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, Minnesota, Hennepin
- Department of Medicine, University of Minnesota Medical School
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Coughlin LN, Bonar EE, Walton MA, Fernandez AC, Duguid I, Nahum-Shani I. New Directions for Motivational Incentive Interventions for Smoking Cessation. Front Digit Health 2022; 4:803301. [PMID: 35310552 PMCID: PMC8931767 DOI: 10.3389/fdgth.2022.803301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Motivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal intervention engagement, individual burden, and up-front costs. Purpose Technological advancements can mitigate some of these barriers. For example, mobile abstinence monitoring and digital, automated incentive delivery have the potential to lower the clinic burden associated with monitoring abstinence and administering incentives while also reducing the frequency of clinic visits. However, to fully realize the potential of digital technologies to deliver motivational incentives it is critical to develop strategies to mitigate longstanding concerns that reliance on extrinsic monetary reinforcement may hamper internal motivation for cessation, improve individual engagement with the intervention, and address scalability limitations due to the up-front cost of monetary incentives. Herein, we describe the state of digitally-delivered motivational incentives. We then build on existing principles for creating just-in-time adaptive interventions to highlight new directions in leveraging digital technology to improve the effectiveness and scalability of motivational incentive interventions. Conclusions Technological advancement in abstinence monitoring coupled with digital delivery of reinforcers has made the use of motivational incentives for smoking cessation increasingly feasible. We propose future directions for a new era of motivational incentive interventions that leverage technology to integrate monetary and non-monetary incentives in a way that addresses the changing needs of individuals as they unfold in real-time.
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Affiliation(s)
- Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Lara N. Coughlin
| | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Anne C. Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Isabelle Duguid
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Childs S, Rogers D, Haber PS, Morley KC. Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings. FRONTIERS IN HEALTH SERVICES 2021; 1:785391. [PMID: 36926478 PMCID: PMC10012778 DOI: 10.3389/frhs.2021.785391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022]
Abstract
Background: We have previously reported that the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians improved identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity. We aimed to identify barriers and facilitators of implementation of the PCC training program in drug and alcohol settings. Methods: The PCC training program was implemented across 6 matched sites in Australia as per (1), and 20 clinicians received training. PCC training included seminar presentations, workshops conducted by local "clinical champions," individual clinical supervision, and access to an online information portal. We examined barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research. Results: Barriers included inner setting (e.g., allocated time for learning) and characteristics of individuals (e.g., resistance). Facilitators included intervention characteristics (e.g., credible sources), inner setting (e.g., leadership), and outer setting domains (e.g., patient needs). Clinical champions were identified as an important component of the implementation process. Conclusions: Barriers included limited specific allocated time for learning. A credible clinical supervisor, strong leadership engagement and an active clinical champion were found to be facilitators of the PCC training program.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gabriela Uribe
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Steven Childs
- Central Coast Local Health District, Drug and Alcohol Clinical Services, Gosford, NSW, Australia
| | - David Rogers
- Drug and Alcohol Services, Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Paul S. Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C. Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Schottenfeld RS, Chawarski MC, Mazlan M. Behavioral counseling and abstinence-contingent take-home buprenorphine in general practitioners' offices in Malaysia: a randomized, open-label clinical trial. Addiction 2021; 116:2135-2149. [PMID: 33404150 DOI: 10.1111/add.15399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/27/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM To address the widespread severe problems with opioid use disorder, buprenorphine-naloxone treatment provided by primary care physicians has greatly expanded treatment access; however, treatment is often provided with minimal or no behavioral interventions. Whether or which behavioral interventions are feasible to implement in various settings and improve treatment outcomes has not been established. This study aimed to evaluate two behavioral interventions to improve buprenorphine-naloxone treatment. DESIGN A 2 × 2 factorial, repeated-measures, open-label, randomized clinical trial. SETTINGS General medical practice offices in Muar, Malaysia. PARTICIPANTS Opioid-dependent individuals (n = 234). INTERVENTIONS Participants were randomly assigned to one of four treatment conditions and received study interventions for 24 weeks: (1) physician management with or without behavioral counseling and (2) physician management with or without abstinence-contingent buprenorphine-naloxone (ACB) take-home doses. MEASUREMENTS The primary outcomes were proportions of opioid-negative urine tests and HIV risk behaviors [assessed by audio computer-assisted AIDS risk inventory (ACASI-ARI)]. FINDINGS The rates of opioid-negative urine tests over 24 weeks of treatment were significantly higher with [68.2%, 95% confidence interval (CI) = 65-71] than without behavioral counseling (59.2%, 95% CI = 56-62, P < 0.001) and with (71.0%, 95% CI = 68-74) than without ACB (56.4%, 95% CI = 53-59, P < 0.001); interaction effects between and among behavioral interventions and time were not statistically significant. Scores on ACASI-ARI decreased significantly from baseline across all treatment groups (P < 0.001) and did not differ significantly with or without behavioral counseling (P = 0.099) or with or without ACB (P = 0.339). CONCLUSIONS Providing opioid-dependent patients in Muar, Malaysia with buprenorphine-naloxone and physician management plus behavioral counseling or abstinence-contingent buprenorphine-naloxone (ACB) resulted in greater reductions of opioid use compared with providing buprenorphine-naloxone and physician management without behavioral counseling or ACB.
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Affiliation(s)
- Richard S Schottenfeld
- Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, DC, USA
| | - Marek C Chawarski
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Metrebian N, Weaver T, Goldsmith K, Pilling S, Hellier J, Pickles A, Shearer J, Byford S, Mitcheson L, Bijral P, Bogdan N, Bowden-Jones O, Day E, Dunn J, Glasper A, Finch E, Forshall S, Akhtar S, Bajaria J, Bennett C, Bishop E, Charles V, Davey C, Desai R, Goodfellow C, Haque F, Little N, McKechnie H, Mosler F, Morris J, Mutz J, Pauli R, Poovendran D, Phillips E, Strang J. Using a pragmatically adapted, low-cost contingency management intervention to promote heroin abstinence in individuals undergoing treatment for heroin use disorder in UK drug services (PRAISE): a cluster randomised trial. BMJ Open 2021; 11:e046371. [PMID: 34210725 PMCID: PMC8252884 DOI: 10.1136/bmjopen-2020-046371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/26/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Most individuals treated for heroin use disorder receive opioid agonist treatment (OAT)(methadone or buprenorphine). However, OAT is associated with high attrition and persistent, occasional heroin use. There is some evidence for the effectiveness of contingency management (CM), a behavioural intervention involving modest financial incentives, in encouraging drug abstinence when applied adjunctively with OAT. UK drug services have a minimal track record of applying CM and limited resources to implement it. We assessed a CM intervention pragmatically adapted for ease of implementation in UK drug services to promote heroin abstinence among individuals receiving OAT. DESIGN Cluster randomised controlled trial. SETTING AND PARTICIPANTS 552 adults with heroin use disorder (target 660) enrolled from 34 clusters (drug treatment clinics) in England between November 2012 and October 2015. INTERVENTIONS Clusters were randomly allocated 1:1:1 to OAT plus 12× weekly appointments with: (1) CM targeted at opiate abstinence at appointments (CM Abstinence); (2) CM targeted at on-time attendance at appointments (CM Attendance); or (3) no CM (treatment as usual; TAU). Modifications included monitoring behaviour weekly and fixed incentives schedule. MEASUREMENTS Primary outcome: heroin abstinence measured by heroin-free urines (weeks 9-12). SECONDARY OUTCOMES heroin abstinence 12 weeks after discontinuation of CM (weeks 21-24); attendance; self-reported drug use, physical and mental health. RESULTS CM Attendance was superior to TAU in encouraging heroin abstinence. Odds of a heroin-negative urine in weeks 9-12 was statistically significantly greater in CM Attendance compared with TAU (OR=2.1; 95% CI 1.1 to 3.9; p=0.030). CM Abstinence was not superior to TAU (OR=1.6; 95% CI 0.9 to 3.0; p=0.146) or CM Attendance (OR=1.3; 95% CI 0.7 to 2.4; p=0.438) (not statistically significant differences). Reductions in heroin use were not sustained at 21-24 weeks. No differences between groups in self-reported heroin use. CONCLUSIONS A pragmatically adapted CM intervention for routine use in UK drug services was moderately effective in encouraging heroin abstinence compared with no CM only when targeted at attendance. CM targeted at abstinence was not effective. TRIAL REGISTRATION NUMBER ISRCTN 01591254.
