SARA BECKER
RTI International, Brown University

Contingency management (CM) is one of the only behavioral interventions shown to improve patient abstinence from opioids when combined with FDA-approved pharmacotherapy. Nonetheless, the implementation of CM in opioid treatment programs (OTPs) remains low. Furthermore, research suggests that when CM is implemented in real-world treatment settings, it is implemented with poor adherence. The objective of this poster is to describe the development and use of the Contingency Management Tracker, which was developed to serve the dual purpose of a research tool for standardizing the assessment of CM implementation and an implementation strategy (develop and implement tools for quality monitoring) to improve fidelity.

Eighteen OTPs in the New England region of the United States recruited thus far for a 30-site, multi-cohort trial.

Funded by the National Institute on Drug Abuse, Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) is a cluster-randomized type 3 implementation-effectiveness hybrid trial testing strategies for helping OTPs and their staff implement CM. As part of Project MIMIC, the maximum number of CM sessions is 12 and the maximum number of prize draws is 78. Beyond general implementation data, the CM Tracker was designed to collect and store data specific to the escalating prize-based CM protocol being implemented as part of Project MIMIC. By providing simple inputs about CM sessions, staff receive a user-friendly dashboard that provides visual information to support CM implementation with patients.

To date, 47 CM staff across 16 OTPs have used the project’s CM Tracker for documenting CM implementation. Of the project’s 284 patient participants, CM was initiated by 229 (81%). Per data collected in the CM Tracker, there have been 1,486 CM sessions to date. The median number of CM sessions implemented per initiated patient was 6 (out of 12 possible sessions). OTPs varied widely in their implementation, with the number of initiated patients ranging from 0 to 31. Across OTPs with at least one initiated patient (n = 16), the average number of CM sessions per initiated patient ranged from 3.1 to 11.5. Across OTPs with at least one initiated patient, the average number of CM prize draws per initiated patient was 23.7 and ranged from 4.8 to 61.5.

The CM Tracker is an innovative tool that can simultaneously serve a research tool and an implementation strategy. Future research is needed to examine the extent to which OTPs sustain the implementation of CM, as well as examine the extent to which they develop their own tools for monitoring quality of CM implementation.

SHEILA V. PATEL
RTI International

The Implementation & Sustainment Facilitation (ISF) Strategy has been found to be effective (Garner et al., 2020) and cost-effective (Hinde et al., 2021) for improving both implementation effectiveness (i.e., the consistency and quality of intervention implementation) and intervention effectiveness (i.e., the extent to which the intervention improves client outcomes). Beyond the importance of “specifying” implementation strategies is the importance of “tracking” implementation strategies (Bunger et al., 2017). The focus of this presentation will be on describing the development and use of two pragmatic tools for tracking the ISF Strategy. Setting: This work is intended to support broad use of the ISF Strategy as part of implementation research and practice.

Funded by the National Institute on Drug Abuse, the SAT2HIV-II Project is a cluster-randomized type 3 hybrid trial testing the impact of the ISF Strategy on helping HIV service organizations (N = 30) and their respective staff implement a motivational interviewing-based brief intervention. Carried forward from the first SAT2HIV Project, the ISF Strategy Workbook is a pragmatic tool for tracking adherence to the ISF Strategy by “action targets” (e.g., the staff at HIV service organizations receiving the ISF Strategy; Proctor et al., 2013). The ISF Strategy Tracker was developed as part of the SAT2HIV-II Project to be a pragmatic tool for:(a) tracking ISF Strategy adherence by the “action targets” as well as (b) tracking ISF Strategy fidelity by the “actor” (e.g., the ISF Facilitator; Proctor et al., 2013).

The ISF Strategy Workbook and the ISF Strategy Tracker have been successfully used together in the SAT2HIV-II Project, which currently has 12 HIV service organizations participating. While some data elements overlap between the tools, using both assures quality of strategy tracking data. The tools currently show 97.14% agreement in documentation of ISF meetings for the participating organizations. For ISF meetings documented in both tools, there is 93.63% agreement in staff participation. Lack of agreement creates flags for reviewing and correcting data as appropriate. The tools have also demonstrated utility beyond assuring data quality. The ISF Strategy Workbook is a useful tool for ISF Facilitators to plan for and document their meetings as well as to reorient and guide participating staff during meetings. Alternatively, the ISF Strategy Tracker supports research efforts by automatically aggregating data across organizations and transforming them to easily link to outcomes and assess the impact of the ISF strategy.

The ISF Strategy Workbook and the ISF Strategy Tracker are two pragmatic tools for tracking the ISF Strategy. Our future research plans include examining the extent to which variation in key implementation outcomes and/or client outcomes can be predicted by variations in ISF Strategy adherence and fidelity.