Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy

Matthew Chinman, Sharon McCarthy, Gordon Hannah, Thomas Hugh Byrne, David A Smelson, Matthew Chinman, Sharon McCarthy, Gordon Hannah, Thomas Hugh Byrne, David A Smelson

Abstract

Background: Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO).

Methods: This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview.

Results: No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet.

Conclusions: This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet.

Trial registration: ClinicalTrials.gov NCT01430741.

Keywords: Co-occurring disorders; Fidelity; Implementation support; Technical assistance; Training.

References

    1. Drake RE, Mueser KT, Brunette MF, McHugo GJ. A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatr Rehabil J. 2004;27(4):360–74. doi: 10.2975/27.2004.360.374.
    1. Rapp CA, Etzel-Wise D, Marty D, Coffman M, Carlson L, Asher D, et al. Barriers to evidence-based practice implementation: results of a qualitative study. Community Ment Health J. 2010;46(2):112–8. doi: 10.1007/s10597-009-9238-z.
    1. Rapp CA, Etzel-Wise D, Marty D, Coffman M, Carlson L, Asher D, et al. Evidence-based practice implementation strategies: results of a qualitative study. Community Ment Health J. 2008;44(3):213–24. doi: 10.1007/s10597-007-9109-4.
    1. Gustafson DH, Quanbeck AR, Robinson JM, Ford JH, 2nd, Pulvermacher A, French MT, et al. Which elements of improvement collaboratives are most effective? A cluster-randomized trial. Addiction. 2013;108(6):1145–57. doi: 10.1111/add.12117.
    1. Nelson G, Stefancic A, Rae J, Townley G, Tsemberis S, Macnaughton E, et al. Early implementation evaluation of a multi-site housing first intervention for homeless people with mental illness: a mixed methods approach. Eval Program Plann. 2014;43:16–26. doi: 10.1016/j.evalprogplan.2013.10.004.
    1. Henry M, Shivji A, de Sousa T, Cohen R. The 2015 Annual Homeless Assessment Report (AHAR) to Congress. Washington: The U.S. Department of Housing and Urban Development; 2015.
    1. Shinseki E. Secretary Shinseki details plan to end homelessness for Veterans. 2009.
    1. Smelson D, Sawh L, Kuhn J, Kane V, Ziedonis D. The MISSION-VET treatment manual. Bedford: Department of Veterans Affairs; 2011.
    1. Smelson D, Sawh L, Rodrigues S, Muñoz E, Marzilli A, Tripp J. In: The MISSION-VET consumer workbook. Affairs DoV, editor. Bedford: Department of Veterans Affairs; 2011.
    1. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. 1974;2(4):354–86. doi: 10.1177/109019817400200405.
    1. Chinman M, George P, Dougherty RH, Daniels AS, Ghose SS, Swift A, et al. Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv. 2014;65(4):429–41. doi: 10.1176/appi.ps.201300244.
    1. Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing first for homeless persons with active addiction: are we overreaching? Milbank Q. 2009;87(2):495–534. doi: 10.1111/j.1468-0009.2009.00565.x.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi: 10.1186/1748-5908-4-50.
    1. Schoenwald SK, Hoagwood K. Effectiveness, transportability, and dissemination of interventions: what matters when? Psychiatr Serv. 2001;52(9):1190–7. doi: 10.1176/appi.ps.52.9.1190.
    1. Ennett ST, Ringwalt CL, Thorne J, Rohrbach LA, Vincus A, Simons-Rudolph A, et al. A comparison of current practice in school-based substance use prevention programs with meta-analysis findings. Prev Sci. 2003;4(1):1–14. doi: 10.1023/A:1021777109369.
    1. Wandersman A, Imm P, Chinman M, Kaftarian S. Getting to outcomes: a results-based approach to accountability. Eval Program Plann. 2000;23(3):389–95. doi: 10.1016/S0149-7189(00)00028-8.
    1. Chinman M, Hannah G, McCarthy S. Lessons learned from a quality improvement intervention with homeless veteran services. J Health Care Poor Underserved. 2012;23(3 Suppl):210–24. doi: 10.1353/hpu.2012.0125.
    1. Chinman M, Hunter SB, Ebener P, Paddock SM, Stillman L, Imm P, et al. The getting to outcomes demonstration and evaluation: an illustration of the prevention support system. Am J Community Psychol. 2008;41(3-4):206–24. doi: 10.1007/s10464-008-9163-2.
    1. Acosta J, Chinman M, Ebener P, Malone PS, Paddock S, Phillips A, et al. An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes. Implement Sci. 2013;8:87. doi: 10.1186/1748-5908-8-87.
    1. Chinman M, Acosta J, Ebener P, Burkhart Q, Malone PS, Paddock SM, et al. Intervening with practitioners to improve the quality of prevention: one-year findings from a randomized trial of Assets-Getting To Outcomes. J Prim Prev. 2013;34(3):173–91. doi: 10.1007/s10935-013-0302-7.