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Affiliation(s)
- Nicola Metrebian
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tim Weaver
- Department of Mental Health & Social Work, Middlesex University, London, UK
| | - Kimberley Goldsmith
- Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Stephen Pilling
- Centre for Outcomes, Research and Effectiveness, University College London, London, UK
| | - Jennifer Hellier
- Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - James Shearer
- Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sarah Byford
- Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Luke Mitcheson
- Addictions, South London and Maudsley NHS Foundation Trust, London, UK
| | - Prun Bijral
- Management Offices, Change Grow Live, Manchester, UK
| | - Nadine Bogdan
- Sankey House, Essex Partnership University NHS Foundation Trust, Pitsea,Essex, UK
| | - Owen Bowden-Jones
- Addictions and Substance Misuse, Central and North West London NHS Foundation Trust, London, UK
| | - Edward Day
- Addiction Services, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - John Dunn
- Drugs and Alcohol Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Anthony Glasper
- Substancce Misuse Service, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Emily Finch
- Addictions, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Forshall
- Drug and Alcohol Services, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Shabana Akhtar
- Addiction Services, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Jalpa Bajaria
- Sankey House, Essex Partnership University NHS Foundation Trust, Pitsea,Essex, UK
| | - Carmel Bennett
- Addiction Services, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Bishop
- Centre for Outcomes, Research and Effectiveness, University College London, London, UK
| | - Vikki Charles
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Clare Davey
- Drug and Alcohol Services, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Roopal Desai
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Goodfellow
- Centre for Outcomes, Research and Effectiveness, University College London, London, UK
| | - Farjana Haque
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicholas Little
- Centre for Outcomes, Research and Effectiveness, University College London, London, UK
| | - Hortencia McKechnie
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Mental Health, Imperial College London, London, UK
| | - Franziska Mosler
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jo Morris
- Drug and Alcohol Services, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Julian Mutz
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ruth Pauli
- Addiction Services, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | | | - Elizabeth Phillips
- Sankey House, Essex Partnership University NHS Foundation Trust, Pitsea,Essex, UK
| | - John Strang
- Addictions, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Addictions, South London and Maudsley NHS Foundation Trust, London, UK
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10
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Scott K, Murphy CM, Yap K, Moul S, Hurley L, Becker SJ. Health Professional Stigma as a Barrier to Contingency Management Implementation in Opioid Treatment Programs. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2021; 7:166-176. [PMID: 34485617 PMCID: PMC8412039 DOI: 10.1037/tps0000245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management (CM) has robust evidence of effectiveness as an adjunct to medication for opioid use disorders. However, CM implementation in opioid treatment programs has been limited by a myriad of well-documented barriers. One relatively unexplored barrier that may hinder CM implementation is health professional stigma toward patients with opioid use disorders. Qualitative interviews were conducted with 43 health professionals (21 leaders, 22 front-line counselors) from 11 different opioid treatment programs across Rhode Island to explore their familiarity with CM and to elucidate barriers and facilitators to CM implementation. Interviews were transcribed and coded by 3 independent raters using a reflexive team approach. Transcripts were analyzed for both a priori and emergent themes. Health professional stigma was identified as an emergent major theme with 4 distinct subthemes: (a) distrust of patients (44%, N = 19); (b) infantilizing views about patients (19%, N = 8); (c) belief that patients do not deserve prizes (19%, N = 8); and (d) recognition of patient self-stigma and community-based stigma (23%, N = 10). In addition, we identified multiple instances of health professional use of potentially stigmatizing language toward patients with opioid use disorders via terms such as drug abuser, addict, and clean or dirty urine screens (70%, N = 30). Stigma themes were identified in 86% of the transcripts, highlighting potential targets for multilevel implementation strategies. Findings of this study suggest that multiple types of health professional stigma should be considered and proactively addressed in efforts by psychologists to implement CM and other evidence-based interventions in opioid treatment programs.
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Affiliation(s)
- Kelli Scott
- Center for Alcohol and Addictions Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Cara M Murphy
- Center for Alcohol and Addictions Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Kimberly Yap
- Center for Alcohol and Addictions Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Samantha Moul
- Center for Alcohol and Addictions Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Linda Hurley
- CODAC Behavioral Healthcare, Providence, Rhode Island
| | - Sara J Becker
- Center for Alcohol and Addictions Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health
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11
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Louie E, Barrett EL, Baillie A, Haber P, Morley KC. A systematic review of evidence-based practice implementation in drug and alcohol settings: applying the consolidated framework for implementation research framework. Implement Sci 2021; 16:22. [PMID: 33663523 PMCID: PMC7931583 DOI: 10.1186/s13012-021-01090-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 02/11/2021] [Indexed: 12/31/2022] Open
Abstract
Background There is a paucity of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. This systematic review aimed to provide a synthesis and evaluation of the effectiveness of implementation programmes of treatment for patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR). Methods A comprehensive systematic review was conducted using five online databases (from inception onwards). Eligible studies included clinical trials and observational studies evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. Extracted data were qualitatively synthesised for common themes according to the CFIR. Primary outcomes included the implementation, service system or clinical practice. Risk of bias of individual studies was appraised using appropriate tools. A protocol was registered with (PROSPERO) (CRD42019123812) and published previously (Louie et al. Systematic 9:2020). Results Of the 2965 references identified, twenty studies were included in this review. Implementation research has employed a wide range of strategies to train clinicians in a few key evidence-based approaches to treatment. Implementation strategies were informed by a range of theories, with only two studies using an implementation framework (Baer et al. J Substance Abuse Treatment 37:191-202, 2009) used Context-Tailored Training and Helseth et al. J Substance Abuse Treatment 95:26-34, 2018) used the CFIR). Thirty of the 36 subdomains of the CFIR were evaluated by included studies, but the majority were concerned with the Characteristics of Individuals domain (75%), with less than half measuring Intervention Characteristics (45%) and Inner Setting constructs (25%), and only one study measuring the Outer Setting and Process domains. The most common primary outcome was the effectiveness of implementation strategies on treatment fidelity. Although several studies found clinician characteristics influenced the implementation outcome (40%) and many obtained clinical outcomes (40%), only five studies measured service system outcomes and only four studies evaluated the implementation. Conclusions While research has begun to accumulate in domains such as Characteristics of Individuals and Intervention Characteristics (e.g. education, beliefs and attitudes and organisational openness to new techniques), this review has identified significant gaps in the remaining CFIR domains including organisational factors, external forces and factors related to the process of the implementation itself. Findings of the review highlight important areas for future research and the utility of applying comprehensive implementation frameworks. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01090-7.
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Affiliation(s)
- Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Emma L Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Baillie
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Paul Haber
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kirsten C Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
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12
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Wild TC, Hammal F, Hancock M, Bartlett NT, Gladwin KK, Adams D, Loverock A, Hodgins DC. Forty-eight years of research on psychosocial interventions in the treatment of opioid use disorder: A scoping review. Drug Alcohol Depend 2021; 218:108434. [PMID: 33302176 DOI: 10.1016/j.drugalcdep.2020.108434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mapped the sources and types of evidence available on psychosocial interventions in the treatment of opioid use disorder (OUD), with and without pharmacotherapies. METHODS Six electronic databases were searched for research published until July 1, 2019. Included studies were coded on publication characteristics, evidence sources, treatment settings and modalities, study populations and patient characteristics, intervention(s) offered to patients, research questions addressed in experimental studies, and outcomes investigated. RESULTS We identified 305 empirical studies of 54,607 patients. Most studies (64 %; n = 194) compared psychosocial interventions to alternative treatment(s) (183 RCTs and 11 quasi-experiments) while 28 % (n = 86) used observational designs, and 8% (n = 25) used qualitative methods. Trials infrequently investigated effects of stand-alone psychosocial interventions without pharmacotherapies (20% of all RCTs). Regardless of research question or study design, program retention and illicit drug use were the most common outcomes investigated (> 81% of all studies and RCTs), typically among longstanding male heroin users attending specialty outpatient addiction services. Studies rarely examined (a) OUD treatment in general health care or prescription OUD (each < 6 % of all studies and RCTs), (b) effects of social assistance (employment, education, social support) and harm reduction (each < 6 % of studies; < 7 % of RCTs), and (c) health-related quality of life and satisfaction with care (each < 10 % and < 15 % of all studies and RCTs, respectively). CONCLUSIONS Scant evidence is available on the putative rehabilitative effects of psychosocial interventions, either as stand-alone treatments or in an adjunct role to pharmacotherapies.
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Affiliation(s)
| | - Fadi Hammal
- School of Public Health, University of Alberta, Canada
| | - Myles Hancock
- School of Public Health, University of Alberta, Canada
| | | | | | - Denise Adams
- School of Public Health, University of Alberta, Canada
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13
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DeFulio A, Rzeszutek MJ, Furgeson J, Ryan S, Rezania S. A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program. J Subst Abuse Treat 2021; 120:108188. [DOI: 10.1016/j.jsat.2020.108188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
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14
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Acceptability and willingness to pay for contingency management interventions among parents of young adults with problematic opioid use. Drug Alcohol Depend 2020; 206:107687. [PMID: 31753735 DOI: 10.1016/j.drugalcdep.2019.107687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a need for new research addressing the cost prohibitive nature of maintaining contingency management (CM) in community settings. While researchers propose managed care as an option to support costs, there is no research on self-pay models. To inform such research, it is important first to understand client willingness to pay for CM services. We examine acceptability and willingness to pay for CM services among parents with and without young adult children with problematic opioid use. METHODS A web-based survey was administered to a sample of parents of adult children ages 18-35 with (target sample) and without (comparison sample) a history of problematic opiate use. RESULTS One hundred thirty parents participated (ntarget = 30; ncomparison = 100) and were predominately white, college educated, and of higher income. Findings showed a high proportion of participants had positive opinions of using incentives for substance use treatment and would consider incentive-based treatments for their child. Most participants reported they would be willing to pay for CM at levels consistent with amounts used in efficacious programs but expressed worry that incentives would be used to buy drugs. Most participants reported this worry would be eased if incentives were delivered via reloadable gift cards and if incentives were only delivered during periods of abstinence. CONCLUSIONS This is the first study to examine parent perceptions of incentives and acceptability and willingness to pay for CM services. Results suggest self-pay models for disseminating CM to young adults with problematic opioid use may be an option.
