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Dopp AR, Hunter SB, Godley MD, González I, Bongard M, Han B, Cantor J, Hindmarch G, Lindquist K, Wright B, Schlang D, Passetti LL, Wright KL, Kilmer B, Aarons GA, Purtle J. Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study. Implement Sci 2023; 18:50. [PMID: 37828518 PMCID: PMC10571404 DOI: 10.1186/s13012-023-01305-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: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Financial barriers in substance use disorder service systems have limited the widespread adoption-i.e., provider-level reach-of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. METHOD A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. RESULTS The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p = .01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). DISCUSSION As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | | | - Michelle Bongard
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Kerry Lindquist
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Blanche Wright
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA
| | - Danielle Schlang
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Gregory A Aarons
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr. (0812), La Jolla, San Diego, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Dopp AR, Hunter SB, Godley MD, Pham C, Han B, Smart R, Cantor J, Kilmer B, Hindmarch G, González I, Passetti LL, Wright KL, Aarons GA, Purtle J. Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study. Implement Sci Commun 2022; 3:51. [PMID: 35562836 PMCID: PMC9099033 DOI: 10.1186/s43058-022-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. METHOD We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types' outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. DISCUSSION The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health-while advancing implementation science through the use of novel methods to study financing strategies and sustainment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Isabelle González
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Gregory A Aarons
- Department of Psychiatry, 9500 Gilman Dr. (0812), University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Staton M, Webster JM, Leukefeld C, Tillson M, Marks K, Oser C, Bush HM, Fanucchi L, Fallin-Bennett A, Garner BR, McCollister K, Johnson S, Winston E. Kentucky Women's Justice Community Opioid Innovation Network (JCOIN): A type 1 effectiveness-implementation hybrid trial to increase utilization of medications for opioid use disorder among justice-involved women. J Subst Abuse Treat 2021; 128:108284. [PMID: 33455828 DOI: 10.1016/j.jsat.2021.108284] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/03/2020] [Accepted: 01/05/2021] [Indexed: 01/20/2023]
Abstract
The opioid crisis has disproportionately affected women, but research on approaches to increase initiation of medications for opioid use disorder (MOUD) among women is limited. The Kentucky Justice Community Opioid Innovation Network (JCOIN) will implement a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pretreatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community. The overall goal of the project is to increase initiation and maintenance of MOUD among high-risk justice-involved women during community reentry to reduce opioid relapse and overdose. This project and other studies through the JCOIN network have the potential to significantly impact the OUD treatment field by contributing empirical evidence about the effectiveness and implementation of innovative technologies to increase initiation and maintenance of MOUD during a critical, high-risk time of community reentry among vulnerable, justice-involved individuals in both urban and nonurban communities.
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Affiliation(s)
- Michele Staton
- University of Kentucky College of Medicine, Department of Behavioral Science, 1100 Veterans Drive, Lexington, KY 40536, USA.
