Comparing Two Federal Financing Strategies on Treatment Penetration and Sustainment

项目摘要/摘要 持续、广泛地提供循证实践(EBP)对于向公众发表讲话至关重要 青少年物质使用障碍(SUD)的健康和社会影响，NIDA优先确认 (战略目标3.4)研究有效和可持续执行循证方案的战略。那里 仍然特别需要确定有效的筹资战略，以确保和直接 提供财政资源，以支持执行和维持环境保护计划的基本活动，并克服 获得有效的青少年sud治疗的成本相关障碍。拟议的R01项目将 比较两个SAMHSA赠款机制(即筹资战略)的效果，这两个机制支持 通过以下两种方式之一为青少年SUD采用EBP，即青少年社区加强办法 以组织为重点或以国家为重点的资金发放。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 项目团队--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(即定量调查和定性调查 访谈、文件审查和焦点小组)、准实验设计以比较赠款类型 结果，并审查理论上知情的调解人和主持人。目标1将检查 在符合条件的临床医生中采用青少年社区强化办法(即 在SAMHSA供资结束时)和客户(即接受治疗的比例)和目标 2将使用10项综合治疗措施检查治疗模式的维持情况 交付和监督活动，最长为5年后资助。我们的方法与之前的一项拨款一致 (R01AA021217)，支持集成我们从以州为重点的拨款接受者那里收集的数据(85 19个州的组织)，其中包括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)。我们还将评估非等价 控制关键字的因变量(即，预计不会因授予类型而改变的结果) 在我们的准实验研究设计中，可观察到的、时变的队列效应。最后，《目标3》将使用 比较案例研究方法，以确定促进EBP渗透的政策影响和 通过整合我们不同的定量和定性措施实现可持续发展。拟议的研究 将对行为健康管理者、政策制定者、实施 拥有新知识的专家和公众，可以直接为融资战略提供信息，以支持大规模、 行为健康中持续的EBP交付-同时推进紧急实施 通过使用新的方法来研究筹资战略和可持续发展成果，在科学领域取得了重大进展。

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.