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Sheidow AJ, McCart MR, Chapman JE, Drazdowski TK. Capacity of juvenile probation officers in low-resourced, rural settings to deliver an evidence-based substance use intervention to adolescents. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:76-88. [PMID: 31393146 DOI: 10.1037/adb0000497] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Substance use is a major public health problem with a host of negative outcomes. Justice-involved youth have even higher risks and lack access to evidence-based interventions, particularly in rural communities. Task-shifting, or redistribution of tasks downstream to an existing workforce with less training, may be an innovative strategy to increase access to evidence-based interventions. Initial findings are presented from a services research trial conducted primarily in rural communities in which an existing workforce, juvenile probation/parole officers (JPOs), were randomized either to learn and deliver contingency management (CM) or to continue delivering probation services as usual (PAU). This study used the prevailing version of CM for adolescents, that is, family-based with behavior modification and cognitive behavioral components. Data included JPOs' self-reports, as well as audio-recorded youth/family sessions with JPOs rated by expert and trained observational coders. Data also included ratings from a comparison study in which therapists were trained and supervised by experts to deliver CM to justice-involved youth/families. Results showed JPOs can feasibly incorporate CM into their services. When adherence of CM JPOs was compared against CM therapists, JPOs delivered significantly more cognitive behavioral components of CM and similar levels of behavior modification components of CM. These findings suggest that JPOs can be leveraged to provide evidence-based substance use interventions like CM in similar, or even greater, capacities to clinically trained therapists. This task-shifting approach could dramatically expand service access for these high-risk youth, particularly in rural areas where substance use services are limited or nonexistent. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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16
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Prihodova L, Guerin S, Tunney C, Kernohan WG. Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review. J Adv Nurs 2019; 75:313-326. [PMID: 30168164 PMCID: PMC7379521 DOI: 10.1111/jan.13836] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/28/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022]
Abstract
AIMS To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research. BACKGROUND There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. DESIGN A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts. DATA SOURCES Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care. REVIEW METHODS Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility. RESULTS Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified. CONCLUSIONS The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.
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Affiliation(s)
- Lucia Prihodova
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
| | - Suzanne Guerin
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - Conall Tunney
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - W. George Kernohan
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- Institute of Nursing and Health ResearchUlster UniversityBelfastNorthern Ireland
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17
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Sloas L, Murphy A, Wooditch A, Taxman FS. Assessing the Use and Impact of Points and Rewards across Four Federal Probation Districts: A Contingency Management Approach. VICTIMS & OFFENDERS 2019; 14:811-831. [PMID: 33041726 PMCID: PMC7545962 DOI: 10.1080/15564886.2019.1656691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Contingency management (CM) is a well-acknowledged behavioral approach for incentivizing changes in behavior and attitudes. A version of CM was piloted in four federal probation districts to determine whether systematically awarding points and rewards for key behaviors could be implemented and impact recidivism rates. A case controlled match design was conducted with a CM sample (referred to as Justice Steps (JSTEPS)) (n=128) who were individually matched to a comparison sample (n=128) on six variables related to recidivism. Analyses compared the number of technical violations and new arrests between JSTEPS participants and a historical comparison sample. Using Kaplan-Meier survival analysis, results indicate JSTEPS sites using early CM rewarding strategies tend have delayed recidivism than others. A research agenda is outlined.
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Affiliation(s)
- Lincoln Sloas
- College for Design and Social Inquiry, School of Criminology and Criminal Justice, Florida Atlantic University, 777 Glades Road, SO 221, Boca Raton, FL 33431
| | - Amy Murphy
- Center for Advancing Correctional Excellence, George Mason University, Fairfax, VA 22030
| | - Alese Wooditch
- Temple University, Department of Criminal Justice, 529 Gladfelter Hall | 1115 Polett Walk, Philadelphia, PA 19122
| | - Faye S Taxman
- Criminology, Law & Society, Center for Advancing Correctional Excellence!, 4087 University Drive, 4100, MSN 6D3, Fairfax, VA 22030
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18
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Washio Y, Humphreys M. Maternal Behavioral Health: Fertile Ground for Behavior Analysis. Perspect Behav Sci 2018; 41:637-652. [PMID: 31976417 PMCID: PMC6701727 DOI: 10.1007/s40614-018-0143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The World Health Organization has identified four behavioral health priorities as risk factors for noncommunicable diseases in maternal populations: tobacco use, harmful alcohol use, poor nutrition, and lack of physical activity. These risk factors also significantly affect pregnant and immediately postpartum mothers, doubling the health risk and economic burden by adversely affecting maternal and birth or infant outcomes. Psychosocial and behavioral interventions are ideal for pregnant and immediately postpartum women as opposed to pharmacotherapy. Among other behavioral interventions, the use of incentives based on the principles of reinforcement has been a successful yet controversial way to change health behaviors. Implementing an incentive-based intervention in maternal health often brings up social validity concerns. The existing guideline on how to develop and conduct research in incentive-based interventions for maternal health lacks enough information on the specific variables to control for to maintain the intervention's effectiveness. This article outlines some of the critical variables in implementing an effective behavior-analytic intervention and addressing social validity concerns to change maternal behaviors in a sustainable manner, along with specific research topics needed in the field to prevent adverse maternal, birth, and infant outcomes.
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Affiliation(s)
- Yukiko Washio
- Christiana Care Health System, Newark, DE USA
- University of Delaware, 4755 Ogletown-Stanton Road, Newark, DE 19713 USA
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19
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Helseth SA, Janssen T, Scott K, Squires DD, Becker SJ. Training community-based treatment providers to implement contingency management for opioid addiction: Time to and frequency of adoption. J Subst Abuse Treat 2018; 95:26-34. [PMID: 30352667 DOI: 10.1016/j.jsat.2018.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Contingency management (CM) is a well-established treatment for opioid use, yet its adoption remains low in community clinics. This manuscript presents a secondary analysis of a study comparing a comprehensive implementation strategy (Science to Service Laboratory; SSL) to didactic training-as-usual (TAU) as a means of implementing CM across a multi-site opioid use disorder program. Hypotheses predicted that providers who received the SSL implementation strategy would 1) adopt CM faster and 2) deliver CM more frequently than TAU providers. In addition, we examined whether the effect of implementation strategy varied as a function of a set of theory-driven moderators, guided by the Consolidated Framework for Implementation Research: perceived intervention characteristics, perceived organizational climate, and provider characteristics (i.e., race/ethnicity, gender). Sixty providers (39 SSL, 21 TAU) across 15 clinics (7 SSL, 8 TAU) completed a comprehensive set of measures at baseline and reported biweekly on CM use for 52 weeks. All participants received didactic CM training; SSL clinics received 9 months of enhanced training, including access to an external coach, an in-house innovation champion, and a collaborative learning community. Discrete-time survival analysis found that SSL providers more quickly adopted CM; provider characteristics (i.e., race/ethnicity) emerged as the sole moderator of time to adoption. Negative binomial regression revealed that SSL providers also delivered CM more frequently than TAU providers. Frequency of CM adoption was moderated by provider (i.e., gender and race/ethnicity) and intervention characteristics (i.e., compatibility). Implications for implementation strategies for community-based training are discussed.
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Affiliation(s)
- Sarah A Helseth
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America.
| | - Tim Janssen
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America
| | - Kelli Scott
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America
| | - Daniel D Squires
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America
| | - Sara J Becker
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America
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20
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The national implementation of Contingency Management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes. Drug Alcohol Depend 2018; 185. [PMID: 29524874 PMCID: PMC6435332 DOI: 10.1016/j.drugalcdep.2017.12.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use). METHODS Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites. RESULTS The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%. CONCLUSION The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.
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21
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Becker SJ, Kelly LM, Kang AW, Escobar KI, Squires DD. Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy. Subst Abus 2018; 40:56-60. [PMID: 29595403 DOI: 10.1080/08897077.2018.1455164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Methods: Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, Mage = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Results: Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. Conclusions: The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation to meet the needs of diverse opioid treatment providers. Entities using the SSL may also wish to incorporate a more explicit focus on patient-level barriers.
