The goal of the proposed R21 application is to assess readiness and capacity to implement, modify, and sustain a process of continuous practice improvement in publicly supported drug abuse prevention and treatment programs. Specifically, the proposed exploratory study will build fidelity ratings and outcome measures into the overall system for quality improvement. Using evidence-based practices (EBPs) in prevention (i.e., Project Towards No Drugs or TND) and treatment (i.e., motivational interviewing or Ml), the investigators will use existing fidelity and outcome measures to assess provider performance and adherence to prevention and treatment guidelines during the process of adopting EBPs in rural communities. The Ml component will utilize the Motivational Interviewing Treatment Integrity (MITI) code to assess fidelity to the protocol. The MITI will be used in combination with client feedback and an outcome measure (i.e., NC Treatment Outcome and Program Performance System or NCTOPPs) to provide clinicians with information on their service delivery and adherence to the Ml guidelines. An instrument will be developed for Project TND to assess providers' fidelity to the model. This instrument will be used in combination with a client feedback mechanism so that the quality of service delivery will be assessed. In both studies, qualitative case studies will be conducted, with results being shared with stakeholders at participating sites throughout the study.
