The Implementation & Sustainment Facilitation (ISF) Strategy: Guiding theory, framework, principles, and empirical support

Posted on May 7, 2021May 21, 2021 by coprhcon

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.

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.

eScreening for Suicide Prevention in VA Programs using a Stepped-wedge, Mixed-method, Hybrid Type-II Implementation Trial

Posted on May 7, 2021May 18, 2021 by coprhcon

BACKGROUND

Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening.

METHODS

This is an eight site, four year, stepped-wedge, mixed-method, hybrid type-II implementation/pragmatic trial comparing eScreening to screening as usual while also evaluating potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high and low eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews.

The Stakeholder Engaged Real-Time Delphi Method: A Method for Empirically Identifying Stakeholder-Driven Recommendations

Posted on May 7, 2021May 21, 2021 by coprhcon

BACKGROUND

The Delphi method has been used since the 1950s as a method for collecting and synthesizing “expert” judgments. To increase the “efficiency of the process” and decrease “the time to perform such studies” Gordon and Pease (2006) introduced the Real-Time Delphi (RTD) method. The RTD method produces results similar to conventional Delphi studies, but more quickly and efficiently due to the feedback being provided immediately (i.e., in real time). To date, the conventional Delphi method and the RTD method have been limited to use with small group of “experts.” According to the Kotter Change Framework, successful change efforts result from building a guiding coalition of stakeholders that can lead the identification of specific recommendations. Guided by this framework, the Substance-Treatment-Strategies for HIV (STS4HIV) Project developed the Stakeholder Engaged RTD (SE-RTD) as a method to engage a large group of key stakeholders and empirically identify stakeholder-driven recommendations for improving the integration of evidence-based treatment interventions for substance use disorders (SUDs) within HIV service settings. This presentation will describe the SE-RTD method, as well as illustrate how it has been successfully used as part of the STS4HIV Project.

METHODS

The RTD web-program developed by Gordon and Pease (2006) was used for our project’s first SE-RTD, which was focused on identifying and comparing stakeholder groups perceptions regarding the prevalence and negative impacts of five different SUDs for people with HIV. For the project’s second SE-RTD, which was focused on identifying stakeholder perceptions regarding the innovation-practice fit of nine evidence-based SUD treatment interventions, we developed a new and improved RTD web-program that addressed key limitations of the original web-program. Our latest RTD web-program is being customized for use as part of the project’s third and final SE-RTD, which is focused on identifying stakeholder perceptions regarding strategy-purveyor fit of 10 strategies AETCs may consider using to help improve the integration of evidence-based SUD treatment interventions within HIV service organizations.