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Affiliation(s)
- Sara J Becker
- a Center for Alcohol and Addictions Studies, Brown University School of Public Health , Providence , Rhode Island , USA
| | - Lourah M Kelly
- a Center for Alcohol and Addictions Studies, Brown University School of Public Health , Providence , Rhode Island , USA.,b Department of Psychology , Suffolk University , Boston, Massachusetts , USA
| | - Augustine W Kang
- a Center for Alcohol and Addictions Studies, Brown University School of Public Health , Providence , Rhode Island , USA
| | - Katherine I Escobar
- a Center for Alcohol and Addictions Studies, Brown University School of Public Health , Providence , Rhode Island , USA
| | - Daniel D Squires
- a Center for Alcohol and Addictions Studies, Brown University School of Public Health , Providence , Rhode Island , USA
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22
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Vamos CA, Cantor A, Thompson EL, Detman LA, Bronson EA, Phelps A, Louis JM, Gregg AR, Curran JS, Sappenfield WM. The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff. Matern Child Health J 2017; 20:2003-11. [PMID: 27178428 DOI: 10.1007/s10995-016-2020-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.
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Affiliation(s)
- Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA. .,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
| | - Allison Cantor
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA
| | - Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Linda A Detman
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Emily A Bronson
- The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Annette Phelps
- Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Judette M Louis
- Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL, 33606, USA
| | - Anthony R Gregg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, P.O Box 100294, Gainesville, FL, 32610, USA
| | - John S Curran
- Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Faculty and Academic Affairs, USF Health, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - William M Sappenfield
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
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Lasser KE, Quintiliani LM, Truong V, Xuan Z, Murillo J, Jean C, Pbert L. Effect of Patient Navigation and Financial Incentives on Smoking Cessation Among Primary Care Patients at an Urban Safety-Net Hospital: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:1798-1807. [PMID: 29084312 PMCID: PMC5820724 DOI: 10.1001/jamainternmed.2017.4372] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE While the proportion of adults who smoke cigarettes has declined substantially in the past decade, socioeconomic disparities in cigarette smoking remain. Few interventions have targeted low socioeconomic status (SES) and minority smokers in primary care settings. OBJECTIVE To evaluate a multicomponent intervention to promote smoking cessation among low-SES and minority smokers. DESIGN, SETTING, AND PARTICIPANTS For this prospective, unblinded, randomized clinical trial conducted between May 1, 2015, and September 4, 2017, adults 18 years and older who spoke English, smoked 10 or more cigarettes per day in the past week, were contemplating or preparing to quit smoking, and had a primary care clinician were recruited from general internal medicine and family medicine practices at 1 large safety-net hospital in Boston, Massachusetts. INTERVENTIONS Patients were randomized to a control group that received an enhancement of usual care (n = 175 participants) or to an intervention group that received up to 4 hours of patient navigation delivered over 6 months in addition to usual care, as well as financial incentives for biochemically confirmed smoking cessation at 6 and 12 months following enrollment (n = 177 participants). MAIN OUTCOMES AND MEASURES The primary outcome determined a priori was biochemically confirmed smoking cessation at 12 months. RESULTS Among 352 patients who were randomized (mean [SD] age, 50.0 [11.0] years; 191 women [54.3%]; 197 participants who identified as non-Hispanic black [56.0%]; 40 participants who identified as Hispanic of any race [11.4%]), all were included in the intention-to-treat analysis. At 12 months following enrollment, 21 participants [11.9%] in the navigation and incentives group, compared with 4 participants [2.3%] in the control group, had quit smoking (odds ratio, 5.8; 95% CI, 1.9-17.1; number needed to treat, 10.4; P < .001). In prespecified subgroup analyses, the intervention was particularly beneficial for older participants (19 [19.8%] vs 1 [1.0%]; P < .001), women (17 [16.8%] vs 2 [2.2%]; P < .001), participants with household yearly income of $20 000 or less (15 [15.5%] vs 3 [3.1%]; P = .003), and nonwhite participants (21 [15.2%] vs 4 [3.0%]; P < .001). CONCLUSIONS AND RELEVANCE In this study of adult daily smokers at 1 large urban safety-net hospital, patient navigation and financial incentives for smoking cessation significantly increased the rates of smoking cessation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02351609.
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Affiliation(s)
- Karen E Lasser
- Boston University, School of Medicine, Section of General Internal Medicine, Crosstown Center, Boston, Massachusetts.,Boston University, School of Public Health, Department of Community Health Sciences, Crosstown Center, Boston, Massachusetts.,Boston Medical Center, Section of General Internal Medicine, Crosstown Center, Boston, Massachusetts
| | - Lisa M Quintiliani
- Boston University, School of Medicine, Section of General Internal Medicine, Crosstown Center, Boston, Massachusetts.,Boston University, School of Public Health, Department of Community Health Sciences, Crosstown Center, Boston, Massachusetts
| | - Ve Truong
- Boston Medical Center, Section of General Internal Medicine, Crosstown Center, Boston, Massachusetts
| | - Ziming Xuan
- Boston University, School of Public Health, Department of Community Health Sciences, Crosstown Center, Boston, Massachusetts
| | - Jennifer Murillo
- Boston Medical Center, Section of General Internal Medicine, Crosstown Center, Boston, Massachusetts
| | - Cheryl Jean
- Bridge Over Troubled Waters, Boston, Massachusetts
| | - Lori Pbert
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, Worcester
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24
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Becker SJ, Squires DD, Strong DR, Barnett NP, Monti PM, Petry NM. Training opioid addiction treatment providers to adopt contingency management: A prospective pilot trial of a comprehensive implementation science approach. Subst Abus 2017; 37:134-40. [PMID: 26682582 DOI: 10.1080/08897077.2015.1129524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multisite opioid addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). METHODS Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the predetermined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, whereas putative mediators were measured at baseline, 3 months, and 12 months. RESULTS Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4-13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. CONCLUSIONS Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed.
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Affiliation(s)
- Sara J Becker
- a Center for Alcohol and Addictions Studies , Brown University , Providence , Rhode Island , USA
| | - Daniel D Squires
- a Center for Alcohol and Addictions Studies , Brown University , Providence , Rhode Island , USA
| | - David R Strong
- b Department of Family and Preventive Medicine , University of California San Diego School of Medicine , La Jolla , California , USA
| | - Nancy P Barnett
- a Center for Alcohol and Addictions Studies , Brown University , Providence , Rhode Island , USA
| | - Peter M Monti
- a Center for Alcohol and Addictions Studies , Brown University , Providence , Rhode Island , USA
| | - Nancy M Petry
- c Department of Medicine , University of Connecticut Health Center , Farmington , Connecticut , USA
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25
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Herrmann ES, Matusiewicz AK, Stitzer ML, Higgins ST, Sigmon SC, Heil SH. Contingency Management Interventions for HIV, Tuberculosis, and Hepatitis Control Among Individuals With Substance Use Disorders: A Systematized Review. J Subst Abuse Treat 2017; 72:117-125. [PMID: 27394070 PMCID: PMC5386179 DOI: 10.1016/j.jsat.2016.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/14/2016] [Accepted: 06/17/2016] [Indexed: 12/12/2022]
Abstract
Hepatitis, HIV and tuberculosis are significant and costly public health problems that disproportionately affect individuals with substance use disorders (SUDs). Incentive-based treatment approaches (i.e., contingency management; CM) are highly effective at reducing drug use. The primary aim of this report is to review the extant literature that examines the efficacy of CM interventions for the prevention, diagnosis and treatment of hepatitis, HIV and tuberculosis among individuals with SUDs. A literature search identified 23 controlled studies on this topic. In approximately 85% of the studies, CM produced significantly better adherence to prevention, diagnosis and treatment-related medical services, with adherence rates averaging almost 35% higher among patients receiving incentives vs. control condition participants. Findings from these studies parallel the results of a meta-analysis of CM interventions for the treatment of SUDs. The results also suggest that the principles that underlie the efficacy of CM generalize across infectious disease and substance abuse treatment behaviors. The application of additional principles from the literature on CM for treatment of SUDs to interventions targeting infectious disease control would be beneficial. Further development and dissemination of these interventions has the potential to greatly impact public health.
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Affiliation(s)
- Evan S Herrmann
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401.
| | - Alexis K Matusiewicz
- Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224
| | - Stephen T Higgins
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Stacey C Sigmon
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Sarah H Heil
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
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26
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Abstract
Drug testing, when carefully collected and thoughtfully interpreted, offers a critical adjunct to clinical care and substance use treatment. However, because test results can be misleading if not interpreted in the correct clinical context, clinicians should always conduct a careful interview with adolescent patients to understand what testing is likely to show and then use testing to validate or refute their expectations. Because of the ease with which samples can be tampered, providers should also carefully reflect on their own collection protocols and sample validation procedures to ensure optimal accuracy."
