Justin Presseau, PhD | April 2, 2024 : Behaviour change theory-informed implementation intervention development and evaluation often focuses on improving sub-optimally performed clinical practice, redressing variations in care, or de-implementing lower-value care. In many instances, such approaches focus on a given clinical action as the target for change. However, the professional context of those delivering healthcare and the lived experience of those receiving healthcare are characterised by navigating contexts involving engaging in multiple behaviours; where engaging in a given action may impact on other competing demands and/or the actions of others. Predominant methodological approaches and theoretical lenses used in implementation science may not yet be accounting for this system of multiple behaviours. This talk will explore the challenges and opportunities of shifting from a single behaviour to a multiple behaviour approach in implementation science. With examples of implementation research across a variety of chronic disease topic areas, this talk will explore the implications and opportunities for shifting to a multiple behaviour change approach for: identifying gaps in care and selecting focal behaviour(s), identifying theory-informed barriers/enablers to change, selecting intervention strategies and change techniques, and evaluating implementation strategies.

Catherine Brown Johnson, PhD and Steve Asch, MD, MPH | March 26, 2024: The Stanford Lightning Report is a structured but flexible rapid qualitative approach used to increase the pace of learning in healthcare implementation. Supporting Learning Health System goals as well as large-scale research agendas, it can be applied across settings, from quality improvement and to randomized trials, ensuring more successful implementation. This talk includes examples of Lightning Report use in addiction settings (e-cigarettes and opioid use), step-by-step instructions on how to employ the approach, and hands-on just-in-time consultation on how to incorporate the Lightning Report into your projects.

Katherine Watkins, MD, MSHS | March 12, 2024: Untreated co-occurring opioid use disorders and mental illness are prevalent and can have devastating consequences for the individual, their families, and the community. The Collaborative Care Model (CoCM) improves outcomes by addressing problems in access and quality for primary care patients with common behavioral health conditions but has not been implemented and tested for co-occurring disorders. This presentation will describe the development and implementation of a CoCM program for co-occurring opioid and mental health disorders in 17 primary care clinics in New Mexico and California. Using Proctor et al.’s 2011/2022 taxonomy of implementation outcomes and data from an ongoing clinical trial, we present the methods used to assess implementation outcomes and results of implementation efforts on model reach and fidelity. We compare the characteristics of individuals who received an initial session with a care coordinator with those whom the care coordinator was unable to engage. Understanding who does and does not receive CC may aid in developing implementation strategies to increase reach and fidelity

Andrea Dakin, PhD, MA, AIDS Foundation Chicago; Serena Rajabiun, PhD, University of Massachusetts Lowell ; Alicia Downes, LMSW AIDS United; Corliss Heath, PhD, US Department of Health and Human Services | March 5, 2024:   The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau(HAB), Ryan White HIV/AIDS Program (RWHAP), Part F- Special Projects of National Significance initiative entitled Improving Care and Treatment Coordination for Black women with HIV funded 12 clinical and community-based organizations and one evaluation center to adapt, implement, and assess the uptake of evidence based/informed (EB/EI) bundled interventions to improve health outcomes and well-being for Black women with HIV. This study examines the successes, challenges, and adaptations to implementation strategies to support intervention uptake and cultural responsiveness for Black women with HIV. Guided by the Expert Recommendations for Implementing Change (ERIC) compilation, the Evaluation and Technical Assistance Center working in partnership with the demonstration sites selected five implementation strategies for intervention uptake: tailoring interventions to local context; train/educate stakeholders; evaluation and iterative strategies; engaging consumers; and changing infrastructure. Tracking implementation strategies and adaptations across sites required multiple approaches to data collection, as each of the twelve sites bundled two-four EB/EIs. Modifications to strategies during the pre-implementation and...

Karen Osilla, PhD | February 27, 2024: Opioid use disorder (OUD) has devastating effects on individuals, families, and communities. This presentation describes eINSPIRE (INtegrating Support Persons Into REcovery), a pragmatic randomized trial that tests the Community Reinforcement Approach and Family Training (CRAFT) intervention delivered via group telehealth therapy compared to usual care. CRAFT is an evidence-based approach for the family members or close friends (referred to as Support Persons; SPs) of individuals with a substance use disorder. Patients and SP dyads were recruited across five community health systems in Southern and Northern California that provide buprenorphine treatment and mental health services. This presentation will describe our dyadic recruitment and implementation insights on the adoption, reach, and feasibility of intervening with SPs in these settings.

