Training community-based treatment providers to implement contingency management for opioid addiction: Time to and frequency of adoption

Abstract

Contingency management (CM) is a well-established treatment for opioid use, yet its adoption remains low in community clinics. This manuscript presents a secondary analysis of a study comparing a comprehensive implementation strategy (Science to Service Laboratory; SSL) to didactic training-as-usual (TAU) as a means of implementing CM across a multi-site opioid use disorder program. Hypotheses predicted that providers who received the SSL implementation strategy would 1) adopt CM faster and 2) deliver CM more frequently than TAU providers. In addition, we examined whether the effect of implementation strategy varied as a function of a set of theory-driven moderators, guided by the Consolidated Framework for Implementation Research: perceived intervention characteristics, perceived organizational climate, and provider characteristics (i.e., race/ethnicity, gender). Sixty providers (39 SSL, 21 TAU) across 15 clinics (7 SSL, 8 TAU) completed a comprehensive set of measures at baseline and reported biweekly on CM use for 52 weeks. All participants received didactic CM training; SSL clinics received 9 months of enhanced training, including access to an external coach, an in-house innovation champion, and a collaborative learning community. Discrete-time survival analysis found that SSL providers more quickly adopted CM; provider characteristics (i.e., race/ethnicity) emerged as the sole moderator of time to adoption. Negative binomial regression revealed that SSL providers also delivered CM more frequently than TAU providers. Frequency of CM adoption was moderated by provider (i.e., gender and race/ethnicity) and intervention characteristics (i.e., compatibility). Implications for implementation strategies for community-based training are discussed.

A systematic review of evidence-based practice implementation in drug and alcohol settings: applying the consolidated framework for implementation research framework

“…Nine (45%) of included studies were randomised controlled trials [59,61,62,[65][66][67][68][69], eight (40%) were randomised trials [39,42,43,50,54,60,70,71](one of which was a subject-by-trial split plot design with repeated measures, [50]), one was a cluster randomised trial [45], one was an interrupted time series design [55], and one was a controlled before-and-after study [47]. Studies varied in terms of the number of participants, the length of follow-up period, the number of addiction services clinicians were sourced from, and the levels of intervention in the approach.…”

“…manuals and seminars) and active (e.g. supervision, workshops and champions) approaches to training [47,59,62,65,66,68,71], while 20% (n = 4) focused on discrete strategies (e.g. supervision [61], financial incentives [45], booster sessions [50], and workshop only [46]).…”

“…Suggestions from Carroll and Rounsaville [72] were also incorporated in one study [59] specifically in regards to the lack of effective programbased supervision in empirically supported treatments being one of the largest barriers to the implementation of these approaches in clinical practice. While only two studies were guided by Rogers' [44,48] argument that individuals are more likely to adopt an intervention after they have an increased knowledge about it and then develop a more favourable attitude towards it, eight (40%) adopted the notion that clinician factors may mitigate the relationship between fidelity to an intervention and patient outcomes [39,42,43,46,47,54,60,62]. Clinician factors of interest included demographics (e.g.…”

“…Clinician factors of interest included demographics (e.g. gender, age, experience, education; measured in all of the studies, although only sixteen (80%) reported an intention to evaluate these factors in relation to the implementation, [39,42,43,46,47,50,54,59,62,[65][66][67][68][69][70][71]), knowledge (3 studies, [67,69,70]) and attitudes (6 [39,43,46,54,59,65], e.g. beliefs about the origins of addictive behaviour, beliefs about evidence-based treatments (EBTs) or about the intervention itself; learning, confidence and commitment).…”

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

“…We also found that the SSL outperformed didactic training-as-usual (without performance feedback or ongoing facilitation) for enhancing CM implementation speci cally in OTPs. SSL resulted in both higher adoption and faster implementation of CM when compared to didactic training-as-usual, providing additional evidence for the utility of the performance feedback and ongoing facilitation strategies [19,20].…”