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Affiliation(s)
- Scott E. Hadland
- Boston Children’s Hospital, Division of Adolescent / Young Adult Medicine, Boston Children’s Hospital, Division of Developmental Medicine, Department of Medicine, 300 Longwood Avenue, Boston, MA, USA, 02115,Harvard Medical School, Department of Pediatrics, 25 Shattuck St., Boston, MA, USA, 02115
| | - Sharon Levy
- Department of Medicine, 300 Longwood Avenue, Boston, MA, USA, 02115,Harvard Medical School, Department of Pediatrics, 25 Shattuck St., Boston, MA, USA, 02115
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27
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Pre-Implementation Review of Contracts, Prompts, and Reinforcement in SUD Continuing Care. J Behav Health Serv Res 2016; 44:135-148. [DOI: 10.1007/s11414-016-9522-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Gupta A, Thorpe C, Bhattacharyya O, Zwarenstein M. Promoting development and uptake of health innovations: The Nose to Tail Tool. F1000Res 2016; 5:361. [PMID: 27239275 PMCID: PMC4863676 DOI: 10.12688/f1000research.8145.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Health sector management is increasingly complex as new health technologies, treatments, and innovative service delivery strategies are developed. Many of these innovations are implemented prematurely, or fail to be implemented at scale, resulting in substantial wasted resources. Methods A scoping review was conducted to identify articles that described the scale up process conceptually or that described an instance in which a healthcare innovation was scaled up. We define scale up as the expansion and extension of delivery or access to an innovation for all end users in a jurisdiction who will benefit from it. Results Sixty nine articles were eligible for review. Frequently described stages in the innovation process and contextual issues that influence progress through each stage were mapped. 16 stages were identified: 12 deliberation and 4 action stages. Included papers suggest that innovations progress through stages of maturity and the uptake of innovation depends on the innovation aligning with the interests of 3 critical stakeholder groups (innovators, end users and the decision makers) and is also influenced by 3 broader contexts (social and physical environment, the health system, and the regulatory, political and economic environment). The 16 stages form the rows of the Nose to Tail Tool (NTT) grid and the 6 contingency factors form columns. The resulting stage-by-issue grid consists of 72 cells, each populated with cell-specific questions, prompts and considerations from the reviewed literature. Conclusion We offer a tool that helps stakeholders identify the stage of maturity of their innovation, helps facilitate deliberative discussions on the key considerations for each major stakeholder group and the major contextual barriers that the innovation faces. We believe the NTT will help to identify potential problems that the innovation will face and facilitates early modification, before large investments are made in a potentially flawed solution.
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Affiliation(s)
- Archna Gupta
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Cathy Thorpe
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
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29
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Abstract
Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.
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Affiliation(s)
- Jason P Connor
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Discipline of Psychiatry, The University of Queensland, Brisbane, QLD, Australia
| | - Paul S Haber
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Addictions Department, King's College London, London, UK.
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30
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Hartzler B, Peavy KM, Jackson TR, Carney M. Finding harmony so the music plays on: pragmatic trial design considerations to promote organizational sustainment of an empirically-supported behavior therapy. Addict Sci Clin Pract 2016; 11:2. [PMID: 26801244 PMCID: PMC4724112 DOI: 10.1186/s13722-016-0049-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Pragmatic trials of empirically-supported behavior therapies may inform clinical and policy decisions concerning therapy sustainment. This retrospective trial design paper describes and discusses pragmatic features of a hybrid type III implementation/effectiveness trial of a contingency management (CM) intervention at an opioid treatment program. Prior reporting (Hartzler et al., J Subst Abuse Treat 46:429–438, 2014; Hartzler, Subst Abuse Treat Prev Policy 10:30, 2015) notes success in recruiting program staff for voluntary participation, durable impacts of CM training on staff-level outcomes, provisional setting implementation of the intervention, documentation of clinical effectiveness, and post-trial sustainment of CM. Methods/design Six pragmatic design features, and both scientific and practical bases for their inclusion in the trial, are presented: (1) a collaborative intervention design process, (2) voluntary recruitment of program staff for therapy training and implementation, (3) serial training outcome assessments, with quasi-experimental staff randomization to either single or multiple baseline assessment conditions, (4) designation of a 90-day period immediately after training in which the setting implemented the intervention on a provisional basis, (5) inclusive patient eligibility for receipt of the CM intervention, and (6) designation of two staff as local implementation leaders to oversee clinical/administrative issues in provisional implementation. Discussion Each pragmatic trial design feature is argued to have contributed to sustainment of CM. Contributions implicate the building of setting proprietorship for the CM intervention, culling of internal staff expertise in its delivery, iterative use of assessment methods that limited setting burden, documentation of setting-specific clinical effectiveness, expanded penetration of CM among staff during provisional implementation, and promotion of setting self-reliance in the oversight of sustainable implementation procedures. It is hoped this discussion offers ideas for how to impact local clinical and policy decisions via effective behavior therapy dissemination.
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Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - K Michelle Peavy
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - T Ron Jackson
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - Molly Carney
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
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31
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Edelman EJ, Hansen NB, Cutter CJ, Danton C, Fiellin LE, O'Connor PG, Williams EC, Maisto SA, Bryant KJ, Fiellin DA. Implementation of integrated stepped care for unhealthy alcohol use in HIV clinics. Addict Sci Clin Pract 2016; 11:1. [PMID: 26763048 PMCID: PMC4711105 DOI: 10.1186/s13722-015-0048-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022] Open
Abstract
Background
Effective counseling and pharmacotherapy for unhealthy alcohol use are rarely provided in HIV treatment settings to patients. Our goal was to describe factors influencing implementation of a stepped care model to address unhealthy alcohol use in HIV clinics from the perspectives of social workers, psychologists and addiction psychiatrists. Methods We conducted two focus groups with Social Workers (n = 4), Psychologists (n = 2), and Addiction Psychiatrists (n = 4) involved in an ongoing randomized controlled trial evaluating the effectiveness of integrated stepped care for unhealthy alcohol use in HIV-infected patients at five Veterans Health Administration (VA) HIV clinics. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) domains, with a focus on the three domains which we considered to be most relevant: intervention characteristics (i.e. motivational interviewing, pharmacotherapy), the inner setting (i.e. HIV clinics), and characteristics of individuals (i.e. the providers). A multidisciplinary team used directed content analysis to identify major themes. Results From the providers’ perspective, the major implementation themes that emerged by CFIR domain included: (1) Intervention characteristics: providers valued tools and processes for facilitating patient motivation for treatment of unhealthy alcohol use given their perceived lack of motivation, but expressed a desire for greater flexibility; (2) Inner setting: treating unhealthy alcohol use in HIV clinics was perceived by providers to be consistent with VA priorities; and (3) Characteristics of individuals: there was high self-efficacy to conduct the intervention, an expressed need for more consistent utilization to maintain skills, and consideration of alternative models for delivering the components of the intervention. Conclusions Use of the CFIR framework reveals that implementation of integrated stepped care for unhealthy alcohol use in HIV clinics is facilitated by tools to help providers enhance patient motivation or address unhealthy alcohol use among patients perceived to be unmotivated. Implementation may be facilitated by its consistency with organizational values and existing models of care and attention to optimizing provider self-efficacy and roles (i.e. approaches to treatment integration).
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Nathan B Hansen
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA. .,College of Public Health, University of Georgia, 131 Wright Hall, Health Sciences Campus, Athens, GA, 30602, USA.
| | - Christopher J Cutter
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Cheryl Danton
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Lynn E Fiellin
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Patrick G O'Connor
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Emily C Williams
- VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA. .,Department of Health Services, University of Washington, 1959 NE Pacific Street, Magnuson Health Sciences Center, Room H-664, Seattle, WA, 98195, USA.
| | - Stephen A Maisto
- Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, 5635 Fishers Lane, Bethesda, MD, 20892-7003, USA.
| | - David A Fiellin
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
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32
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Hartzler B, Garrett S. Interest and preferences for contingency management design among addiction treatment clientele. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:287-95. [PMID: 26646619 DOI: 10.3109/00952990.2015.1096365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite strong support for its efficacy, debates persist about how dissemination of contingency management is most effectively undertaken. Currently-promoted contingency management methods are empirically-validated, yet their congruence with interests and preferences of addiction treatment clientele is unknown. Such client input is a foundational support for evidence-based clinical practice. OBJECTIVE This study documented interest in incentives and preferences for fixed-ratio vs. variable-ratio and immediate vs. distal distribution of earned incentives among clients enrolled at three community programs affiliated with the National Institute on Drug Abuse Clinical Trials Network. METHODS This multi-site study included anonymous survey completion by an aggregate sample of 358 treatment enrollees. Analyses first ruled out site differences in survey responses, and then tested age and gender as influences on client interest in financial incentives, and preferences for fixed-ratio vs. variable-ratio reinforcement and immediate vs. distal incentive distribution. RESULTS Interest in different types of $50 incentives (i.e. retail vouchers, transportation vouchers, cash) was highly inter-correlated, with a mean sample rating of 3.49 (0.83) on a five-point scale. While consistent across client gender, age was an inverse predictor of client interest in incentives. A majority of clients stated preference for fixed-ratio incentive magnitude and distal incentive distribution (67% and 63%, respectively), with these preferences voiced by a larger proportion of females. CONCLUSION Sample preferences contradict currently-promoted contingency management design features. Future efforts to disseminate contingency management may be more successful if flexibly undertaken in a manner that incorporates the interests and preferences of local client populations.
