A Large-Scale Dissemination and Implementation Model for Evidence-Based Treatment and Continuing Care

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Clinical Psychology Science and Practice (Impact Factor: 2.92). 03/2011; 18(1):67-83. DOI: 10.1111/j.1468-2850.2011.01236.x
Source: PubMed


[Clin Psychol Sci Prac 18: 67–83, 2011]
Multiple evidence-based treatments for adolescents with substance use disorders are available; however, the diffusion of these treatments in practice remains minimal. A dissemination and implementation model incorporating research-based training components for simultaneous implementation across 33 dispersed sites and over 200 clinical staff is described. Key elements for the diffusion of the Adolescent Community Reinforcement Approach and Assertive Continuing Care were as follows: (a) 3 years of funding to support local implementation; (b) comprehensive training, including a 3.5-day workshop, biweekly coaching calls, and ongoing performance feedback facilitated by a web tool; (c) a clinician certification process; (d) a supervisor certification process to promote long-term sustainability; and (e) random fidelity reviews after certification. Process data are summarized for 167 clinicians and 64 supervisors.

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    • "All data were de-identified prior to analysis. Each organization received grant funding specifically to implement A-CRA, and all clinicians participated in the same standardized training, cross-site supervision, and certification process based on individualized review and feedback provided by the treatment developers throughout the grant period (Godley, Garner, Smith, Meyers, & Godley, 2011). Grantees were located in 26 different states and served diverse communities. "
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    ABSTRACT: This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classified as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only. ©
    Journal of Substance Abuse Treatment 10/2014; Journal of Substance Abuse Treatment 46 (2014) 463–471(46 (2014) 463–471). · 3.14 Impact Factor
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    • "It must address multiple factors, including the organizational climate in which new practices will be introduced, characteristics of clinicians to be trained, processes for preparing for and implementing treatment, and methods for evaluating these efforts (Addis, 2002; Damschroder & Hagedorn, 2011; Godley, Garner, Smith, Meyers, & Godley, 2011; Gotham, 2006; Proctor et al., 2007; Rosenthal, 2002). To illustrate, Godley and colleagues' (2011) comprehensive model for the dissemination and implementation of a behaviorally based substance abuse intervention for adolescents includes 3.5 days of initial clinician training, knowledge tests on the manualized treatment, biweekly coaching calls to receive feedback on the implementation of the intervention, expert review of digital recordings of treatment and supervision sessions, provision of electronically based feedback, and postcertification fidelity monitoring. Although such an undertaking presents considerable challenge, training addiction counselors to competently deliver ESTs for co-occurring disorders would provide advantages for both clients and provider systems. "
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    • "In addition to the significant relationship between turnover and outcomes described above, we observed generally weak relationships between organizational-level rates of staff turnover and the majority of client-level outcomes examined. A possible explanation for these weak relationships might be related to the equalizing effects of training staff in an EBP since all staff were trained using the same comprehensive training and ongoing monitoring/ coaching approach (Godley et al., 2011). That is, if the training process worked as intended, it would decrease variability associated with the clinician delivering treatment (i.e., therapist effects). "
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