Maintaining Efficacy while Adapting Contingency Management: State and Tribal partnerships as examples

Sara Parent, ND
Washington State University

K. Michelle Peavy, PhD
Washington State University

Michael McDonnell, PhD
Washington State University

Kait Hirchak, PhD
Washington State University

ABSTRACT:
Contingency Management (CM) is an evidence-based behavioral intervention for substance use disorders that is receiving increasing attention as the most effective treatment available for stimulant use disorder. Decades of research have established its efficacy, and more recent Dissemination and Implementation Science suggest effective ways to facilitate its uptake. Each time a CM program is launched in a real-world setting, decisions must be made to address implementation goals and constraints. Our team works closely with state funders, Tribal partners, and other clinical and non-clinical sites implementing CM to navigate these adaptations, balancing fidelity with practical needs. We will present our experiences with state- and Tribe-partnered CM programs to illustrate how collaborations among funders, training and technical assistance team/subject matter experts, and CM sites/practitioners can help strike this balance. Our focus will be on how these partnerships support site-specific adaptations while maintaining evidence-based protocol integrity, ultimately centering positive outcomes for the individuals and communities served.

From glitter to gold: Recommendations for effective dashboards from design through sustainment

Fernanda Sequeira Rossi, PhD
Stanford University

ABSTRACT:
Dashboards—tools that compile and summarize key performance data—have become increasingly utilized for supporting data organization and decision-making processes across various fields, such as business, economics, healthcare, and policy. The dashboard’s impact is dependent on its use by the individuals for whom it was designed. Yet, few studies measure dashboard use, and of those that do, their utility is limited. When dashboards go unused, they provide little value and impact. This presentation discusses the common pitfalls of dashboards that result in their limited use and how human-centered design and implementation science can improve dashboard relevance. It provides eight recommendations for effective dashboards from across the design to the sustainment phase.

Understanding and Applying the HIV Self-Test Program Preferences of Black and Latino Sexual and Gender Minorities in the Southern United States: An Online Discrete Choice Experiment with Patients and CFIR Interviews with Providers

John Guigayoma, PhD
Northwestern University

ABSTRACT:
Black and Latino sexual and gender minorities in the Southern United States have experienced the greatest burden of HIV for the past 25 years. HIV self-testing is an effective strategy to identify individuals living with undiagnosed HIV, but little implementation research is known about which program characteristics foster the highest patient engagement. Discrete choice experiments are a survey tool that can answer this question by providing insight on the most important program components to patients. This presentation will report on the design and results of an online discrete choice experiment with Black and Latino sexual and gender minorities living in the South to optimize the design of HIV self-test programs. Results will include preference estimates and marginal willingness to pay. This presentation will then report on the application of these results to a qualitative study examining barriers and facilitators to implementing a low-price HIV self-test home-delivery program from the perspectives of HIV prevention program decisionmakers in the South using the updated Consolidated Framework for Implementation Research. This presentation will include considerations in study design, data collection, and analysis for those who may use discrete choice experiments in their own research.

Addressing Underlying Trauma in Opioid Use

Tanya Saraiya, PhD
Medical University of South Carolina

ABSTRACT:
Up to 90% of people with opioid use disorder (OUD) have trauma exposure and up to 41% have posttraumatic stress disorder (PTSD). However, studies estimate that less than 12% of people with OUD and co-occurring PTSD receive treatment for their PTSD. Dr. Saraiya will present her early career work on assessing and addressing underlying trauma among people struggling with opioid use. Specifically, she will share findings from a new integrated therapy for opioid use disorder and PTSD and the development of a digital toolkit to assess for intimate partner violence in three opioid treatment programs in South Carolina. Throughout this talk, other projects and associated reflections on how systemic racism and healthcare barriers influence trauma and opioid use treatment will be discussed.

TITLE: TBD

Corey Bradley, PhD, MSW, MPH
Northwestern University

ABSTRACT:
TBD

Low Threshold Buprenorphine: What do we know and where do we go from here?