| | - J Matthew Webster
- University of Kentucky College of Medicine, Department of Behavioral Science, 1100 Veterans Drive, Lexington, KY 40536, USA
| | - Carl Leukefeld
- University of Kentucky College of Medicine, Department of Behavioral Science, 1100 Veterans Drive, Lexington, KY 40536, USA
| | - Martha Tillson
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY 40536, USA; University of Kentucky College of Arts & Sciences, Department of Sociology, Lexington, KY 40508, USA
| | - Katherine Marks
- Kentucky Cabinet for Health and Family Services, Department of Behavioral Health, 275 East Main Street, Frankfort, KY, 40621, USA
| | - Carrie Oser
- University of Kentucky College of Arts & Sciences, Department of Sociology, Lexington, KY 40508, USA
| | - Heather M Bush
- University of Kentucky College of Public Health, Department of Biostatistics, 760 Press Avenue, Healthy Kentucky Bldg, Suite 260, Lexington, KY 40536-0082, USA
| | - Laura Fanucchi
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY 40536, USA; University of Kentucky College of Medicine, Division of Infectious Diseases, 740 S. Limestone St., K512, Lexington, KY 40356, USA
| | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, 520 College of Nursing Building, Lexington, KY 40536, USA
| | - Bryan R Garner
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA
| | - Kathryn McCollister
- University of Miami, Department of Public Health Sciences, 1120 N.W. 14th Street, Suite 1019, Miami, FL 33136, USA
| | - Sarah Johnson
- Kentucky Department of Corrections, 2439 Lawrenceburg Road, Frankfort, KY 40602, USA
| | - Erin Winston
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY 40536, USA
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Stolldorf DP, Fortune-Britt AG, Nieuwsma JA, Gierisch JM, Datta SK, Angel C, Millspaugh DD, Jackson GL. Measuring sustainability of a grassroots program in a large integrated health care delivery system: the Warrior to Soul Mate Program. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2018; 4:81-90. [PMID: 31448320 DOI: 10.3138/jmvfh.2017-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Veterans experience many physical and psychosocial adjustment problems that challenge personal relationships and social functioning and successful social reintegration. The Warrior to Soul Mate (W2SM) program uses a structured curriculum [i.e., the Practical Application of Intimate Relationships Skills (PAIRS)] to address veterans' interpersonal needs by teaching participants effective interpersonal skills. Veterans who attended the W2SM program reported lower anxiety levels, improvements in marital alterations and satisfaction, and increased intimacy, cohesion, and affection. Therefore, sustaining the W2SM program can have long-term positive effects for veterans, families, and the greater society. The purpose of this paper is to describe the sustainability of the W2SM program. Methods The Model of Community-based Program Sustainability conceptually guided the evaluation. Twenty-three VA hospitals in the U.S. that offer W2SM programs completed a self-report survey to measure sustainability. Results The highest scoring sustainability elements were "Demonstrating program results" (M=5.82, SD=1.23), "Staff involvement and integration" (M= 5.79, SD= 1.34), and "Program responsivity" (M=4.39, SD= 1.16); the lowest scoring element was "Strategic funding" (M=2.78, SD=1.75). Statistically significant associations were found between the global middle-range program results and three sustainability elements: leadership competence (r = .472, p = .023), effective collaboration (r = .470, p = .024), and strategic funding (r = .507, p = .014). Discussion Efforts to sustain programs should focus on leaders planning for sustainability at the onset of program implementation, collaborators must be involved in program design, implementation and evaluation, and long-term funding sources must be secured to support program operations and continuation.
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Affiliation(s)
| | - Alice G Fortune-Britt
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jason A Nieuwsma
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Santanu K Datta
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Clyde Angel
- Chaplain Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - Dick D Millspaugh
- Chaplain Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Duke University, Durham, NC, USA
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Garner BR, Zehner M, Roosa MR, Martino S, Gotham HJ, Ball EL, Stilen P, Speck K, Vandersloot D, Rieckmann TR, Chaple M, Martin EG, Kaiser D, Ford JH. Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial. Addict Sci Clin Pract 2017; 12:32. [PMID: 29149909 PMCID: PMC5693537 DOI: 10.1186/s13722-017-0096-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. METHODS Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). DISCUSSION Although not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO's capacity to address substance use may improve the HIV Care Continuum. Trial registration ClinicalTrials.gov: NCT03120598.
