Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial

Abstract

BackgroundImproving the extent to which evidence-based practices (EBPs)—treatments that have been empirically shown to be efficacious or effective—are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness–implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Methods Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration–preparation–implementation–sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). DiscussionAlthough not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO’s capacity to address substance use may improve the HIV Care Continuum. Trial registration ClinicalTrials.gov: NCT03120598.Electronic supplementary materialThe online version of this article (10.1186/s13722-017-0096-7) contains supplementary material, which is available to authorized users.

The Implementation & Sustainment Facilitation Strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized type 2 hybrid trial

“…As such, the ATTC strategy was identified as one of the most promising strategies for helping HIV-CBOs and their staff integrate the project's MIBI. However, given implementation and sustainment are acknowledged as multilevel processes (16,52), the staff-focused ATTC strategy was hypothesized to be a necessary, but not sufficient, strategy (14). Thus, building upon research that identified facilitation (i.e., process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship) as a promising strategy (53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63), we aimed to test the team-focused ISF strategy as an effective adjunct to the staff-focused ATTC strategy (14).…”

“…As detailed by Garner et al (14) the ISF strategy is a multifaceted strategy with facilitation as the overarching discrete strategy, encompassing six additional discrete strategies (i.e., develop tools for quality improvement; organize implementation team meetings; identify and prepare champions; assess for readiness and identify barriers; conduct local consensus discussions; conduct cyclical small tests of change). Grounded in the theory of implementation effectiveness (20)(21)(22)(23), the ISF strategy seeks to improve implementation effectiveness (i.e., the consistency and quality of implementation of the clinical intervention) and intervention effectiveness (i.e., the clinical intervention's effectiveness in terms of improving client outcomes) via improving implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded).…”

“…However, guided by the Exploration-Preparation-Implementation-Sustainment (EPIS) framework (16), we sought to expand the theory of implementation effectiveness in two ways. Specifically, by examining the extent to which the ISF strategy would help decrease staff time-to-proficiency (the project's preparation phase outcome) and increase staff level-of-sustainment (the project's sustainment phase outcome) (14). In addition to being grounded in the theory of implementation effectiveness, the ISF strategy was grounded in motivational interviewing principles (64), which is similar to how Kauth et al (56) employed motivational interviewing techniques as part of their multifaceted facilitation strategy for improving implementation of cognitive behavioral therapy within 20 Department of Veteran Affairs clinics.…”

“…Staff completed surveys prior to randomization (i.e., before the preparation phase), after the implementation phase (month 13), and after the sustainment phase (month 19), and received a $25 e-gift card per survey. For more details, see the study protocol paper (14). (66) for SUD for that substance during the past 12 months.…”

“…Complementing the comprehensive descriptions provided as part of our study protocol paper (14), Table 1 highlights: (a) the 10 discrete strategies in the ATTC strategy, (b) the 7 discrete strategies in the ISF strategy, and (c) the phase that each strategy was made available. For the ATTC strategy, the HIV-CBO's two MIBI staff were given the opportunity to receive 12 months of MIBI training and technical assistance: during the preparation phase, monthly 1-hour group consultation calls during the implementation phase).…”