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Affiliation(s)
- Bryan Hartzler
- a Alcohol & Drug Abuse Institute, University of Washington , Seattle , WA , USA
| | - Sharon Garrett
- a Alcohol & Drug Abuse Institute, University of Washington , Seattle , WA , USA
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33
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López-Núñez C, Alonso-Pérez F, Pedrosa I, Secades-Villa R. Cost-effectiveness of a voucher-based intervention for smoking cessation. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:296-305. [PMID: 26484869 DOI: 10.3109/00952990.2015.1081913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Contingency management (CM) has been shown to be effective in reducing smoking consumption, but has traditionally been criticized for its costs. OBJECTIVES This study assessed the cost-effectiveness of using a voucher-based CM protocol added to a cognitive behavioral treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. METHODS A total of 92 patients were randomly assigned to CBT or CBT plus CM for abstinence. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the increase in costs by the increase in effects (continuous abstinence, longest duration of abstinence at 6-month follow-up and cotinine results during the treatment). An acceptability curve illustrated the statistical uncertainty surrounding the cost-effectiveness estimate. We also determined the optimum cost per participant for predicting the smoking status at 6-month follow-up. RESULTS The average cost per participant in the CBT condition was €138.73 (US$ 150.23) as opposed to €411.61 (US$ 445.73) in the CBT plus CM condition (p < 0.01). The incremental cost of using voucher-based CM to increase the number of participants that maintained abstinence at 6-month follow-up by one extra participant was €68.22 (US$ 73.88), and to lengthen the longest duration of abstinence by 1 week was €53.92 (US$ 58.39). The incremental cost to obtain an extra cotinine-negative result was €181.90 (US$ 196.98). CONCLUSION Compared with CBT alone, the voucher-based protocol required additional costs but achieved significantly better outcomes. These results will allow stakeholders to make policy decisions about CM implementation for smoking cessation in the broader community.
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Affiliation(s)
| | | | - Ignacio Pedrosa
- a Department of Psychology , University of Oviedo , Oviedo , Spain
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Breimaier HE, Heckemann B, Halfens RJG, Lohrmann C. The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice. BMC Nurs 2015; 14:43. [PMID: 26269693 PMCID: PMC4533946 DOI: 10.1186/s12912-015-0088-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/13/2015] [Indexed: 11/21/2022] Open
Abstract
Background Implementing clinical practice guidelines (CPGs) in healthcare settings is a complex intervention involving both independent and interdependent components. Although the Consolidated Framework for Implementation Research (CFIR) has never been evaluated in a practical context, it appeared to be a suitable theoretical framework to guide an implementation process. The aim of this study was to evaluate the comprehensiveness, applicability and usefulness of the CFIR in the implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian university teaching hospital setting. Methods The evaluation of the CFIR was based on (1) team-meeting minutes, (2) the main investigator’s research diary, containing a record of a before-and-after, mixed-methods study design embedded in a participatory action research (PAR) approach for guideline implementation, and (3) an analysis of qualitative and quantitative data collected from graduate and assistant nurses in two Austrian university teaching hospital departments. The CFIR was used to organise data per and across time point(s) and assess their influence on the implementation process, resulting in implementation and service outcomes. Results Overall, the CFIR could be demonstrated to be a comprehensive framework for the implementation of a guideline into a hospital-based nursing practice. However, the CFIR did not account for some crucial factors during the planning phase of an implementation process, such as consideration of stakeholder aims and wishes/needs when implementing an innovation, pre-established measures related to the intended innovation and pre-established strategies for implementing an innovation. For the CFIR constructs reflecting & evaluating and engaging, a more specific definition is recommended. The framework and its supplements could easily be used by researchers, and their scope was appropriate for the complexity of a prospective CPG-implementation project. The CFIR facilitated qualitative data analysis and provided a structure that allowed project results to be organised and viewed in a broader context to explain the main findings. Conclusions The CFIR was a valuable and helpful framework for (1) the assessment of the baseline, process and final state of the implementation process and influential factors, (2) the content analysis of qualitative data collected throughout the implementation process, and (3) explaining the main findings. Electronic supplementary material The online version of this article (doi:10.1186/s12912-015-0088-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helga E Breimaier
- Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria
| | - Birgit Heckemann
- Department of Health Services Research, CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Ruud J G Halfens
- Department of Health Services Research, CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria
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Hartzler B. Building a bonfire that remains stoked: sustainment of a contingency management intervention developed through collaborative design. Subst Abuse Treat Prev Policy 2015; 10:30. [PMID: 26243132 PMCID: PMC4526292 DOI: 10.1186/s13011-015-0027-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community dissemination of empirically-supported behavior therapies is fostered by collaborative design, a joint process pooling expertise of purveyors and treatment personnel to contextualize a therapy for sustainable use. The adaptability of contingency management renders it an exemplary therapy to model this collaborative design process. METHODS At conclusion of an implementation/effectiveness hybrid trial conducted at an opiate treatment program, a group elicitation interview was conducted with the setting's five managerial staff to cull qualitative impressions of a collaboratively-designed contingency management intervention after 90 days of provisional implementation in the setting. Two independent raters reviewed the audio-recording and conducted a phenomenological narrative analysis, extracting themes and selecting excerpts to correspond with innovation attributes (i.e., relative advantage, compatibility, complexity, trialability, observability) of a well-known implementation science framework. RESULTS This qualitative analysis suggested the intervention was regarded as: (1) cost-effective and clinically useful relative to prior practices, (2) a strong fit with existing service structure and staffing resources, (3) procedurally uncomplicated, with staff consistently implementing it as intended, (4) providing site-specific data to sufficiently inform decisions about its sustainment, and (5) offering palpable benefits to staff-patient interactions. CONCLUSIONS The current work complements prior reports of positive implementation outcomes and intervention effectiveness for the parent trial, mapping qualitative managerial accounts of this contingency management intervention to a set of attributes thought to influence the speed and effectiveness with which an innovative practice is disseminated. Findings support the incorporation of collaborative design processes in future efforts to transport contingency management to the addiction treatment community.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, , 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
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Fitzsimons H, Tuten M, Borsuk C, Lookatch S, Hanks L. Clinician-delivered contingency management increases engagement and attendance in drug and alcohol treatment. Drug Alcohol Depend 2015; 152:62-7. [PMID: 25982007 DOI: 10.1016/j.drugalcdep.2015.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/22/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined the impact of a low-cost contingency management (CM) delivered by program clinicians on treatment attendance and utilization for patients enrolled in outpatient psychosocial substance abuse treatment. METHODS The study used a pre-posttest design to compare substance abuse patients who received Reinforcement-Based Treatment (RBT) plus low cost CM (n=130; RBT+CM) to patients who received RBT only (n=132, RBT). RBT+CM participants received a $10 incentive for returning to treatment the day following intake assessment (day one), and a $15 incentive for attending treatment on day five following admission. RBT clients received standard care intervention without the addition of the CM procedures. Groups were compared on proportion of participants who returned to treatment on day one, mean days of treatment attendance, individual sessions attended, and treatment utilization during the first week and the first month following treatment admission. RESULTS Both the RBT+CM and RBT group participants returned to the clinic on day one at high rates (95% versus 89%, respectively). However, the RBT group participants were more likely to attend the intake assessment only (i.e., never return to treatment) compared to the RBT+CM participants. Additionally, the RBT+CM participants attended significantly more treatment days, attended more individual counseling sessions, and had higher rates of overall treatment utilization compared to the RBT participants during the one week and one month following treatment admission. CONCLUSIONS Findings support the feasibility and effectiveness of a CM intervention delivered by clinicians for increasing treatment attendance and utilization in a community substance abuse program.
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Affiliation(s)
- Heather Fitzsimons
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Michelle Tuten
- University of Maryland School of Social Work, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
| | - Courtney Borsuk
- University of Texas at San Antonio College of Education and Human Development, Department of Counseling, San Antonio, TX, USA
| | - Samantha Lookatch
- University of Tennessee, Department of Psychology, Knoxville, TN, USA
| | - Lisa Hanks
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
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Aletraris L, Shelton JS, Roman PM. Counselor Attitudes Toward Contingency Management for Substance Use Disorder: Effectiveness, Acceptability, and Endorsement of Incentives for Treatment Attendance and Abstinence. J Subst Abuse Treat 2015; 57:41-8. [PMID: 26001821 DOI: 10.1016/j.jsat.2015.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 11/28/2022]
Abstract
Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client-counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counselors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of "Promoting Awareness of Motivational Incentives" (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the impact of multiple Web-based educational strategies. Given the barriers to CM adoption, identifying predictors of positive attitudes among counselors can help diffuse CM into routine clinical practice.
