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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Available from: Robert J Meyers
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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. ©
    Full-text · Article · Oct 2014 · Journal of Substance Abuse Treatment
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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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    ABSTRACT: One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from two clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. Unique challenges in working with counselors unaccustomed to traditional clinical supervision are highlighted. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted one year following implementation, and interviews with key organization executives and administrators.
    Full-text · Article · May 2013 · Cognitive and Behavioral Practice
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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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    ABSTRACT: High staff turnover has been described as a problem for the substance use disorder treatment field. This assertion is based primarily on the assumption that staff turnover adversely impacts treatment delivery and effectiveness. This assumption, however, has not been empirically tested. In this study, we computed annualized rates of turnover for treatment staff (N = 249) participating in an evidence-based practice implementation initiative and examined the association between organizational-level rates of staff turnover and client-level outcomes. Annualized rates of staff turnover were 31% for clinicians and 19% for clinical supervisors. In addition, multilevel analyses did not reveal the expected relationship between staff turnover and poorer client-level outcomes. Rather, organizational-level rates of staff turnover were found to have a significant positive association with two measures of treatment effectiveness: less involvement in illegal activity and lower social risk. Possible explanations for these findings are discussed.
    Full-text · Article · Dec 2011 · Journal of substance abuse treatment
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