Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

Abstract

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

Exploring Provider Perspectives on Implementing Coordinated Specialty Care: A Qualitative Study

“…At the provider-level, the challenges and need for training to address high rates of substance use among individuals with FEP was also a point of concern, which is consistent with prior research (Oluwoye & Fraser, 2021 ; Oluwoye et al, 2019 ). The CSC model used in the five programs that participated in the present study includes a substance use module focused on harm reduction in the individual therapy component of the program.…”

Exploring service provider perspectives on service user engagement across service components in coordinated specialty care programs for psychosis.

“…Substance use has consistently been associated with disengagement from services (Kreyenbuhl et al, 2009; Mascayano et al, 2021). For instance, a recent quantitative study found that cannabis and alcohol use reduced the likelihood of graduating from CSC (Oluwoye & Fraser, 2021). The findings presented in the present study extend previous research by illustrating how substance use impacts engagement in individual psychotherapy by increasing symptoms and decreasing motivation to meaningfully engage in sessions.…”

Substance use approaches among peer support specialists in community mental health early psychosis programs.

“…All participants emphasized their desire to know more about SU and effective treatment approaches. One study suggested that professionals trained in SU treatment, for example, certified SU and addiction specialists, could be incorporated into CSC teams (Oluwoye & Fraser, 2021). To date, research of teams with a recovery/SU specialist role has not been published, although qualitative work reveals that providers feel this would be a useful additional role (Stokes et al, 2022), and CSC teams in several states have SU specialist roles (Bello & Dixon, 2022).…”