    1. Chinman M, Tremain B, Imm P, Wandersman A. Strengthening prevention performance using technology: a formative evaluation of interactive Getting To Outcomes. Am J Orthopsychiatry. 2009;79(4):469–81. doi: 10.1037/a0016705.
    1. Chinman M, Acosta J, Ebener P, Malone PS, Slaughter ME. Can implementation support help community-based settings better deliver evidence-based sexual health promotion programs? A randomized trial of Getting To Outcomes(R) Implement Sci. 2016;11(1):78. doi: 10.1186/s13012-016-0446-y.
    1. Klar N, Donner A. Current and future challenges in the design and analysis of cluster randomization trials. Stat Med. 2001;20(24):3729–40. doi: 10.1002/sim.1115.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26. doi: 10.1097/MLR.0b013e3182408812.
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7. doi: 10.2105/AJPH.89.9.1322.
    1. Smelson D, Kalman D, Losonczy MF, Kline A, Sambamoorthi U, Hill LS, et al. A brief treatment engagement intervention for individuals with co-occurring mental illness and substance use disorders: results of a randomized clinical trial. Community Ment Health J. 2012;48(2):127–32. doi: 10.1007/s10597-010-9346-9.
    1. Smelson D, Losonczy M, Castles-Fonseca K, Stewart P, Kaune M, Ziedonis D. Preliminary outcomes from a booster case management program for individuals with a co-occurring substance abuse and a persistent psychiatric disorder. J Dual Diagn. 2005;3:47–59. doi: 10.1300/J374v01n03_05.
    1. Smelson D, Williams J, Ziedonis D, Losonczy M, Williams J, Steinberg ML, et al. The efficacy of clonazepam for decreasing cue-elicited craving in individuals with schizophrenia and cocaine dependence: a preliminary report. J Clin Psychopharmacol. 2006;26(1):9–12. doi: 10.1097/01.jcp.0000194624.07611.5e.
    1. Smelson DA, Kline A, Kuhn J, Rodrigues S, O’Connor K, Fisher W, et al. A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychol Serv. 2013;10(2):161–7. doi: 10.1037/a0030948.
    1. Smelson DA, Chinman M, McCarthy S, Hannah G, Sawh L, Glickman M. A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs. Implement Sci. 2015;10:79. doi: 10.1186/s13012-015-0267-4.
    1. Chinman M, Imm P, Wandersman A. Getting to Outcomes 2004: promoting accountability through methods and tools for planning, implementation, and evaluation. Santa Monica: RAND Corporation; 2004.
    1. Hannah G, McCarthy S, Chinman M. Getting To Outcomes in services for homeless Veterans: 10 steps for achieving accountability. Philadelphia: National Center on Homelessness Among Veterans; 2011.
    1. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64. doi: 10.1177/1090198104263660.
    1. Fishbein M, Ajzen I. Attitudes towards objects as predictors of single and multiple behavioral criteria. Psychol Rev. 1974;81(1):59–74. doi: 10.1037/h0035872.
    1. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3-4):327–50. doi: 10.1007/s10464-008-9165-0.
    1. Kirchner JE, Ritchie MJ, Pitcock JA, Parker LE, Curran GM, Fortney JC. Outcomes of a partnered facilitation strategy to implement primary care-mental health. J Gen Intern Med. 2014;29(Suppl 4):904–12. doi: 10.1007/s11606-014-3027-2.
    1. Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998;7(3):149–58. doi: 10.1136/qshc.7.3.149.
    1. Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004;13(8):913–24. doi: 10.1111/j.1365-2702.2004.01007.x.
    1. Chinman M, Acosta J, Ebener P, Burkhart Q, Clifford M, Corsello M, et al. Establishing and evaluating the key functions of an interactive systems framework using an assets-getting to outcomes intervention. Am J Community Psychol. 2012;50(3-4):295–310. doi: 10.1007/s10464-012-9504-z.
    1. Damschroder LJ, Lowery JC. Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR) Implement Sci. 2013;8:51. doi: 10.1186/1748-5908-8-51.
    1. Damschroder LJ. CFIR codebook template. Ann Arbor, MI. 2015. . Accessed 1 Oct 2015.
    1. Cividin TM, Ottoson JM. Linking reasons for continuing professional education participation with postprogram application. J Contin Educ Health Prof. 1997;17(1):46–55. doi: 10.1002/chp.4750170107.
    1. Smelson DA, Zaykowski H, Guevermont N, Siegfriedt J, Sawh L, Modzelewski D et al. Integrating permanent supportive housing and co-occurring disorders treatment for individuals who are homeless. J Dual Diagn. 2016:0. doi:10.1080/15504263.2016.1174010.

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