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Affiliation(s)
- Bryan R. Garner
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Mark Zehner
- School of Medicine and Public Health, University of Wisconsin–Madison, 1930 Monroe St., Madison, WI 53711-2027 USA
| | | | - Steve Martino
- Department of Psychiatry, VA Connecticut Healthcare System, Yale University, 950 Campbell Avenue (116B), West Haven, CT 06516 USA
| | - Heather J. Gotham
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108 USA
| | - Elizabeth L. Ball
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108 USA
| | - Kathryn Speck
- University of Nebraska Public Policy Center, 215 Centennial Mall South, Suite 401, Lincoln, NE 68588 USA
| | - Denna Vandersloot
- Vandersloot Training & Consulting, 11845 NW Stone Mt. Lane, #108, Portland, OR 97229 USA
| | - Traci R. Rieckmann
- School of Medicine Psychiatry, and Greenfield Health Medicine, Oregon Health & Science University, 9450 SW Barnes Road St. 100, Portland, OR 97225 USA
| | - Michael Chaple
- National Development and Research Institutes, Inc, 71 West 23rd Street, New York, NY 10010 USA
| | - Erika G. Martin
- Rockefeller Institute of Government, State University of New York, New York, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, 1400 Washington Avenue, Milne 300E, Albany, NY 12222 USA
| | - David Kaiser
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - James H. Ford
- School of Medicine and Public Health, University of Wisconsin–Madison, 1930 Monroe St., Madison, WI 53711-2027 USA
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Garner BR, Hunter SB, Slaughter ME, Han B, Godley SH. Factors associated with an evidence-based measure of implementation for the Adolescent Community Reinforcement Approach. Drug Alcohol Depend 2017; 180:144-150. [PMID: 28888154 PMCID: PMC6757189 DOI: 10.1016/j.drugalcdep.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND An evidence-based measure of implementation (EBMI) is an implementation outcome measure shown to have predictive validity with one or more future-measured constructs of importance. The current study sought to identify correlates and predictors of an EBMI called procedure exposure. Garner et al. (2016) found procedure exposure to be an EBMI for the Adolescent Community Reinforcement Approach (A-CRA). METHODS The dataset included 76 community-based substance use treatment organizations located across the United States. Organizational-level regression analyses, which were framed within the context of Chaudoir et al. (2013) framework for predicting implementation outcomes, were used to examine predictors of A-CRA procedure exposure RESULTS: The Washington Circle's treatment initiation performance measure (B=5.05 [SE=1.60], p=0.002), as well as session exposure (B=0.18 [SE=0.06], p=0.003), were significant predictors of A-CRA procedure exposure in the backward stepwise regression analysis (Adjusted R-square=0.55). The Washington Circle's treatment engagement performance measure (B=7.93 [SE=0.77], p<0.001), as well as time-to-proficiency (B=-0.04 [SE=0.02], p=0.02), each had significant bivariate relationships with A-CRA procedure exposure but were not retained in the final model. CONCLUSIONS Organizations implementing A-CRA are encouraged to make the following high priorities: (a) scheduling and completing a subsequent treatment session within 14days of their index session (treatment initiation) and (b) providing a targeted number of treatment sessions to each client (session exposure). To the extent organizations do this, they may be more likely to achieve higher levels of A-CRA procedure exposure.
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Affiliation(s)
- Bryan R. Garner
- RTI International, P. O. Box 12194, Research Triangle Park, NC 27709, USA,Corresponding author. (B.R. Garner)
| | | | | | - Bing Han
- RAND Corp, P.O. Box 2138, Santa Monica, CA 90407, USA.
| | - Susan H. Godley
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA
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Hunter SB, Han B, Slaughter ME, Godley SH, Garner BR. Predicting evidence-based treatment sustainment: results from a longitudinal study of the Adolescent-Community Reinforcement Approach. Implement Sci 2017; 12:75. [PMID: 28610574 PMCID: PMC5470280 DOI: 10.1186/s13012-017-0606-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation support models are increasingly being used to enhance the delivery of evidence-based treatments (EBTs) in routine care settings. Little is known about the extent to which these models lead to continued EBT use after implementation support ends. Moreover, few empirical studies longitudinally examine the hypothesized factors associated with long-term psychosocial EBT use (i.e., sustainment). In an effort to address this gap, the current study examined sustainment of an EBT called the Adolescent-Community Reinforcement Approach (A-CRA) following the end of implementation support. METHODS Between 2006 and 2010, the Substance Abuse and Mental Health Services Administration awarded 3 years of A-CRA implementation support to 82 community-based organizations around the USA. The extent to which A-CRA was sustained following grant end and the hypothesized factors associated with EBT sustainment were collected using both retrospective and prospective data. We examined the extent to which 10 core treatment elements of A-CRA were sustained and the associations between the extent of A-CRA sustainment and hypothesized factors using a pattern-mixture longitudinal modeling approach. RESULTS Staff from 76 organizations participated in data collection for a 92.86% response rate. On average, about half of the 10 core treatment elements were sustained following the loss of implementation support. Factors that appeared most important to A-CRA sustainment included characteristics that were related to the outer setting (communication, funding, and partnerships), inner setting (political support, organizational capacity, and supervisor turnover rate), implementation support period (number of clinicians and supervisors certified and employed at support end and number of youth served), and staff perceptions of the intervention (implementation difficulty, relative advantage, and perceived success). CONCLUSIONS Even with multiple years of implementation support, community-based organizations face challenges in sustaining EBT delivery over time. Consistent with implementation theories, multiple factors appear related with EBT sustainment, including the degree of implementation during the initial support period, as well as adequate funding, infrastructure support, and staff support following the end of funding.
