scholarly journals Implementation support for contingency management: preferences of opioid treatment program leaders and staff

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Kelli Scott ◽  
Shelly Jarman ◽  
Samantha Moul ◽  
Cara M. Murphy ◽  
Kimberly Yap ◽  
...  
Keyword(s):  
Performance Feedback ◽  
Contingency Management ◽  
Scale Up ◽  
Team Approach ◽  
Evidence Based ◽  
Implementation Support ◽  
Training Performance ◽  
Opioid Treatment ◽  
Treatment Providers ◽  
External Facilitation

Abstract Background Contingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, is an evidence-based adjunct to medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. This study applied user-informed approaches to adapt a multi-level implementation strategy called the Science to Service Laboratory (SSL) to support CM implementation. Methods Leaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for training and support implementation strategies (didactic training, performance feedback, and external facilitation). Our team coded interviews using a reflexive team approach to identify common a priori and emergent themes. Results Leaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio-recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled external facilitation to support their continued use of CM. Conclusions This study provides an exemplar of a user-informed approach to adapt the SSL implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.

scholarly journals Implementation Support for Contingency Management: Preferences of Opioid Treatment Program Leaders and Staff 

2020 ◽  
Author(s):  
Kelli Scott ◽  
Shelly Jarman ◽  
Samantha Moul ◽  
Cara M Murphy ◽  
Kimberly Yap ◽  
...  
Keyword(s):  
Learning Strategies ◽  
Performance Feedback ◽  
Contingency Management ◽  
Scale Up ◽  
Team Approach ◽  
Opioid Use ◽  
Implementation Support ◽  
Training Performance ◽  
Opioid Treatment ◽  
Treatment Providers

Abstract Background: Contingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, has strong evidence for its effectiveness when combined with medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. User-informed approaches offer a unique opportunity to adapt implementation strategies to support CM implementation. Methods: Leaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for implementation support (didactic training, performance feedback, and ongoing facilitation). Interviews were coded using a reflexive team approach to identify common a priori and emergent themes. Results: Leaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled ongoing facilitation to support their continued use of CM. Conclusions: This study provides an exemplar of a user-informed approach to adapt implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.

scholarly journals Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy

2018 ◽  
Vol 40 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Sara J. Becker ◽  
Lourah M. Kelly ◽  
Augustine W. Kang ◽  
Katherine I. Escobar ◽  
Daniel D. Squires
Keyword(s):  
Implementation Strategy ◽  
Contingency Management ◽  
Opioid Treatment ◽  
Factors Associated ◽  
Treatment Providers

Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

2020 ◽  
Author(s):  
MariaGabriela Uribe Guajardo ◽  
Andrew James Baillie ◽  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Katie Wood ◽  
...  
Keyword(s):  
Substance Use ◽  
Clinical Supervision ◽  
Mental Health Problems ◽  
Scale Up ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Self Report ◽  
Evidence Based ◽  
Face To Face ◽  
Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

scholarly journals Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lisa Mwaikambo ◽  
Sarah Brittingham ◽  
Saori Ohkubo ◽  
Ruwaida Salem ◽  
Denis Joel Sama ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Systems ◽  
Thematic Analysis ◽  
Urban Areas ◽  
Local Governments ◽  
Scale Up ◽  
Analytical Framework ◽  
Essential Elements ◽  
Evidence Based ◽  
Country Ownership

Abstract Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

scholarly journals Extent, Type and Reasons for Adaptation and Modification When Scaling-Up an Effective Physical Activity Program: Physical Activity 4 Everyone (PA4E1)

2021 ◽  
Author(s):  
Matthew Mclaughlin ◽  
Elizabeth Campbell ◽  
Rachel Sutherland ◽  
Tom McKenzie ◽  
Lynda Davies ◽  
...  
Keyword(s):  
Physical Activity ◽  
Program Effectiveness ◽  
Negative Impact ◽  
Positive Impact ◽  
Scale Up ◽  
Evaluation Methods ◽  
Physical Activity Program ◽  
Implementation Support ◽  
Support Strategies ◽  
Activity Program

Abstract Background Few studies have described the extent, type and reasons for making changes to a program prior to and during its delivery using a consistent taxonomy. Physical Activity 4 Everyone (PA4E1) is a secondary school physical activity program that was scaled-up for delivery to a greater number of schools. We aimed to describe the extent, type and reasons for changes to the PA4E1 program (the evidence-based physical activity practices, implementation support strategies and evaluation methods) made before its delivery at scale (adaptations) and during its delivery in a scale-up trial (modifications). Methods The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) was used to describe adaptations (planned and made prior to the scale-up trial) and modifications (made during the conduct of the trial). A list of adaptations was generated from a comparison of the efficacy and scale-up trials via published PA4E1 protocols, trial registrations and information provided by trial investigators. Monthly trial team meetings tracked and coded modifications in ‘real-time’ during the conduct of the scale-up trial. The extent, type and reasons for both adaptations and modifications were summarized descriptively. Results In total, 20 adaptations and 20 modifications were identified, these were to physical activity practices (n = 8; n = 3), implementation support strategies (n = 6; n = 16) and evaluation methods (n = 6, n = 1), respectively. Few adaptations were ‘fidelity inconsistent’ (n = 2), made ‘unsystematically’ (n = 1) and proposed to have a ‘negative’ impact on the effectiveness of the program (n = 1). Reasons for the adaptations varied. Of the 20 modifications, all were ‘fidelity consistent’ and the majority were made ‘proactively’ (n = 12), though most were ‘unsystematic’ (n = 18). Fifteen of the modifications were thought to have a ‘positive’ impact on program effectiveness. The most common decision-maker in the modification process was the ‘program manager’ (n = 17). The main reason for modification was the ‘available resources’ (n = 14) of the PA4E1 Implementation Team. For both adaptations and modifications respectively, the most common goal was to ‘improve fit with recipients’ (n = 8; n = 7). Conclusions A considerable number of adaptations and modifications were made for scale-up that could have important impacts on intervention effects and are important to the interpretation of trial findings. Trial Registration Australia New Zealand Clinical Trial Registry: ACTRN12617000681358

