A peek behind the curtain: exploring coaching styles within the implementation and sustainment facilitation (ISF) strategy in the substance abuse treatment to HIV care study

Background The Grasha-Riechmann teaching styles, which includes three didactic and two prescriptive styles, have been shown to help enhance learning within educational settings. Although an adaption of the Grasha-Riechmann style classification has enabled coaching styles to be identified for use as part of quality improvement (QI) initiatives, research has not examined the styles actually utilized by coaches within a QI initiative or how the styles change overtime when the coach is guiding an organization through change implementation. Interactions between coaches and HIV service organization (HSO) staff participating in a large implementation research experiment called the Substance Abuse Treatment to HIV care (SAT2HIV) Project were evaluated to begin building an evidence base to address this gap in implementation research. Methods Implementation & Sustainment Facilitation (ISF) Strategy meetings (n = 137) between coaches and HSO staff were recorded and professionally transcribed. Thematic coding classifications were developed from the Grasha-Riechmann framework and applied to a purposively selected sample of transcripts (n = 66). Four coders independently coded transcripts using NVivo to facilitate text identification, organization, and retrieval for analysis. Coaching style use and changes across the three ISF phases were explored. Results Facilitator and formal authority were the two coaching styles predominately used. Facilitator sub-themes shifted from asking questions and providing support to supporting independent action over time. Coaches’ use of formal authority sub-styles shifted notably across time from setting expectations or ensuring preparation to offering affirmation or feedback about changes that the HSO’s were implementing. The use of the delegator or personal model coaching styles occurred infrequently. Conclusions The current research extends implementation research’s understanding of coaching. More specifically, findings indicate it is feasible to use the Grasha-Riechmann framework to qualitatively identify coaching styles utilized in a facilitation-based implementation strategy. More importantly, results provide insights into how different coaching styles were utilized to implement an evidence-based practice. Further research is needed to examine how coaching styles differ by organization, impact implementation fidelity, and influence both implementation outcomes and client outcomes. Trial registration ClinicalTrials.gov NCT02495402. Registered on July 6, 2015.

A Geographic Perspective on Opioid Misuse: Substance Abuse Treatment Deserts in Southwestern Ohio

Background: The opioid crisis is one of the most pressing public health issues facing Ohio, with an impact uneven-ly distributed across the state. This work examined geographical barriers to substance abuse treatment in southwestern Ohio through examining geographical areas with limited access to substance abuse treatment services and identifying substance abuse treatment deserts. Methods: The study domain included the 13 counties in the Ohio Mental Health and Addiction Service's Cincinnati region. Publicly available substance use disorders treatment data were collected from government agency resources, pharmaceutical websites, and web searches. Substance abuse treatment deserts were defined as areas in the 13-county study area that were not within a 15-minute drive from a treatment center. Results: We found large portions of the study region that were considered a substance abuse treatment desert for methadone and naltrexone/buprenorphine clinics, behavioral health treatment centers, and both medicated assisted treatment (MAT) and behavioral health treatment combined. Out of the 2 017 337 total persons living in the 13-county study area, 17% (n = 342 872) live in a desert for all MAT and behavioral treatment. Similarly, 19.7% (n = 396 581) live in a desert for naltrexone/buprenorphine treatment, 60.9% (n = 1 227 560) live in a desert for methadone treatment, and 19.7% (n = 396 581) live in a desert for behavioral health treatment. Conclusion: We successfully defined substance abuse treatment deserts in southwestern Ohio, which will be useful for future research to determine its association with opioid-related health outcomes. This resource is publicly available online (https://doi.org/10.5281/zenodo.4011051).