Fidelity, Assessment and Clinical Effectiveness Tracking (FACET) System: Making EBTs Feasible and Sustainable

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Advances in treating adolescent substance abuse and related problems have resulted in an increased emphasis on redirecting resources to transport evidence-based treatments (EBTs) into “real-world” settings, yet the science-practice gap remains a pressing problem. Due to highly complex and multifaceted processes involved in translating EBTs to practice settings and to a host of diffusion barriers, including lack of resources, infrastructure, and technology-based and quality assurance capacity, only a fraction of individuals in treatment for substance use disorder (SUD) receive EBTs. Further, the significant gains achieved in efficacy trials are difficult to replicate in actual practice without intensive monitoring of fidelity, an essential component of success. The lack of feasible cost efficient fidelity monitoring tools and superstructures to ensure community-based practitioners sustain competent and adherent service delivery represents a major impediment for dissemination; innovative methods and procedures are urgently needed. The proposed Phase II SBIR will complete the development of a commercially viable theory-guided, empirically based, and user-friendly online feedback and monitoring system, “Fidelity, Assessment, and Clinical Effectiveness Tracking” (FACET), to guide and sustain the implementation of EBTs and evaluate the system in a randomized trial. FACET is designed to foster clinicians' self-regulation of treatment adherence and provide community programs with more direct access to quality assurance information pertinent to maintaining fidelity and achieving positive youth and family treatment outcomes. The randomized trial will be conducted in staggered cohorts, with a sequential roll-out of training for clinicians within cohorts (n=60; 20 per cohort) to enhance study feasibility. Clinicians will be trained to deliver Functional Family Therapy (FFT), an established treatment for adolescent substance abuse and co-occurring problems. Within each cohort, treatment sites will be randomized to either Implementation as Usual (IAU) or FACET-assisted implementation (FAI) and clinicians will participate in the condition of their employing site. Measurement will involve multi-method, multi-source data collection. Clinicians will complete five assessments over a 9-month period. The impact of FAI, compared to IAU on implementation outcomes will be assessed using measures of clinician EBT knowledge and efficacy, behavioral observations of clinician EBT skills, and work process improvements linked to staff time savings for potential customers. The adoption of FACET is expected to bridge the science-practice gap and enhance the appeal, user-friendliness, and marketability of FFT dissemination services delivered to adolescent outpatient drug treatment programs by LIFFT, Co. The proposed project will result in an evidence-based monitoring system that can be marketed within a repeatable and scalable business model. The primary long-term goal of this project is to establish a data-driven foundation for marketing the commercial FACET system in conjunction with EBT dissemination and establish the potential for FACET for other domains.