Andrea Jakubowski, MD, MS
Montefoire

ABSTRACT:
Over two decades into the opioid overdose crisis, buprenorphine remains underutilized and inaccessible to many people with opioid use disorder. Improving accessibility and utilization requires attention to where treatment is offered and how patients are treated once they enter care. In this presentation, Dr. Jakubowski will describe: 1) principles of low-threshold buprenorphine; 2) clinical and implementation data on syringes services program (SSP)-based buprenorphine programs; 3) early findings from Dr. Jakubowski’s NIDA K23 examining implementation of long-acting injectable buprenorphine in SSP and primary care clinics; 4) description and rationale of CTN-0155: Low-Threshold Buprenorphine Treatment at Syringe Services Programs: A Type I Hybrid Effectiveness-implementation Trial.

Designing for Dissemination: Building and Testing a Mobile App to Reduce Cannabis Use Among Justice-Involved Youth

Sarah Helseth, PhD
Northwestern University

ABSTRACT:
Dr. Helseth's program of research seeks to increase equitable access to and utilization of effective interventions and health services, particularly among underserved populations and high-risk youth. She pursues this objective via several complementary lines of research that span from treatment development and evaluation to widespread dissemination and community-based implementation. Broadly, her work includes: 1) developing and evaluating behavioral health interventions, 2) using patient-directed dissemination strategies to increase demand for effective health services, 3) using provider-directed implementation strategies to increase the availability of effective health services, and 4) leveraging technology to deliver interventions to underserved populations. Her presentation will center on activities conducted during her 5-year, NIDA-funded Early Career Award (K23DA048062; PI: Helseth) to develop and evaluate the TECH app, a novel digital health adjunct designed to help court-involved, non-incarcerated adolescents reduce their use of cannabis.

A Mobile Approach to Empower Perinatal Women with Opioid Use Disorder and Enhance Neonatal Abstinence Syndrome Care

Ekaterina Burduli, PhD, MS
Washington State University

ABSTRACT:
Substance use during pregnancy and parenthood presents significant public health challenges, with potentially severe consequences for mothers and infants with Neonatal Abstinence Syndrome (NAS). Addressing this issue requires innovative, comprehensive interventions and patient-centered approaches to improve care for perinatal women and families impacted by substance use disorders (SUD). This presentation will describe a NIDA-funded K01 study that focuses on developing and assessing the usability, acceptability, and feasibility of a mobile educational tool designed to support pregnant women with OUD in navigating the perinatal period and infant NAS care. Qualitative data that guided the tool's development will be presented, alongside findings from user testing and a pilot randomized trial.

Longitudinal Pathways of Depression and Suicidal Thoughts and Behaviors Among LGBTQ Youth of Color: An Integrative Data Analysis

Alberto Valido, PhD
University of Missouri

ABSTRACT:
Recent data from the Trevor Project reveals alarming disparities in mental health outcomes among LGBTQ youth of color, with significantly higher rates of depression and suicide risk compared to their White LGBTQ peers. Despite these documented disparities, there has been limited longitudinal research examining how these outcomes develop throughout adolescence among Black/African American and Hispanic/Latinx LGBTQ youth. This presentation will provide an overview of an innovative integrative data analysis combining 19 longitudinal studies to examine developmental trajectories of depression and suicidal thoughts and behaviors among LGBTQ youth of color. We will discuss the theoretical frameworks guiding this research, including intersectionality and minority stress theory, and will present findings on distinct developmental patterns identified through longitudinal statistical techniques. The presentation will highlight critical periods of elevated risk during adolescence, demographic differences in risk trajectories, and specific depression symptoms that strongly predict high-risk suicide outcomes. We will conclude by discussing implications for early intervention and culturally responsive prevention strategies to address these health disparities. The methodological approaches demonstrated in this research offer new pathways for understanding complex mental health outcomes in underrepresented populations and developing more effective interventions.

