Table 4 Enhancing Implementation of Incentive Therapy for Substance Use Disorders Guided by the RE-AIM & PARIHS Frameworks (Section VI.A)
From: An introduction to implementation science for the non-specialist
| RE-AIM Framework [67] | |
|---|---|
| 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. | |
| PARIHS Framework [68, 69] | |
| 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. |