Comparing Two Federal Financing Strategies on Treatment Penetration and Sustainment

比较两种治疗渗透和维持的联邦融资策略

• 批准号: 10456814
• 负责人: Alex Richard Dopp
• 金额: $ 65.56万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10456814
• 关键词: Address; Administrator; Adolescent; Adoption; Award; Case Study; Certification; Client; Cohort Effect; Communities; Consultations; Data; Development; Elements; Evidence based practice; Exploration Preparation Implementation and Sustainment; Focus Groups; Funding; Grant; Health; Health Services; Infrastructure; Interview; Investments; Knowledge; Leadership; Measures; Mediating; Mediation; Mediator of activation protein; Methods; Modeling; National Institute of Drug Abuse; Natural experiment; Outcome; Penetration; Perception; Politics; Psychological reinforcement; Public Health; Public Policy; Quasi-experiment; Research; Research Design; Resources; Sampling; Secure; Substance Abuse Treatment Centers; Substance Use Disorder; Supervision; Surveys; System; Time; Training; United States National Institutes of Health; United States Substance Abuse and Mental Health Services Administration; Variant; Work; adolescent substance use; base; behavioral health; community based treatment; comparative; contextual factors; cost; data integration; design; health economics; implementation science; implementation strategy; innovation; novel; policy implication; statistics; substance use treatment; success; sustainability framework; treatment organization; treatment services

PROJECT SUMMARY/ABSTRACT Sustained, widespread availability of evidence-based practices (EBPs) is essential to addressing the public health and societal impacts of adolescent substance use disorders (SUD), as recognized by the NIDA priority (Strategic Objective 3.4) to investigate strategies for effective and sustainable implementation of EBPs. There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support essential activities for EBP implementation and sustainment, and overcome cost-related barriers to the availability of effective adolescent SUD treatments. The proposed R01 project will compare the effects of two SAMHSA grant mechanisms (i.e., financing strategies), which supported the adoption of an EBP for adolescent SUD, the Adolescent Community Reinforcement Approach, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation- Sustainment framework will guide our study aims, hypotheses, and selection of measures. The interdisciplinary project team – consisting of experts in implementation science, adolescent SUD treatment, health economics, public policy, and statistics – will employ a longitudinal, mixed method (i.e., quantitative surveys and qualitative interviews, document review, and focus groups), quasi-experimental design to compare the grant types’ outcomes and examine theoretically-informed mediators and moderators. Aim 1 will examine penetration of the Adolescent Community Reinforcement Approach among eligible clinicians (i.e., proportion certified with adequate fidelity) and clients (i.e., proportion receiving the treatment) at the end of SAMHSA funding; and Aim 2 will examine sustainment of the treatment model, using a 10-element composite measure of treatment delivery and supervision activities, up to 5 years post-funding. Our approach aligns with a previous grant (R01AA021217), enabling integration of the data we collect from state-focused grant recipients (85 organizations in 19 states) with previously collected data on implementation and sustainment outcomes among organization-focused grant recipients (84 organizations in 26 states). We will also evaluate non-equivalent dependent variables (i.e., outcomes that are not expected to change as a result of grant type) to control for key observable, time-varying cohort effects within our quasi-experimental study design. Finally, Aim 3 will use comparative case study methods to identify policy implications for promoting EBP penetration and sustainability through integration of our diverse quantitative and qualitative measures. The proposed research will have immediate, practical implications for behavioral health administrators, policymakers, implementation experts, and the public with new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health – while simultaneously advancing the emergent implementation science field through use of novel methods to study financing strategies and sustainment outcomes.

项目总结/摘要 持续、广泛地提供循证实践（EBP）对于解决公众问题至关重要 青少年物质使用障碍（SUD）的健康和社会影响，如NIDA优先事项所承认的那样 （战略目标3.4）研究有效和可持续地实施循证优先事项的战略。那里 仍然特别需要确定有效的筹资战略， 财政资源用于支持EBP实施和维持的基本活动，并克服 有效的青少年SUD治疗的成本相关障碍。R 01项目将 比较两种SAMHSA授权机制的效果（即，融资战略）， 通过以下方式，为青少年SUD采用EBP，即青少年社区强化方法 以组织为中心或以国家为中心的资金发放。探索-准备-实施- 可持续发展框架将指导我们的研究目标，假设和措施的选择。跨学科 项目小组-由实施科学、青少年SUD治疗、卫生经济学、 公共政策和统计-将采用纵向混合方法（即，定量调查和定性 访谈，文件审查，和焦点小组），准实验设计，以比较赠款类型的 结果和检查理论上知情的调解人和主持人。目标1将检查 合格临床医生中的青少年社区强化方法（即，比例认证， 足够的保真度）和客户端（即，在SAMHSA资助结束时接受治疗的比例）;以及 2将使用10个要素的综合治疗措施， 交付和监督活动，供资后长达5年。我们的方法与之前的资助一致 （R 01 AA 021217），使我们能够整合从以州为重点的赠款接受者收集的数据（85 19个国家的组织），以前收集的关于执行和维持成果的数据， 以组织为重点的赠款接受者（26个州的84个组织）。我们还将评估非等效 因变量（即，预期不会因补助金类型而发生变化的结果），以控制关键 在我们的准实验研究设计中观察到的随时间变化的队列效应。最后，Aim 3将使用 比较案例研究方法，以确定促进EBP渗透的政策影响， 通过整合我们多样化的定量和定性指标实现可持续性。拟议研究 将对行为健康管理者、政策制定者、实施者 专家和公众的新知识，可以直接告知融资战略，以支持大规模， 行为健康方面的持续EBP交付-同时推进紧急实施 通过使用新的方法研究筹资战略和可持续成果，在科学领域取得了重大进展。