Gregory Aarons, PhD | February 20, 2024: Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. Presenters will identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues. These eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

Jonathan Purtle, DrPH, MSc | February 13, 2024: This presentation will offer a typology of four ways to conceptualize policy in implementation science research: 1) Policy as something to adopt, 2) Policy as something to implement, 3) Policy as context to understand, and 4) Policy as strategy to use. Examples will be provided of studies that have conceptualized policy in these different ways in the area of behavioral health.

Bethany M. Kwan, PhD, MSPH, FSBM | January 30, 2024: Designing for dissemination and sustainability (D4DS) refers to the process of ensuring that the products of research are likely to be adopted, implemented, and sustained in the context of intended use. D4DS involves use of methods such as participatory co-design, active dissemination planning, and pragmatic trial designs to develop evidence that “fits the context” and can be readily adopted in real-world settings. This presentation will provide an overview of the rationale, principles, methods, and frameworks for D4DS. The Fit to Context Framework for D4DS is a novel process framework to guide planning, conduct, and dissemination of research, based on a narrative review of the literature on D4DS. Tools to support application of the Fit to Context Framework, including https://dicemethods.org/ and https://app.d4dsplanner.com/, will be demonstrated. A case example will describe D4DS applications in the Invested in Diabetes study, a pragmatic, type II hybrid implementation-effectiveness trial of two models of diabetes shared medical appointments.

Donald Warne, MD, MPH | January 23, 2024: American Indians and Alaska Natives (AI/ANs) endure some of the worst health disparities in the nation. The history of marginalization and exclusion of Indigenous voices from setting the research agenda, determining priorities, and conducting research will be explored. We will also define American Indian, Alaska Native, Native American, and Indigenous populations in the US; and we will describe the impact of preventable conditions on Indigenous health equity. We will also explore and identify opportunities to promote prevention science, methods, and implementation in AI/AN populations to improve outcomes.

Antonio Morgan-Lopez, PhD | January 16, 2024: In the majority of randomized controlled trials (RCTs) the focus is on differences in the average change over time on outcomes across intervention conditions, with variation in individual trajectories often treated as nuisance. In contrast, a primary focus on inferences regarding the improvement (or worsening) of individual participants is best represented by clinical significance or clinically significant change (CSC). One of the primary tools in the assessment of CSC is Jacobson and Truax (1991’s) Reliable Change Index (RCI). The RCI is still very popular, as evidenced by 12,000 total citations and over 300 citations in 2023 alone. However, three specific limitations have been identified with the RCI: a) the RCI estimate is based on a pre-post difference score, b) the scores upon which the RCI estimate is based (typically total scores) often contain both measurement bias and measurement error and c) the RCI standard error of measurement (SEM) is erroneously assumed to be constant across participants and time. We present an approach that addresses all three limitations simultaneously: a) scale score and SEM estimation using moderated nonlinear factor analysis and b) RCI estimation using a modification of a three-level multilevel model with modeling...

Jessica Magidson, PhD and Sarah Kattakuzhy, MD, MPH | December 5, 2023: There is a severe shortage of providers to treat opioid use disorder (OUD), which is further exacerbated in rural areas. Similar to the shortage of prescribers, there is also a severe shortage of trained behavioral health providers to meet the needs of patients with OUD. This talk will provide an overview of a newly launched NIDA-funded R01 trial “Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention” (PRISM)–a randomized Type 1 hybrid effectiveness-implementation trial (n=180) to examine a peer recovery specialist-delivered behavioral intervention to improve retention and polysubstance use on a mobile telemedicine treatment unit in rural Maryland. We will describe a novel telemedicine mobile treatment unit approach to expand access to OUD treatment in hard hit rural areas, as well as how our team is integrating an evidence-based, peer-delivered behavioral activation intervention to support retention and polysubstance use outcomes.

Lauren K. Whiteside, MD, MS | November 14, 2023: The opioid epidemic is rapidly evolving with the proliferation of nonpharmaceutical fentanyl. Simultaneously, researchers, public health officials, and clinicians are working to develop and implement interventions to improve clinical care for patients with opioid use disorder (OUD). The Emergency Department Longitudinal Integrated Care (ED-LINC) randomized clinical trial harnesses the Collaborative Care model to reduce illicit opioid use and improve initiation and retention of evidence-based medications for opioid use disorder (MOUD) for patients that visit the ED with OUD. The original ED-LINC intervention was developed and pilot-tested prior to the overwhelming availability of fentanyl in our community.  We present information on a systematic rapid qualitative approach leveraging real-time clinical observations related to fentanyl use among the initial n=30 ED-LINC intervention participants.  This method was used to systematically produce and document protocol modifications and intervention adaptations required to ensure successful implementation of an intervention that is relevant to the target population amidst the rapidly intensifying fentanyl epidemic. As an implementation practitioner, there is an unavoidable urgency in treating patients with OUD due to fentanyl now and it is crucial that research does not lag behind the current state given the rapidly evolving epidemic.