What works, for whom, and when: Coincidence analysis for implementation science

Theresa Matson, PhD, MPH
Kaiser Permanente Washington Health Research Institute

ABSTRACT:
Understanding why some interventions succeed while others fail is crucial for implementing evidence-based practices in real-world settings. Implementation efforts are complex, involving many factors, including the intervention itself, the strategies used to put it into practice, and the unique characteristics of each setting. Traditional research methods provide valuable insights, but they may not fully capture how different factors come together to influence success. This presentation provides an overview of Coincidence Analysis (CNA), a mathematical, case-based method that can uncover multiple pathways to success by modeling combinations of factor values that are minimally necessary and sufficient for an outcome. CNA can be applied as a standalone method or in conjunction with other approaches; we will discuss the types of questions that CNA is well-suited to answer. Finally, in an applied example, this presentation will share novel findings from secondary analysis of an implementation trial that used CNA to identify “difference-makers” that consistently and uniquely distinguished clinics that increased opioid use disorder treatment from those that did not. 

Contingency Management: Implementation of a Highly Effective Intervention for the Treatment of Stimulant Use Disorder

Beth Rutkowski, MPH
University of California, Los Angeles

Thomas Freese, PhD
University of California, Los Angeles

ABSTRACT:
Recent evidence indicates that methamphetamine and cocaine play a substantial and increasing role in the illicit drug crisis in the US—the 4th wave of the overdose crisis. The behavioral treatment known as contingency management (CM) has more than three decades of robust research supporting its efficacy for individuals with stimulant use disorder (StimUD). Despite overwhelming evidence supporting CM, it has not been widely used in routine treatment outside the VA healthcare system. This situation is changing as states are arranging funding for CM and developing CM programming for individuals with StimUD.

This presentation will begin with a brief overview of how cocaine and methamphetamine use are contributing to the current overdose crisis. Presenters will review CM protocol elements, evidence for CM, current obstacles to widespread implementation of CM, and strategies for addressing barriers. Present implementation strategies and preliminary results form the Recovery Incentive Program: California’s Contingency Management Benefit. This is the first program to implement CM using Medicaid funding through an 1115 Waiver. The Recovery Incentives Program is being systematically implemented using the Science to Service Lab (SSL) implementation approach which features three core components: didactic training, performance feedback, and external facilitation, augmented with a readiness assessment process for sites and an ongoing fidelity monitoring and feedback component. Strategies to track results of urine drug screens, calculate incentive amounts, and deliver incentives to the participants will be discussed. The presentation will describe implementation processes and will present preliminary results after 18 months of operation, demonstrating both the feasibility, replicability, and effectiveness of a large-scale rollout of this treatment.

Enhancing Data Driven Approaches to Recovery Monitoring via Measurement Based Care Co-Design and Implementation

Kelli Scott, PhD
Northwestern University

ABSTRACT:
Measurement-based care (MBC) involves the systematic evaluation of client treatment progress and the use of progress data to inform treatment planning. Although MBC is an evidence-based practice that has been widely studied in behavioral health settings, there is a dearth of research exploring its potential to monitor recovery progress for individuals receiving treatment for opioid use disorder. Key gaps in the literature include: 1) the lack of measurement tools aligned with treatment provider and patient needs; 2) limited study of needed MBC adaptations to support integration into opioid treatment; and 3) the need for greater evidence supporting the effectiveness and implementation of MBC in the opioid treatment program setting. This webinar will highlight findings from two ongoing studies, the Measurement Based Care to Opioid Treatment Programs Project (MBC2OTP) and the HEALing Measurement Center, which aim to evaluate the effectiveness and implementation of MBC in Chicagoland and Pennsylvania opioid treatment programs, respectively. This webinar has three key aims: 1) to orient participants to the potential impact of MBC on substance use treatment outcomes; 2) to highlight community-partnered co-design processes that can support MBC implementation in opioid treatment programs; and 3) to present preliminary data on needed MBC measure and protocol adaptations, as well as implementation strategies to support scale up.

The Longitudinal Implementation Strategy Tracking System (LISTS): Lessons learned from applying the method and new online tool

JD Smith, PhD
University of Utah

James Merle, PhD
University of Utah

ABSTRACT:
Documenting and tracking the dynamic changes to implementation strategies over time is crucial for advancing implementation science. Several methods for tracking strategies have been proposed recently, underscoring the importance of continued development of methods to accurately assess and monitor which strategies are used, and how and why they change over time. Continued methodologic work is needed to test and optimize a methodology and a data capture interface that balances rigor, feasibility, and usability. The novel Longitudinal Implementation Strategy Tracking System (LISTS) method was developed to address the limitations of the existing methods to advance the science of strategy tracking toward greater transparency and use of common data elements. Drs. Smith and Merle will provide an overview of the LISTS method and its use and lessons learned from use of the method in several implementation trials, followed by a demonstration of a freely-accessible online tool.

