This proposal, in response to PAR-16-455, aims to test the impact of an empirically derived implementation strategy?under real-world conditions and across multiple child service systems?on successful adoption and sustainment of two evidence-based programs that address adolescent substance abuse: Treatment Foster Care Oregon (TFCO; formerly Multidimensional Treatment Foster Care) and Multidimensional Family Therapy (MDFT), both developed with funding from NIDA. Methods for this study utilize ?technology-based approaches? for ?implementing large-scale change.? Leveraging previous data focused on developing and testing the 8- staged Stages of Implementation Completion (SIC) tool?a measure of implementation progress from Engagement (Stage 1) to development of Competency (Stage 8)?a randomized evaluation of a SIC Coaching Strategy (SIC-CS) is proposed. Study activities include extending the SIC into the Sustainment Phase and testing the SIC-CS to support the adoption of new evidence-based programs. Previous findings with the SIC suggest its potential utility as a measure of implementation fidelity. The overarching goal of this proposal is to evaluate if the integration of implementation fidelity (fidelity to the implementation process) with intervention fidelity (fidelity to the clinical intervention) can increase the probability that a new organizational site not only successfully adopts a program but develops the infrastructure to ensure it can sustain. Patterns of cost and resource allocation will be examined using the Cost of Implementing New Strategies (COINS) cost mapping tool, an adjunct to the SIC, to assess how resource use impacts program sustainability. A web-based SIC and COINS tool provides feedback about a site's implementation behavior relative to other successful sites and will be used in the current study as part of the SIC-CS. Purveyors for TFCO and MDFT will be trained to integrate SIC coaching into their existing coaching activities with newly adopting sites randomized to receive the SIC-CS. SIC data and feedback will be withheld from sites randomized to Standard (STAND) Consultation. Within a rapid audit and feedback system, it is hypothesized that sites that receive integrated implementation and intervention fidelity feedback as part of their technical assistance will more likely develop sustainable programs than sites that receive standard support. Study targets include the following specific aims: (a) evaluate the effect of SIC-CS on outcomes of program adoption and sustainment, (b) extend the SIC to include measurement of sustainment, and (c) examine cost and resource patterns most likely to yield sustainable programs. This data-driven approach to guide new sites has the potential to help them to implement sustainable evidence-based programs for adolescent substance abuse and other high-risk behaviors. If successful, the study will have a significant impact for organizations adopting new programs and has the potential to have a substantial public health impact by increasing the availability of evidence-based programs for costly public health problems.

Public Health Relevance

Substance use has continued to plague populations in the United States, with an estimated combined annual spending for alcohol and illicit substance use exceeding $400 billion despite the existence of evidence- based, cost-effective treatments. This proposal aims to define the organizational activities that are needed to sustain the adoption of evidence-based programs that address adolescent substance abuse and other high- risk behaviors, and test the impact of an empirically derived strategy to support the integration of implementation fidelity and intervention fidelity. These innovative methods have the potential for a highly significant public health impact by reducing wasted resources on failed implementation attempts and increasing the availability of quality evidence-based services for vulnerable and costly populations.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1)
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Crump, Aria
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Oregon Social Learning Center, Inc.
United States
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