Table 1 Name, definition, and operationalization of each discrete implementation strategy
Discrete implementation strategies: defining characteristic according to Proctor and colleagues [31] | Operational definition of key dimensions for each discrete implementation strategy | ||||
|---|---|---|---|---|---|
Actor(s) | Actions(s) | Target(s) of the action | Temporality/dose | Justification | |
A. Centralized technical assistance: Develop and use a system to deliver technical assistance focused on implementation issues. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Technical assistance contract awarded to Chestnut Health System’s EBT coordinating center by SAMHSA/CSAT. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Ongoing throughout the SAMHSA/CSAT-funded implementation initiative. | |
B. Develop educational materials: Develop and format guidelines, manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | The A-CRA protocol manual [61], which provides information and knowledge about how the MIBI is intended to be implemented. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Developed prior to the start of the SAMHSA/CSAT-funded implementation initiative. | |
C. Develop and organize quality monitoring system: Develop and organize systems and procedures that monitor clinical processes and/or outcomes for quality assurance and improvement. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | A Web-based tool (EBTx.org) that enables secure and efficient sharing of A-CRA session information and audio recordings. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Developed prior to the start of the SAMHSA/CSAT-funded implementation initiative. | |
D. Develop tools for quality monitoring: Develop, test, and introduce quality-monitoring tools with inputs (e.g., measures) specific to the innovation being implemented. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | The A-CRA coding manual [62], which enables rating of A-CRA fidelity. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Developed prior to the start of the SAMHSA/CSAT-funded implementation initiative. | |
E. Distribute educational materials: Distribute educational materials (e.g., manuals) in-person, by mail, and/or electronically. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Distribute copies of the A-CRA manual [61] to therapists. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Distributed approximately one month prior to the SAMHSA/CSAT-funded implementation initiative’s in-person training workshop. | |
F. Conduct educational meetings: Hold meetings targeted toward providers, administrators, other organizational stakeholders, and community, patient or consumer, and family stakeholders to teach them about the clinical innovation. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | In-person workshop training that enables direct interaction between the actors (A-CRA developers) and targeted users (therapists). | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | In-person 3.5 day training workshop at the beginning of the SAMHSA/CSAT-funded implementation initiative, with similar training workshops provided approximately every 6–12 months throughout the SAMHSA/CSAT-funded implementation initiative. | |
G. Make training dynamic: Vary the information delivery methods to cater to different learning styles and work contexts and shape the training in the innovation to be interactive. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Incorporate role plays that enable therapists to practice implementing A-CRA procedures. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | As possible throughout the SAMHSA/CSAT-funded implementation initiative. | |
H. Audit & provide feedback: Collect and summarize clinical performance data over a specified period, and give data to clinicians and administrators in the hopes of changing provider behavior. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Generate and email feedback reports based on ratings of session audio recordings that were rated using the A-CRA coding manual [62]. | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Approximately weekly prior to demonstrating A-CRA proficiency and then approximately monthly throughout the remainder of SAMHSA/CSAT-funded implementation initiative. | |
I. Provide ongoing consultation: Provide clinicians with continued consultation with an expert in the clinical innovation. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Individual coaching that enables direct contact between the actor (A-CRA developer) and a targeted user (therapist). | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Approximately weekly prior to demonstrating A-CRA proficiency and then approximately monthly throughout the remainder of SAMHSA/CSAT-funded implementation initiative. | |
J. Create a learning collaborative: Develop and use groups of providers or provider organizations that will implement the clinical innovation and develop ways to learn from one another to foster better implementation. | The A-CRA developer team contracted to help implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Group coaching meetings that enable direct contact between the actor (A-CRA developer) and a group of targeted users (therapists). | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative. | Monthly throughout the SAMHSA/CSAT-funded implementation initiative. | |
K. Use other payment schemes: Introduce payment approaches motivate the clinician to provide better service. | Our research team funded by NIAAA to test the incremental effectiveness and cost-effectiveness of P4P as an implementation strategy. | $50 for each month a therapist demonstrated competence in treatment delivery (A-CRA competence) and $200 for each patient who received at least the targeted number of treatment procedures and sessions (target A-CRA). | Therapists selected to learn to implement A-CRA as part of the SAMHSA/CSAT-funded implementation initiative and who work at organizations randomized to the IAU+P4P condition. | Monthly throughout the NIAAA-funded cluster randomized trial. | |