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Affiliation(s)
- Lydia Aletraris
- Owens Institute for Behavioral Research, 112 Barrow Hall, University of Georgia, Athens, GA, 30602, USA.
| | - Jeff S Shelton
- Owens Institute for Behavioral Research, 103 Barrow Hall, University of Georgia, Athens, GA, 30602, USA.
| | - Paul M Roman
- Owens Institute for Behavioral Research, 106 Barrow Hall, University of Georgia, Athens, GA, 30602, USA.
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Hartzler B. Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: preliminary psychometrics. J Subst Abuse Treat 2015; 55:52-7. [PMID: 25770870 DOI: 10.1016/j.jsat.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 11/15/2022]
Abstract
A paper/pencil instrument, adapted from Miller and colleagues' (1991) Helpful Responses Questionnaire (HRQ), was developed to assess clinician skill with core communicative aspects involved in delivering contingency management (CM). The instrument presents a single vignette consisting of six points of client dialogue to which respondents write 'what they would say next.' In the context of an implementation/effectiveness hybrid trial, 19 staff clinicians at an opiate treatment program completed serial training outcome assessments before, following, and three months after CM training. Assessments included this adaptation of the HRQ, a multiple-choice CM knowledge test, and a recorded standardized patient encounter scored for CM skillfulness. Study results reveal promising psychometric properties for the instrument, including strong scoring reliability, internal consistency, concurrent and predictive validity, test-retest reliability and sensitivity to training effects. These preliminary findings suggest the instrument is a viable, practical method to assess clinician skill in communicative aspects of CM delivery.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
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Dougherty DM, Karns TE, Mullen J, Liang Y, Lake SL, Roache JD, Hill-Kapturczak N. Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking. Drug Alcohol Depend 2015; 148:77-84. [PMID: 25582388 PMCID: PMC5505238 DOI: 10.1016/j.drugalcdep.2014.12.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, we demonstrated that transdermal alcohol monitors could be used in a contingency management procedure to reduce problematic drinking; the frequency of self-reported heavy/moderate drinking days decreased and days of no to low drinking increased. These effects persisted for three months after intervention. In the current report, we used the transdermal alcohol concentration (TAC) data collected prior to and during the contingency management procedure to provide a detailed characterization of objectively measured alcohol use. METHODS Drinkers (n=80) who frequently engaged in risky drinking behaviors were recruited and participated in three study phases: a 4-week Observation phase where participants drank as usual; a 12-week Contingency Management phase where participants received $50 each week when TAC did not exceed 0.03g/dl; and a 3-month Follow-up phase where self-reported alcohol consumption was monitored. Transdermal monitors were worn during the first two phases, where each week they recived $105 for visiting the clinic and wearing the monitor. Outcomes focused on using TAC data to objectively characterize drinking and were used to classify drinking levels as either no, low, moderate, or heavy drinking as a function of weeks and day of week. RESULTS Compared to the Observation phase, TAC data indicated that episodes of heavy drinking days during the Contingency Management phase were reduced and episodes of no drinking and low to moderate drinking increased. CONCLUSIONS These results lend further support for linking transdermal alcohol monitoring with contingency management interventions. Collectively, studies to date indicate that interventions like these may be useful for both abstinence and moderation-based programs.
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Affiliation(s)
- Donald M. Dougherty
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX,Corresponding Author: Donald M. Dougherty, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA, , Phone: 210-567-2745, Fax: 210-567-2748
| | - Tara E. Karns
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jillian Mullen
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Yuanyuan Liang
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Sarah L. Lake
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John D. Roache
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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Landovitz RJ, Fletcher JB, Shoptaw S, Reback CJ. Contingency management facilitates the use of postexposure prophylaxis among stimulant-using men who have sex with men. Open Forum Infect Dis 2015; 2:ofu114. [PMID: 25884003 PMCID: PMC4396429 DOI: 10.1093/ofid/ofu114] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/04/2022] Open
Abstract
Compared to a control behavioral intervention, Contingency Management, an escalating voucher-based incentive system to reinforce stimulant abstinence, better supported MSM stimulant users in PEP course completion, decreased stimulant use, and a trend toward fewer condomless sexual acts. Background. Stimulant-using men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition. Contingency Management (CM) is a robust substance abuse intervention that provides voucher-based incentives for stimulant-use abstinence. Methods. We conducted a randomized controlled trial of CM with postexposure prophylaxis (PEP) among stimulant-using MSM. Participants were randomized to CM or a noncontingent “yoked” control (NCYC) intervention and observed prospectively. Generalized linear models were used to estimate the effect of CM on PEP course completion, medication adherence, stimulant use, and sexual risk behaviors. Results. At a single site in Los Angeles, 140 MSM were randomized to CM (n = 70) or NCYC (n = 70). Participants were 37% Caucasian, 37% African American, and 18% Latino. Mean age was 36.8 (standard deviation = 10.2) years. Forty participants (29%) initiated PEP after a high-risk sexual exposure, with a mean exposure-to-PEP time of 32.9 hours. PEP course completion was greater in the CM group vs the NCYC group (adjusted odds ratio [AOR] 7.2; 95% confidence interval {CI}, 1.1–47.9), with a trend towards improved medication adherence in the CM group (AOR, 4.3; 95% CI, 0.9–21.9). Conclusions. CM facilitated reduced stimulant use and increased rates of PEP course completion, and we observed a trend toward improved adherence. Participants in the CM group reported greater reductions in stimulant use and fewer acts of condomless anal intercourse than the control group. This novel application of CM indicated the usefulness of combining a CM intervention with PEP to produce a synergistic HIV prevention strategy that may reduce substance use and sexual risk behaviors while improving PEP parameters.
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Affiliation(s)
- Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine , University of California
| | | | | | - Cathy J Reback
- Friends Research Institute, Inc., ; UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles
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Neta G, Glasgow RE, Carpenter CR, Grimshaw JM, Rabin BA, Fernandez ME, Brownson RC. A Framework for Enhancing the Value of Research for Dissemination and Implementation. Am J Public Health 2015; 105:49-57. [PMID: 25393182 PMCID: PMC4265905 DOI: 10.2105/ajph.2014.302206] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/04/2022]
Abstract
A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers.
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Affiliation(s)
- Gila Neta
- Gila Neta is with Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD. Russell E. Glasgow is with Department of Family Medicine and Colorado Health Outcomes Research Program University of Colorado, Denver. Christopher R. Carpenter is with Washington University School of Medicine, Division of Emergency Medicine, St Louis, MO. Jeremy M. Grimshaw is with Clinical Epidemiology Program, Ottawa Hospital Research Institute, and Department of Medicine, University of Ottawa, Ontario. Borsika A. Rabin is with Department of Family Medicine, School of Medicine, University of Colorado, and CRN Cancer Communication Research Center, Institute for Health Research, Kaiser Permanente Colorado, Denver. Maria E. Fernandez is with Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston. Ross C. Brownson is with Prevention Research Center in St Louis, Brown School, Washington University in St Louis, and Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine
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'Better Health Choices' by telephone: a feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders. Psychiatry Res 2014; 220:63-70. [PMID: 25078563 DOI: 10.1016/j.psychres.2014.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 11/23/2022]
Abstract
The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aimed at improving diet and physical activity in people diagnosed with psychotic disorders. Twenty participants diagnosed with a non-acute psychotic disorder were recruited. The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use (as appropriate). F&V frequency and variety, and overall diet quality (measured by the Australian Recommended Food Score, ARFS), leisure screen time, overall sitting and walking time, smoking, alcohol consumption, mood, quality of life, and global functioning were examined before and 4-weeks post-treatment. Nineteen participants (95%) completed all intervention sessions, and 17 (85%) completed follow-up assessments. Significant increases from baseline to post-treatment were seen in ARFS fruit, vegetable and overall diet quality scores, quality of life and global functioning. Significant reductions in leisure screen time and overall sitting time were also seen. Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis. A randomized controlled trial is warranted to replicate and extend these findings.
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Bickel WK, Johnson MW, Koffarnus MN, MacKillop J, Murphy JG. The behavioral economics of substance use disorders: reinforcement pathologies and their repair. Annu Rev Clin Psychol 2014; 10:641-77. [PMID: 24679180 DOI: 10.1146/annurev-clinpsy-032813-153724] [Citation(s) in RCA: 397] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The field of behavioral economics has made important inroads into the understanding of substance use disorders through the concept of reinforcer pathology. Reinforcer pathology refers to the joint effects of (a) the persistently high valuation of a reinforcer, broadly defined to include tangible commodities and experiences, and/or (b) the excessive preference for the immediate acquisition or consumption of a commodity despite long-term negative outcomes. From this perspective, reinforcer pathology results from the recursive interactions of endogenous person-level variables and exogenous environment-level factors. The current review describes the basic principles of behavioral economics that are central to reinforcer pathology, the processes that engender reinforcer pathology, and the approaches and procedures that can repair reinforcement pathologies. The overall goal of this review is to present a new understanding of substance use disorders as viewed by recent advances in behavioral economics.