scholarly journals Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

2020 ◽  
Author(s):  
Samia El Joueidi ◽  
Kevin Bardosh ◽  
Richard Musoke ◽  
Binyam Tilahun ◽  
Maryam Abo Moslim ◽  
...  
Keyword(s):  
Implementation Research ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Implementation Process ◽  
Evidence Based ◽  
Structured Interviews ◽  
User Friendliness ◽  
Domain 3 ◽  
And Performance

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012

scholarly journals Canada's Progress to Make Smoking Cessation a First-Line Cancer Treatment

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 90s-90s
Author(s):  
M. Halligan ◽  
D. Keen
Keyword(s):  
Smoking Cessation ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Smoking Status ◽  
Scale Up ◽  
Evidence Based ◽  
First Line ◽  
Quit Smoking ◽  
Substantial Progress ◽  
Oncology Practice

Background: Evidence indicates that smoking cessation improves the effectiveness of treatment and likelihood of survival among all cancer patients, not just those with tobacco-related disease, yet smoking is rarely addressed in oncology practice. Prior to 2016, only 3 provinces in Canada (out of a total of 10 provinces and three territories) reported implementation of smoking cessation for ambulatory cancer patients. Aim: Based on this evidence, the Canadian Partnership Against Cancer (CPAC) implemented a systems change initiative to promote adoption of evidence-based smoking cessation within provincial and territorial cancer systems across Canada. Methods: In 2016, CPAC funded seven provinces and two territories over a 15-month period to plan, implement or evaluate integration of evidence-based smoking cessation for ambulatory cancer patients within cancer systems. Funds were used to plan (2 provinces and 2 territories), implement (3 provinces) or evaluate (2 provinces) systematic, evidence-based approaches to smoking cessation within ambulatory cancer care settings (e.g., establishing routine systems for identification of smoking cancer patients and system to support patients to quit). Funds could not be used for direct service delivery (e.g., cessation counseling). Results: After 15-months of funding from CPAC, 6 provinces reported implementation of smoking cessation for ambulatory cancer patients. The remaining province and 2 territories funded by CPAC reported development of plans for adoption of smoking cessation for cancer patients in the future. Within provinces reporting implementation of smoking cessation for cancer patients, between 65%-97% of ambulatory cancer patients were screened for smoking status; 22%-80% of these patients were offered a referral to cessation services, and 21%-45% of cancer patients accepted a referral. Conclusion: Despite provincial and territorial variations in readiness to uptake evidence-based smoking cessation for cancer patients, CPAC's approach has led to substantial progress in adoption of this approach across Canada. While progress has been made, adoption of smoking cessation and relapse prevention by cancer systems is not yet widespread in Canada. Scale-up to remaining provinces and territory, and spread within existing provinces and territories is required to reach all cancer patients and families who require support to quit smoking. Framing smoking cessation as a therapeutic intervention, not prevention, and a routine part of cancer treatment will be critical for sustainability of this work.

scholarly journals V.I.T.A.M. in COVID 19: A Systematic Approach to a Global Pandemic

2021 ◽  
Vol 15 ◽  
pp. 117954842110474
Author(s):  
Siva Naga S. Yarrarapu ◽  
Pankaj Bansal ◽  
David Abia-Trujillo ◽  
Austin Cusick ◽  
Megan Melody ◽  
...  
Keyword(s):  
Primary Objective ◽  
Team Approach ◽  
Evidence Based ◽  
Treatment Protocols ◽  
Ongoing Research ◽  
Treatment Algorithms ◽  
Global Pandemic ◽  
Treatment Review ◽  
Infectious Disease Specialists ◽  
Multi Disciplinary Team

Introduction In the unprecedented era of COVID-19, ongoing research and evolution of evidence has led to ever-changing guidelines for clinical monitoring and therapeutic options. Formulating treatment protocols requires the understanding and application of the evolving research. Objective The primary objective of this study is to present a systematic evidence-based approach to synthesize the necessary data in order to optimize the management of COVID-19. Methods At Mayo Clinic Florida, we developed a multidisciplinary centralized COVID Treatment Review Panel (TRP) of expert pulmonologists, intensivists, infectious disease specialists, anesthesiologists, hematologists, rheumatologists, and hospitalists that in real-time reviews the latest evidence in peer-reviewed journals, the available clinical trials, and help guide the rapid application of therapeutics or interventions to the patient and the bedside provider. Results/Conclusions The multi-disciplinary team approach of synthesizing clinical data and coordinating care is effective in responding to rapidly evolving and changing evidence. Systematic data collection and evidence-based treatment algorithms enable physicians to rapidly translate the current literature to clinical practice, and improve care and outcomes of patients.

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