Lessons learned in the Development of De-Implementation Strategies to Address Mammography Overscreening among Older Women: Findings from an Innovation Tournament and Discrete Choice Experiment

Rachel Shelton, ScD, MPH
Columbia University

Nathalie Moise, MD, MS
Columbia University

ABSTRACT:
There is a need and opportunity to advance the science of de-implementation. Mammography screening among women 75 and older presents a robust area for inquiry related to de-implementation, as routine screening can lead to potential harms (e.g., overdiagnosis, overtreatment) while health benefits remain uncertain. Guided by de-implementation frameworks and methodological approaches from the field of implementation science, this presentation will discuss lessons learned and key findings from an online innovation tournament and discrete choice experiment to identify, select, and tailor de-implementation strategies at the patient, provider, and system levels for reducing mammography overuse in older women.

Methadone Patient Access to Collaborative Treatment (MPACT)

Beth Meyerson, MDiv, PhD
University of Arizona

ABSTRACT:
Methadone Patient Access to Collaborative Treatment (MPACT) is an experimental, multimodal intervention for methadone clinic staff and funded by NIDA. This presentation will provide a brief overview of MPACT, discuss the planned hybrid trial (late fall 2025), the village that collaboratively developed MPACT and the importance of fidelity tracking for intervention precision.

The Buprenorphine Prescribing Support Program for Rural Primary Care

Berkeley Franz, PhD
Heritage College of Osteopathic Medicine

ABSTRACT:
Buprenorphine is a critical tool to prevent overdose and infectious disease transmission in people with opioid use disorder, but it is difficult to access in rural areas. A promising solution is to engage rural primary care professionals. But the willingness of primary care professionals to prescribe this medication presents a vexing implementation science challenge—fewer than 8% of PCPs have ever prescribed buprenorphine. Stigma is a well-accepted prescribing barrier, but few implementation studies have focused on measuring and addressing the different types of stigma that matter for implementation. To address these barriers, we developed, iterated, refined, and pilot tested a brief, online stigma-reduction intervention that pairs clinical training on buprenorphine with exposure to 1) other rural PCPs who prescribe buprenorphine and 2) patients who received buprenorphine and are in sustained recovery. The Buprenorphine Prescribing Support Program (BPSP) is paired with a booster module and long-term prescribing mentorship. In this presentation, we will present the data that informed the development of the Buprenorphine Prescribing Support Program and results from a pilot clinical trial. Our long-term goal is a brief, effective stigma-reduction program that can be easily scaled to encourage widespread, appropriate buprenorphine use in rural primary care.

Establishing evidence criteria to identify and disseminate best practice implementation strategies in HIV

Ginger McKay, PhD
Washington University in St. Louis

ABSTRACT:
Given the progress of implementation research to address the HIV epidemic in the US, criteria specifically for evaluating the quality of implementation research and strategy effectiveness are needed to recommend strategies likely to have impact for practitioners. We will describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies. Our approach involved in three steps: key informant interviews to develop an initial set of criteria, a Delphi to refine the tool, and then piloting with existing published research to finalize our tool. We now are currently working to identify and disseminate strategies that meet the highest criteria levels for improving the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV and HIV testing with plans to address subsequent aspects of the HIV care continuum.

Revisiting Concepts of Evidence in Implementation Science

Ross Brownson, PhD
Washington University in St. Louis

ABSTRACT:
Evidence, in multiple forms, is a foundation of implementation research. For public health and clinical practice, evidence includes: Type 1 evidence on etiology and burden; Type 2 evidence on effectiveness of interventions; and Type 3: evidence on dissemination and implementation within context. Because current concepts of evidence have been relatively narrow and insufficient, this presentation will identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation research. Intersecting gaps include the need to: (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, and (4) learn from audience and stakeholder differences. Recommendations for enhancing the uses and usefulness of evidence will be presented.