Lesia Ruglass, PhD | October 31, 2023: Data from the United States National Survey on Drug Use and Health (NSDUH, 2021) indicate that while certain racial/ethnic minoritized populations may have equivalent or lower rates of substance use disorders (SUD) compared to White people, evidence suggests that once developed, and given structural inequities and barriers, racial/ethnic minoritized people may suffer more deleterious consequences (i.e., health, criminal justice system involvement etc.) related to SUD than their White counterparts. In tandem, racial/ethnic minoritized people are less likely to access, utilize, and receive quality evidence-based SUD treatment than their White counterparts, which may further contribute to worsening of their SUD over time. This presentation will review research findings on some of the key factors (individual, interpersonal, community, and social) associated with inequities in treatment access and outcomes for racial/ethnic minoritized populations. Recommendations for research, clinical, and community/societal changes to advance health equity for racial/ethnic minoritized populations with SUD will be discussed.

Justin Knox, PhD, MPH | October 10, 2023: We recently proposed the observational-implementation hybrid approach, or the incorporation of implementation science elements into observational studies in order to collect information that will allow for anticipation, estimation, and/or inference about the effects of interventions and implementation strategies. We describe this approach, including examples of how we are applying it to an ongoing observational study among n=600 Black sexual minority (SMM) men in order to collect relevant implementation data regarding the use of evidence-based practices to support drinking reductions. An initial step for employing an observational-implementation hybrid approach is knowing about the state of the research on relevant interventions or policies that aim to address the modifiable constructs relevant to the research questions of the study, including their implementation. Evidence-based practices that have been shown to help individuals reduce their alcohol use that we will focus on include: electronic screening and brief intervention, motivational interviewing, HealthCall (an mHealth intervention for people living with HIV), and naltrexone. We will employ various approaches to collect information on how to deliver these alcohol interventions to Black SMM. We are using survey measures to collect factors related to transportability of the alcohol interventions that we selected...

Moira McNulty, MD and Maria Pyra, MEd, MPH, PhD | October 3, 2023: A daily pill, PrEP, has changed HIV prevention and could help end the HIV epidemic in the U.S. Thus far, use of PrEP has not been evenly or effectively distributed. Much of the focus to date on PrEP delivery has been on linkage and initiation of PrEP. We know that effectiveness of PrEP depends not only on initiation, but also on adherence, which typically requires retention in care for ongoing monitoring and prescriptions per the CDC guidelines; i.e., persistence on PrEP. While the annual number of PrEP users has been increasing, improvement in retention and adherence has lagged, with many individuals who initiate PrEP no longer adherent or retained at 6 months, despite the likelihood that risk of exposure to HIV continues. Furthermore, some of the most vulnerable populations such as young Black MSM are more likely to fall out of PrEP care than their non-Black peers. Yet, measuring persistence has been challenging, particularly in a way that is standardized and can be used across patient populations and PrEP programs. Dr. Moira McNulty, from the University of Chicago, and Dr. Maria Pyra, from Northwestern University, will present...

Jeffrey De Flavio, MD | September 26, 2023: Across medicine clinical innovations take years to disseminate widely into practice, while some best practices in addiction medicine fail to ever gain widespread adoption. This presentation describes two private medical practices (Groups Recover Together and Affect Therapeutics) which have brought underutilized and evidence-based interventions to scale across the United States. The presentation will focus on the clinical models, patient outcomes, workforce considerations, revenue models and capital formation which was required to scale these effective care programs.

Rinad Beidas, MA, PhD | September 19, 2023: This presentation will describe efforts to apply the tools and insights from behavioral economics to improve upon implementation of evidence-based practices.

Gregory Simon, MD, MPH | September 12, 2023: This presentation will consider specific considerations in the design and implementation of embedded pragmatic trials, including: eligibility criteria, unit of allocation, method of allocation, standardization of “active” interventions, standardization of “control” interventions, blinding, and analytic strategy. For each of these design decisions, investigators must focus on the specific study question and consider scientific rigor, practical constraints, and ethical obligations to potential study participants.