Table 4 Enhancing Implementation of Incentive Therapy for Substance Use Disorders Guided by the RE-AIM & PARIHS Frameworks (Section VI.A)

Reach

• Target intervention to patients that will be attending treatment at least twice • per week for other treatment services.

Adoption

• Solicit explicit support from the highest levels of the organization through, for example, performance measures or treatment recommendations.

• Identify or create measures of clinic effectiveness which can be used to identify gaps in performance and monitor the impact of implementation.

• Solicit agreement in advance for designated funding.

• Educate leadership about potential strategies for integrating the intervention into current practices.

• Adopt incrementally. Start with a specific treatment track or clinic to reduce staff and funding burden until local evidence of effectiveness and feasibility is available to support spread

Implementation

• Train staff on urine test cups and breathalyzer including sensitivity and specificity of the screen results.

• Make scripts available for communicating positive and negative test results to patients.

• Supply a tracking database to ensure consistency in awarding prize picks.

• Provide a step by step intervention appointment protocol.

• Facilitate documentation in the electronic health record.

Maintenance

• Ensure all staff are aware of their responsibilities related to incorporating information from the intervention into clinical interactions with patients to facilitate integration into the clinic.

• Consider option of having case managers administer the intervention to their own patients rather than having one or two individuals responsible for the intervention.

Evidence

• Staff may not be aware of strength of evidence or may express philosophical disagreement with incentive interventions: Engage staff early on to understand and address concerns.

• Staff may need education on evidence and/or how behavioral reinforcements function in a variety of settings.

• Staff may benefit from engaging with clinics that have already implemented or may be willing to engage in a brief test of the intervention.

Context

• Even in highly supportive contexts, barriers are substantial and implementation has a high likelihood of failure if barriers are not identified and addressed up front.