Multi-level alignment processes in the sustainment of a youth substance use treatment model following a federal implementation initiative: A mixed method study.

Autor: Wright B; Department of Psychology, University of Oregon, Eugene, OR, United States of America; RAND, Santa Monica, CA, United States of America. Electronic address: bwright1@uoregon.edu., González I; Department of Psychology, Georgetown University, Washington, DC, United States of America., Chen M; RAND, Santa Monica, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America., Aarons GA; Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States of America., Hunter SB; RAND, Santa Monica, CA, United States of America., Godley MD; Chestnut Health Systems, Normal, IL, United States of America., Purtle J; Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, New York, NY, United States of America., Dopp AR; RAND, Santa Monica, CA, United States of America.
Jazyk: angličtina
Zdroj: Journal of substance use and addiction treatment [J Subst Use Addict Treat] 2024 Nov; Vol. 166, pp. 209445. Date of Electronic Publication: 2024 Jul 01.
DOI: 10.1016/j.josat.2024.209445
Abstrakt: Introduction: Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic.
Methods: In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions.
Results: At the time of interview, staff from 80 % of the treatment organizations (n = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items mostly followed the pattern predicted from the qualitative findings.
Conclusions: The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.
Competing Interests: Declaration of competing interest MDG is the past center director for A-CRA training of clinicians and supervisors in the USA and other countries for Chestnut Health Systems, a not-for-profit organization. All other authors do not have any declarations of interest to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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