Integrated Dual Disorders Treatment: Implementation During Early Adoption

综合双重疾病治疗：早期采用期间的实施

• 批准号: 8658765
• 负责人: Angela Leigh Rollins
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658765
• 关键词: Address; Adherence; Adoption; Alcohol or Other Drugs use; Clinical; Collaborations; Combined Modality Therapy; Communicable Diseases; Comorbidity; Consultations; Cost Control; Country; Data; Data Analyses; Disease; Employment; Evidence based practice; Feedback; Funding; Future; Goals; Homelessness; Hospitalization; Housing; Imprisonment; Intervention; Interview; Knowledge; Length; Mental Health; Modeling; Motivation; Ohio; Outcome; Population; Provider; Psyche structure; Qualitative Evaluations; Relapse; Research Infrastructure; Research Personnel; Services; Site; Structure; Substance Use Disorder; Substance abuse problem; Time; Training; Travel; Unemployment; Universities; Veterans; Violence; Work; cost; evidence base; follow-up; health practice; implementation research; improved; meetings; outreach; programs; prospective; severe mental illness

This project involves prospective observation of the early implementation of integrated dual disorders treatment (IDDT) at two VA facilities in the Midwest, plus interviews and fidelity assessments at two additional VA sites. IDDT is an evidence-based practice for people with serious mental illnesses and co-occurring substance use disorders. This model combines mental health and substance abuse services on a single treatment team, with strong emphases on stagewise assessment and interventions, comprehensive services, and use of motivational approaches to achieve improvements in mental health and substance use. Though the IDDT is being implemented more widely outside the VA, the model is not routinely implemented in VA facilities. This RRP proposal seeks to answer basic questions that will inform future implementation efforts for IDDT in the VA: What barriers are encountered in implementation of IDDT? Are there additional barriers noted in the second and third years of early implementation? What strategies do early adopters employ to overcome barriers? Which of these strategies seem to work? What are the promising VA service contexts for implementing IDDT? How much do early implementation efforts cost? Each participating VA facility has expressed interest in IDDT implementation to staff of the Ohio Center for Evidence-Based Practice (CEBP) at Case Western Reserve University, a national leader in IDDT implementation. One site obtained funding to receive technical assistance and training on IDDT from the CEBP and had their baseline fidelity assessment in January 2012. Another site began implementing the practice in Fall 2012. Two sites would start implementation with this project, using RRP funds. External facilitation includes a baseline fidelity assessment with report and recommendations for beginning the implementation, intensive onsite clinical training for staff, ongoing phone and onsite consultation (at least monthly contact), and a 12-month follow-up fidelity assessment to gauge adherence to the model and plan for further improvements. The project would also fund a 24- month fidelity assessment to track the progress of the two sites who began implementation in 2012. Members of the research team will observe implementation efforts and conduct individual interviews with key stakeholders at the two facilities beginning implementation with this RRP -- after baseline fidelity feedback is received and again after the 12-month fidelity feedback is received. Individual interviews with key stakeholders will also be conducted either in person or via phone for the two sites who began implementation in 2012. Key stakeholders could include the designated IDDT "team leader," mental health, psychiatry and/or social work service chiefs, substance abuse service chief, a portion of implementing clinicians, and the external facilitator from the Ohio CEBP. The veteran perspective is also a valuable one and will be sought in interviews that take place during fidelity assessments. Observations will be summarized by research staff in written form for analysis. Interviews will be audiotaped and transcribed for analysis. To facilitate completion of qualitative data coding and analysis in a limited timeframe, the study team will hold intensive coding sessions early in the project and use an iterative process to further refine interview questions, codes, and determine themes throughout the remainder of the project period. In month 6, the study investigators will convene an expert panel of both local site and VA Central Office leaders relevant to IDDT implementation to provide formative feedback on the implementation approach to improve efforts in the remaining 12 months of the project. The panel will meet again in Month 16 to formulate the final set of important themes obtained and plan the service-directed project proposal.

该项目涉及对集成双元早期实施的前瞻性观察 在中西部的两个退伍军人事务部设施进行疾病治疗（IDDT），加上访谈和保真度评估 在另外两个退伍军人管理局IDDT是针对严重精神疾病患者的循证实践 以及同时存在的物质滥用障碍这种模式结合了心理健康和药物滥用 在一个单一的治疗团队的服务，重点是阶段性评估， 干预措施，综合服务，并使用激励方法，以实现改善 精神健康和物质使用。虽然IDDT正在VA之外更广泛地实施， 该模型在退伍军人事务部设施中没有常规实施。本RRP提案旨在回答基本问题 将为今后在弗吉尼亚州实施IDDT工作提供信息的问题： 在实施IDDT时遇到的问题？在第二和第三项中是否有其他障碍 多年来，早期实施？早期采用者采用什么策略来克服障碍？这 这些策略是否有效实施IDDT的有前途的VA服务环境是什么？ 早期实施工作的成本是多少？ 每个参与的VA设施都向俄亥俄州的工作人员表达了实施IDDT的兴趣 凯斯西储大学循证实践中心（CEBP），是美国 IDDT的实施。有一个地点获得了资金，以接受关于IDDT的技术援助和培训 并于2012年1月进行了基线保真度评估。另一个网站开始 2012年秋季实施。两个站点将开始实施该项目，使用 RRP资金。外部促进包括基线保真度评估报告， 开始实施的建议，对工作人员进行密集的现场临床培训， 电话和现场咨询（至少每月一次），以及12个月的随访忠诚度评估 以衡量对模型的遵守情况，并计划进一步改进。该项目还将资助一个24- 一个月的保真度评估，以跟踪谁在2012年开始实施的两个网站的进展。 研究小组成员将观察实施工作，并进行个人 在开始实施本RRP后，与两家工厂的主要利益相关者进行访谈 接收基线保真度反馈，并且在接收12个月保真度反馈之后再次接收。 此外，我们亦会亲自或透过电话与主要持份者进行个别访谈， 两个网站于2012年开始实施。主要利益攸关方可包括指定的国际荒漠化贸易小组 “组长”，精神健康、精神病学和/或社会工作服务主管，药物滥用服务 负责人、部分实施临床医生以及来自俄亥俄州CEBP的外部推动者。这位资深 观点也是一个有价值的，将在面试中寻找发生在忠诚 评估。研究人员将以书面形式总结观察结果，以供分析。 访谈将被录音和转录以供分析。便于完成定性数据 为了在有限的时间内进行编码和分析，研究小组将在2015年年初举行密集的编码会议。 项目，并使用迭代过程来进一步细化面试问题、代码， 在整个项目期间的剩余时间。在第6个月，研究者将召集 由当地站点和VA中央办公室负责人组成的与IDDT实施相关的专家小组， 就执行办法提供形成性反馈意见，以改进其余12个国家的工作 项目的几个月。该小组将在第16个月再次开会，制定最后一套重要的 获得主题和计划服务导向的项目建议书。