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Affiliation(s)
- Sarah B Hunter
- RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Bing Han
- RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Susan H Godley
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL, 61761, USA
| | - Bryan R Garner
- Research Triangle Institute, 3040 E. Cornwallis Rd, Research Triangle Park, NC, 27709-2194, USA
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8
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Garner BR, Hunter SB, Funk RR, Griffin BA, Godley SH. Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes. J Subst Abuse Treat 2016; 67:15-21. [PMID: 27296657 PMCID: PMC5033242 DOI: 10.1016/j.jsat.2016.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Developing consistent, valid, and efficient implementation outcome measures is necessary to advance implementation science. However, development of such measures has been limited to date, especially for validating the extent to which such measures are associated with important improvements in client outcomes. This study seeks to address this gap by developing one or more evidence-based measures of implementation (EBMIs; i.e., implementation outcome measure that is predictive of improvements in key client outcomes) for the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based practice (EBP) for adolescent substance use. METHODS Data for the current study were collected as part of a large-scale federally funded EBP dissemination and implementation initiative. The multilevel dataset included 65 substance use treatment organizations, 308 clinicians, and 5873 adolescent clients. Adjusted multilevel regression analyses were used to examine the extent to which client-level outcome measures assessed at 6-month follow-up (i.e., substance use, emotional problems) could be predicted by four implementation outcomes: two measures of fidelity (i.e., session exposure, procedure exposure) and two measures of penetration (i.e., absolute client penetration, absolute staff penetration). RESULTS Adjusting for client substance use at intake, as well as several client characteristics (e.g., age, race, criminal justice involvement), client substance use at follow-up was significantly lower for treatment organizations that had higher procedure exposure (B=-1.227, standard error [SE]=0.583, 95% confidence interval=-2.370, 0.252; p<.05). None of the other three implementation outcome measures were found to predict improvements in client outcomes. CONCLUSIONS The current study provides support for procedure exposure as an organizational-level EBMI for A-CRA. Thus, future efforts focused on implementing A-CRA could be improved by measuring and monitoring the extent to which A-CRA procedures are being delivered to clients. Additionally, given the dearth of studies that have examined the relationship between organizational-level measures of implementation and client outcomes, this article provides a prototype for future research to identify EBMIs for other behavioral treatments.
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Affiliation(s)
- Bryan R Garner
- RTI International, P. O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Rodney R Funk
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL, 61761, USA.
| | | | - Susan H Godley
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL, 61761, USA.
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Abstract
Schools provide an ideal setting for screening, brief interventions, and outpatient treatment for substance use disorders (SUD). Individual treatment for SUD is effective at decreasing substance use as well as substance-related harm. In some contexts, rather than being helpful, group interventions can result in harm to participants; therefore, individual treatment may be preferred. Early interventions for adolescents who are using alcohol and other drugs (AOD) are generally effective in decreasing frequency and quantity of AOD use as well as decreasing risky behaviors.
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