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Affiliation(s)
- Warren K Bickel
- Virginia Tech Carilion Research Institute, Roanoke, Virginia 24016; ,
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Hartzler B, Jackson TR, Jones BE, Beadnell B, Calsyn DA. Disseminating contingency management: impacts of staff training and implementation at an opiate treatment program. J Subst Abuse Treat 2013; 46:429-38. [PMID: 24462242 DOI: 10.1016/j.jsat.2013.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 12/15/2022]
Abstract
Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study's collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105.
| | - T Ron Jackson
- School of Social Work, University of Washington, Seattle, WA 98105; Evergreen Treatment Services, Seattle, WA 98134
| | - Brinn E Jones
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105
| | - Blair Beadnell
- School of Social Work, University of Washington, Seattle, WA 98105
| | - Donald A Calsyn
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105; Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98105
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Abstract
After decades of defining which behavioral treatments are effective for treating addictions, the focus has shifted to exploring how these treatments work, how best to disseminate and implement them in the community, and what underlying factors can be manipulated in order to increase the rates of treatment success. These pursuits have led to advances in our understanding of the mechanisms of treatment effects, the incorporation of technology into the delivery of current treatments and development of novel applications to support relapse prevention, as well as the inclusion of neurocognitive approaches to target the automatic and higher-order processes underlying addictive behaviors. Although such advances have the promise of leading to better treatments for more individuals, there is still much work required for these promises to be realized. The following review will highlight some of these recent developments and provide a glimpse into the future of behavioral treatments.
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Affiliation(s)
- Brian D. Kiluk
- Corresponding Author Phone: (203) 974-5736 Fax: (203) 974-5790
| | - Kathleen M. Carroll
- Yale School of Medicine, Department of Psychiatry 950 Campbell Ave (151D) West Haven, CT 06516 Phone: (203) 932-5711x7403 Fax: (203) 937-3486
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Ducharme LJ, Chandler RK, Wiley TRA. Implementing drug abuse treatment services in criminal justice settings: Introduction to the CJ-DATS study protocol series. HEALTH & JUSTICE 2013; 1:5. [PMID: 24707454 PMCID: PMC3975625 DOI: 10.1186/2194-7899-1-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/10/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND Despite a growing pipeline of effective clinical treatments, there remains a persistent research-to-practice gap in drug abuse services. Delivery of effective treatment services is especially lacking in the U.S. criminal justice system, where half of all incarcerated persons meet the need for drug abuse or dependence, yet few receive needed care. Structural, financial, philosophical and other barriers slow the pace of adoption of available evidence-based practices. These challenges led to the development of a multi-site cooperative research endeavor known as the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS), funded by the National Institute on Drug Abuse (NIDA). CJ-DATS engages university-based research teams, criminal justice agencies, and community-based treatment providers in implementation research studies to test strategies for enhancing treatment service delivery to offender populations. METHODS This Introduction reviews the mission of NIDA, the structure and goals of the CJ-DATS cooperative, and the implementation studies being conducted by the participating organizations. The component Study Protocols in this article collection are then described. DISCUSSION CJ-DATS applies implementation science perspectives and methods to address a vexing problem - the need to link offender populations with effective treatment for drug abuse, HIV, and other related conditions for which they are at high risk. Applying these principles to the U.S. criminal justice system is an innovative extension of lessons that have been learned in mainstream healthcare settings. This collection is offered as both an introduction to NIDA's work in this area, as well as a window onto the challenges of conducting health services research in settings in which improving public health is not the organization's core mission.
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Affiliation(s)
- Lori J Ducharme
- National Institute on Drug Abuse, 6001 Executive Blvd., Rm 5185 MSC 9589, Bethesda, MD 20892-9589 USA
| | - Redonna K Chandler
- National Institute on Drug Abuse, 6001 Executive Blvd., Rm 5185 MSC 9589, Bethesda, MD 20892-9589 USA
| | - Tisha RA Wiley
- National Institute on Drug Abuse, 6001 Executive Blvd., Rm 5185 MSC 9589, Bethesda, MD 20892-9589 USA
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Rash CJ, Dephilippis D, McKay JR, Drapkin M, Petry NM. Training workshops positively impact beliefs about contingency management in a nationwide dissemination effort. J Subst Abuse Treat 2013; 45:306-12. [PMID: 23856601 DOI: 10.1016/j.jsat.2013.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/22/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
Abstract
In 2011, the Veterans Administration called for nationwide implementation of contingency management (CM) in its intensive outpatient substance use disorders treatment programs, and this study evaluated the impact of the initial 1 and ½ day training workshops on knowledge and perceptions about CM among 159 clinical leaders from 113 clinics. Workshop attendance significantly increased CM-related knowledge (d=1.88) and changed attendees' perceptions of CM (ds=0.26-0.74). Endorsement of barriers to CM adoption decreased and positive impressions of CM increased. These perceptions about CM emerged as key correlates of post-training preparedness to implement CM. Results suggest that training workshops can be an effective avenue for increasing CM-related knowledge, as well as addressing persistent misperceptions about CM that may impede adoption efforts. Continued efforts to introduce educational materials and offer training and consultation opportunities may increase understanding about this evidence-based intervention among clinicians, thereby leading to improved patient outcomes.
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Affiliation(s)
- Carla J Rash
- Calhoun Cardiology Center - Behavioral Health, University of Connecticut Health Center, Farmington, CT 06030-3944, USA.
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Meredith SE, Dallery J. Investigating group contingencies to promote brief abstinence from cigarette smoking. Exp Clin Psychopharmacol 2013; 21:144-54. [PMID: 23421358 PMCID: PMC3657835 DOI: 10.1037/a0031707] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In contingency management (CM), monetary incentives are contingent on evidence of drug abstinence. Typically, incentives (e.g., "vouchers" exchangeable for goods or services) are contingent on individual performance. We programmed vouchers contingent on group performance to investigate whether these contingencies would promote brief abstinence from cigarette smoking. Thirty-two participants were divided into small teams (n = 3 per team). During three 5-day within-subject experimental conditions, participants submitted video recordings of breath carbon monoxide (CO) measures twice daily via Motiv8 Systems, an Internet-based remote monitoring application. During the interdependent contingency condition, participants earned vouchers each time they and their teammates submitted breath CO samples indicative of abstinence (i.e., negative samples). During the independent contingency condition, participants earned vouchers each time they submitted negative samples, regardless of their teammates' performance. During the no vouchers condition, no monetary incentives were contingent on abstinence. In addition, half of the participants (n = 16) could communicate with their teammates through an online peer support forum. Although forum access did not appear to promote smoking abstinence, monetary incentives did promote brief abstinence. Significantly more negative samples were submitted when vouchers were contingent on individual performance (56%) or team performance (53%) relative to when no vouchers were available (35%; F = 6.9, p = .002). The results show that interdependent contingencies can promote brief abstinence from cigarette smoking. Moreover, the results suggest that these contingencies may help lower treatment costs and promote social support.
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Lash SJ, Burden JL, Parker JD, Stephens RS, Budney AJ, Horner RD, Datta S, Jeffreys AS, Grambow SC. Contracting, prompting and reinforcing substance use disorder continuing care. J Subst Abuse Treat 2013; 44:449-56. [DOI: 10.1016/j.jsat.2012.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 09/20/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Hartzler B, Rabun C. Community treatment adoption of contingency management: a conceptual profile of U.S. clinics based on innovativeness of executive staff. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:333-41. [PMID: 22940140 DOI: 10.1016/j.drugpo.2012.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/10/2012] [Accepted: 07/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Community adoption of contingency management (CM) varies considerably, and executive innovativeness may help explain variance due to its presumed influence on clinic decision-making. METHODS Sixteen U.S. opioid treatment programs (OTPs) were visited, with ethnographic interviewing used in casual contacts with executives to inform their eventual classification by study investigators into one of Rogers' (2003) five adopter categories. Audio-recorded interviews were also conducted individually with the executive and three staff members (N = 64) wherein they reported reactions to clinic CM implementation during the prior year, from which study investigators later identified salient excerpts during interview transcript reviews. RESULTS The executive sample was progressive, with 56% classified as innovators or early adopters. Implementation reports and corresponding staff reactions were generally consistent with what might be expected according to diffusion theory. Clinics led by innovators had durably implemented multiple CM applications, for which staff voiced support. Clinics led by early adopters reported CM exposure via research trial participation, with mixed reporting of sustained and discontinued applications and similarly mixed staff views. Clinics led by early majority adopters employed CM selectively for administrative purposes, with staff reticence about its expansion to therapeutic uses. Clinics led by late majority adopters had either deferred or discontinued CM adoption, with typically disenchanted staff views. Clinics led by a laggard executive evidenced no CM exposure and strongly dogmatic staff views against its use. CONCLUSION Study findings are consistent with diffusion theory precepts, and illustrate pervasive influences of executive innovativeness on clinic practices and staff impressions of implementation experiences.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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