Using IM-Adapt to Implement CREST in Spanish-speaking Rural Communities for Hoarding Disorder

Join us as this presenter discusses this poster live on May 25, 2021 | Track A at 1:00 PM Mountain

PRESENTER
JAMES PITTMAN
University of California San Diego, VA San Diego Center of Excellence for Stress and Mental Health
BACKGROUND
Hoarding disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and community consequences. HD is defined by persistent difficulty discarding or parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. As a result, clutter accumulates and fills active living areas, preventing the normal use of space resulting in distress and disability. The accumulation of clutter places individuals at risks of falls, fires, infestation, food contamination, medication mismanagement, social isolation, and nutritional deprivation. HD starts early in life and progresses in severity with age and does not remit if left untreated. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) provides training in compensatory cognitive strategies to address the executive dysfunction typical of individuals with HD, then uses exposure therapy to reduce the distress associated with discarding items. CREST improves hoarding symptoms and functioning in older adults with HD, but there has been little focus on the implementation and dissemination of evidence-based treatment for hoarding in community settings.
SETTING/POPULATION
Spanish-speaking adults with HD who reside in rural communities, including East San Diego County and Imperial County, which reliably have worse outcomes and access to evidenced-based mental care compared to more urban communities.
METHODS
To address the lack of evidence-based interventions for HD in the rural heavily Spanish speaking East San Diego and Imperial Counties, we plan to use the IM-Adapt (Intervention Mapping – Analyze, Discover, Adapt, Practice, Test) model to tailor an implementation strategy. The tailored implementation strategy will be used to scale-out CREST to these communities, focused on Spanish-speaking adults with HD. This project will work with a diverse group of stakeholders to analyze the needs and goals of these regions via focus groups and interviews to provide evidence-based services to residents with HD, adapt a strategy, and develop a practice plan for implementing CREST in these communities.
CONCLUSIONS
Preliminary results demonstrate the feasibility of using the Practical Robust Implementation and Sustainability Model (PRISM) to implement the CREST intervention in a community setting to effectively treat hoarding disorder in low income older adults. The current project will generate additional knowledge and innovations to inform larger implementation efforts. The overall goal of this project is to reduce mental healthcare disparities in these regions related to HD.
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Perspectives about Pharmacy Champions for Medication Safety for Veterans

Join us as this presenter discusses this poster live on May 25, 2021 | Track A at 1:00 PM Mountain

PRESENTER
ANJU SAHAY, PhD
Veterans Affairs Palo Alto Health Care System
BACKGROUND
The focus of the Department of Veteran Affairs’ (VA) Medication Safety QUERI Program is to reduce potentially unsafe or unnecessary medications for the Veterans. VA facilities (sites) use strategies to implement VA Pharmacy Benefits Management (PBM) Services initiatives and VISN (region) measures. The Medication Safety QUERI Program aimed to understand the role and use of champions in promoting select strategies to optimize medication safety for Veterans which included provider education, academic detailing, electronic reminders, patient specific care plan, draft orders, patient mailings and calling patients.
SETTING/POPULATION
Participants were two pharmacists from each of the 18 VISNs (N=36). The VISN Pharmacy Executives (VISN-level PBM Leads) identified these pharmacists from their own VISN.
METHODS
In Summer 2018 we conducted semi-structured phone interviews with these pharmacists. Participants were asked “…is there is a “Champion” such as a VA provider, pharmacist, administrator, or someone else who is leading or promoting the efforts to implement these strategies at your facility?” and if yes, participants were asked to respond regarding the champion’s location at the facility, VISN or both levels. All interviews were recorded and then transcribed for coding and analysis. An open iterative process was used to create the codebook which was then applied by a trained qualitative coder who adjudicated content as needed.
RESULTS
Sixteen participants (44.4%) said they have champion(s) leading or promoting effective implementation strategies, while the remaining majority of participants (55.6%) said they do not have such a champion. Among those participants who reported having champion(s), the number of champions ranged from having one champion (n=8), two champions (n=3) to multiple champions (n=5). These champions were located at their own local level (n=11), at their own region(n=2) and both at their own local and own regional levels (n=3).
 
Participants identified qualities in a ‘champion’ as one who encourages strategy utilization, is willing to listen and have regular communications such as hosting monthly phone calls and VISN meetings, addresses potential barriers encountered by the providers, encourages provider education about best practices and assists with the development, implementation and on-going oversight of initiatives and measures at their facility.
 
These champions were described as “…he really is overseeing and helping us throughout the entire process” and “…has been more than willing to listen to our recommendations, provide feedback, kind of go out on a limb…to discuss these issues with a provider that may not be seeing eye-to-eye with us and recommend what can we do to resolve this issue and keep the patient safe and provide good care…”.
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The Implementation & Sustainment Facilitation (ISF) Strategy: Guiding theory, framework, principles, and empirical support

Join us as this presenter discusses this poster live on May 25, 2021 | Track A at 1:00 PM Mountain

PRESENTER
BRYAN R. GARNER, PhD
RTI International
BACKGROUND
Facilitation (i.e., the process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship) has been identified as one of 73 discrete implementation strategies (Powell et al., 2015). The Implementation and Sustainment Facilitation (ISF) Strategy is a facilitation-based strategy that has experimental evidence that supports its effectiveness (Garner et al., 2020). This presentation/poster will focus on describing the ISF Strategy’s guiding theory, framework, principles, and empirical support.
SETTING/POPULATION
The ISF Strategy was originally developed to help improve the integration of a motivational interviewing-based brief intervention for substance use within HIV service settings. However, the ISF Strategy is currently being used to help improve the implementation of contingency management with opioid treatment settings.
METHODS
The ISF Strategy is guided by the theory of implementation effectiveness (Klein & Sorra, 1996), the EPIS (exploration-preparation-implementation-sustainment) framework (Aarons, Hurlburt, and Horwitz, 2011), and the principles of motivational interviewing in groups (Wagner & Ingersoll, 2012). See www.ISFstrategy.org for more information. As part of the Substance Abuse Treatment to HIV Care (SAT2HIV) Project, a dual-randomized type 2 hybrid trial was used to test the effectiveness of the ISF Strategy as an adjunct to the staff-focused Addiction Technology Transfer Center (ATTC) Strategy for implementation of motivational interviewing (i.e., training, feedback, and on-going consultation).
RESULTS
Thirty-nine HIV organizations were randomized to either the ATTC Strategy (n = 19) or the ATTC+ISF Strategy (n = 20). Each HIV organization identified two staff members to be prepared to implement the MIBI (N = 78). Subsequently, during the implementation phase, HIV organizations in each condition randomized client participants (N = 824) to one of the two intervention conditions: usual care (UC; n = 415) or UC + MIBI (n = 409). The ISF Strategy improved implementation effectiveness (i.e., the consistency and the quality of implementation; ? = .65, p = .01), as well as intervention effectiveness (i.e., the effectiveness of the MIBI), at least in terms of significantly decreasing the odds (odds ratio = 0.11, p = .02) of clients using their primary substance daily during follow-up.
CONCLUSIONS
ISF Strategy is a well-grounded facilitation-based strategy with experimental evidence supporting its effectiveness. Use of the ISF Strategy as part of future implementation research and/or implementation practice is warranted.
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