Lessons learned from statewide contingency management rollouts addressing stimulant use in the Northwestern United States.
Lessons learned from statewide contingency management rollouts addressing stimulant use in the Northwestern United States.
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从解决美国西北部兴奋剂使用问题的全州应急管理推广中吸取的经验教训。
DOI：
10.1016/j.ypmed.2023.107614
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发表时间：
2023
影响因子：
5.1
通讯作者：
McDonell,MichaelG
中科院分区：
文献类型：
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作者：
Parent,SaraC;Peavy,KMichelle;Tyutyunnyk,Diana;Hirchak,KatherineA;Nauts,Tammera;Dura,Amy;Weed,Lora;Barker,Linda;McDonell,MichaelG
兴奋剂(如甲基苯丙胺)的使用和相关死亡的增加使得社区环境必须采取循证做法来帮助使用兴奋剂的人。应急管理(CM)是一种行为干预，数十年的研究表明，它对治疗兴奋剂使用障碍具有有效性，但由于众所周知的实施障碍，包括难以为增强剂提供资金和耻辱，实际应用一直很缓慢。本文描述了美国西北部(蒙大拿州和华盛顿州)两个以兴奋剂为重点的全州CM实施项目的培训和技术援助(TTA)努力和经验教训。从2021年开始，共有来自35个社区服务站点的154名提供者接受了CM教学培训。其中17个站点，蒙大拿州11个站点中的10个(90.9%)和华盛顿州24个站点中的7个(29.2%)继续实施遵循其所在州既定CM协议的应急管理计划，并以实施指导电话的形式收到持续的TTA。这些发现表明，特定地点的障碍，如后勤匹配，阻碍了超过50%的培训地点的实施；然而，在所需协议中针对地点进行特定定制的策略有助于实施，导致在各州不同的服务地点成功启动CM计划。学到的经验教训增加了描述CM实施障碍和解决方案的文献正文。
Increases in stimulant drug use (such as methamphetamine) and related deaths creates an imperative for community settings to adopt evidence-based practices to help people who use stimulants. Contingency management (CM) is a behavioral intervention with decades of research demonstrating efficacy for the treatment of stimulant use disorder, but real-world adoption has been slow, due to well-known implementation barriers, including difficulty funding reinforcers, and stigma. This paper describes the training and technical assistance (TTA) efforts and lessons learned for two state-wide stimulant-focused CM implementation projects in the Northwestern United States (Montana and Washington). A total of 154 providers from 35 community-based service sites received didactic training in CM beginning in 2021. Seventeen of these sites, ten of eleven in Montana (90.9%) and seven of 24 in Washington (29.2%), went on to implement contingency management programs adherent to their state's established CM protocol and received ongoing TTA in the form of implementation coaching calls. These findings illustrate that site-specific barriers such as logistical fit precluded implementation in more than 50% of the trained sites; however, strategies for site-specific tailoring within the required protocol aided implementation, resulting in successful CM program launch in a diverse cross-section of service sites across the states. The lessons learned add to the body of literature describing CM implementation barriers and solutions.