Transforming Health Systems to Address Addiction

Melissa Weimer, DO, MCR, FASAM
Yale University

ABSTRACT:
The talk will discuss the need to change health systems to address addiction and implementation strategies that promote change.

Costing and Payment Tools in Addiction Research to Support Effective Dissemination of Economic Evidence

Kathryn McCollister, PhD
University of Miami

ABSTRACT:
Recent studies of the costs and economic impact of interventions for substance use disorder (SUD) have led to the development of costing tools and reimbursement calculators that support cost-effectiveness and cost-offset analyses and provide payers and other stakeholders with tailored products to assess budget impact and financial sustainability. This work reflects products from recent large-scale NIH research cooperatives (Helping End Addiction Long-term (HEAL)-ing Communities Study; Justice Community Opioid Innovation Network (JCOIN); HEAL Prevention Cooperative; HEAL Data2Action), which have established direct partnerships between health economic researchers, clinical researchers, SUD providers, state and local community agencies, and payers. An important objective in working more directly with different stakeholders to design tailored products and resources is to support both rigorous economic data collection and the effective dissemination of economic evidence for better decision making. This webinar will provide an overview of recently developed costing and payment tools and discuss how these tools are being implemented by stakeholders to optimize sustainability of high value interventions.

Understanding the Impact of Discrimination on Substance Use Among Black Justice-Involved Youth: A NIDA K23 Study

Brittany Bryant, DSW, LCSW-CP/S
University of California San Francisco

ABSTRACT:
Substance use among Black justice-involved youth is a critical public health issue, often exacerbated by experiences of discrimination and systemic racism. This NIDA K23 study aims to investigate the complex relationship between discrimination and substance use within this vulnerable population. Through qualitative interviews, the study will explore how perceived discrimination shapes substance use behaviors and the protective factors that may buffer against these effects. The insights gained will inform the development of culturally adapted interventions designed to reduce substance use and promote mental health, addressing the broader issues of criminalization and health disparities among Black youth. The process for culturally adaptations will be discussed with examples of the culturally adapted intervention provided.

TITLE: TBD

Jeremy D Goldhaber-Fiebert, PhD
Stanford School of Medicine

ABSTRACT:
TBD

Integration of a 1-session pain relief skills intervention across patient populations and practice settings

Beth Darnall, PhD
Stanford School of Medicine

ABSTRACT:
While national best practices guidelines call for a biopsychosocial approach to treating acute and chronic pain, few evidence-based options are broadly accessible to the people who need them. Poor access to effective non-pharmacologic pain treatment contributes to substance use, pain care disparities and human suffering. Brief, effective, and online behavioral pain treatments are needed across the continuum of care. In this session, Dr. Darnall will review published efficacy data from 4 randomized trials on a 1-session pain relief skills intervention (Empowered Relief®). Empowered Relief is NIH and PCORI-funded, scalable, evidence-based, disseminated and adopted by major healthcare organizations across the U.S. and internationally (29 countries) within primary care, tertiary care and perioperative pathways. Adaptations and applications in special populations will be discussed (Veterans, Military, Corrections settings).

Tackling the Uptake of MOUD for Individuals Incarcerated in Jail

Todd Molfenter, PhD
University of Wisconsin-Madison

Faye Taxman, PhD
George Mason University

ABSTRACT:
In an experiment that explored which implementation strategy—coaching using the NIATx goal process and ECHO, which prepares clinicians to increase the use of MOUD—affects the uptake and penetration of MOUD in jail settings. The presentation will: 1)identify techniques to correct misinformation; 2) discuss the impact of interagency change teams; 3) discuss the efficacy of different coaching and/or ECHO implementation strategies; and 4) use a web-based coaching model. The study findings illustrate that improving MOUD utilization in jail settings requires attention to cultural and work process issues.

Better, Faster, Cheaper, and Scaled: Opioid Use Disorder Treatment in the Fentanyl Era

Stephen Martin, MD, EdM
Boulder Care

Stephanie Strong, CEO, Founder
Boulder Care

ABSTRACT:
Treating opioid use disorder may be described as a “strike while the iron’s hot” scenario. Treatment must occur before doubts, withdrawal, or challenging life circumstances overwhelm someone who is interested, closing the window of opportunity. Despite nationwide efforts to expand access to highly effective medications like methadone and buprenorphine, both remain underused due to a combination of regulatory and attitudinal barriers. These barriers manifest in long wait-times (a problem of timing) and treatment scarcity (a problem of scale).

Measuring Interprofessional Communication in Pediatric Hospital Care

Sara Malone, LCSW, PhD
Washington University in St. Louis

ABSTRACT:
This presentation will discuss multiple studies aimed at measuring interprofessional communication and assessing it as a determinant of implementation and sustainability. I will discuss measurement development and the use of network methods to assess provider communication.

Supervision in addiction treatment programs: (Some) insights and future research ideas.

Jure Baloh, PhD, MHA
University of Arkansas for Medical Sciences

ABSTRACT:
Substance use disorders (SUDs) are a significant public health burden in the US, affecting almost 50 million individuals annually. Community specialty SUD treatment programs (“SUD programs”) are key treatment providers and while effective treatments for SUD exist, significant issues in the organization and delivery of SUD programs undermine the delivery of high-quality services. Supervisors in SUD programs are centrally positioned to support SUD counselors (frontline clinical providers) and ensure high service quality. In this presentation, we will provide an overview of supervision and its conceptualization, highlight recent findings from Arkansas, and outline (some) research directions for the future.

Implementation and User-Centered Design in Outpatient Care: A Case-Study with Pediatric Asthma and Digital Health

Kristin Kan, MD, MPH, MSc
Ann & Robert H. Lurie Children’s Hospital of Chicago

ABSTRACT:
Of the 5.5 million US children with pediatric asthma, over half have uncontrolled symptoms due in part to poor asthma self-management, leading to high rates of acute unscheduled care and activity limitations. Guideline-based, preventive asthma care is a critical step in reducing uncontrolled symptoms among high-risk asthma populations. An asthma care model using technology-enhanced tools, like digital device monitoring and population health management, is one promising approach to aid patients’ adherence to recommended care. However, implementation of technology-based care in outpatient care settings poses real-world barriers with integration in health delivery systems, changing health provider behaviors, and shifting care out of the clinic into home and community environments. In 2016, the Center for Food Allergy and Asthma Research (NU) partnered with community and hospital-affiliated primary care practices with using digital medication sensors and a mobile app with patients in a randomized trial. Using CFIR, interviews with patients, nurses, and clinicians were conducted post-trial to understand implementation constructs. The findings informed an upcoming feasibility trial, leveraging a population health model and digital asthma app and device. This presentation will reflect on the dynamic context of health system’s use of digital-enhanced healthcare, engagement of health providers and patients in changed expectations with these tools, and redesign that had to be considered for implementing in the outpatient care setting.

Pragmatic Implementation Science Guides and Measures to Enhance the Impact of Your Research

Helene Chokron Garneau, PhD, MPH
Stanford School of Medicine

Bryan Garner, PhD
Ohio State University

Heather Gotham, PhD
Stanford School of Medicine

Beth McGinty, PhD
Weill Cornell Medical College

Terrinieka Powell, PhD
Johns Hopkins Bloomberg School of Public Health

ABSTRACT:
Implementation science focuses on how to get effective interventions into practice; however, there is a lack of feasible, pragmatic tools that intervention researchers or those curious about implementation science can use to increase the likelihood that effective treatments are spread and scaled up in healthcare. Workgroups composed of implementation science experts, addiction and pain management intervention developers, and health services researchers from the NIDA-funded Center for Dissemination and Implementation At Stanford (C-DIAS) and HEAL Data2Action Research Adoption Support Center (RASC) developed a set of pragmatic guides and measures to democratize implementation science concepts and frameworks. These guides and measures focus on five key components of implementation science and are designed to support researchers, and anyone seeking to evaluate or implement a health care innovation. 

At the Pace of Trust: The Role of Trustworthiness in Implementation Science

Whitney Irie, PhD
Boston College

ABSTRACT:
Abstract: This manuscript-in-progress presentation will prompt critical discourse around trustworthiness as a fundamental determinant, critical strategy, and indispensable outcome in implementation science.