Table 1 SAIA-Naloxone implementation strategy specification and fidelity
Name it | Systems Analysis and Improvement Approach for Naloxone (SAIA-Naloxone) | |
|---|---|---|
Define it | Facilitate development of a quality monitoring system to conduct cyclical small tests of change led by the organizational implementation teams | |
Specify it | Actor | External specialist works and facilitates discussion with the organization’s implementation team with regards to the SAIA-Naloxone process |
Actions | 1. Identify gaps: a. Present data evaluating the SSP’s naloxone delivery cascade with NCAT b. Facilitate discussions and support the implementation team to identify and develop consensus with regards to the areas of attrition along the naloxone cascade that they would like to address 2. Identify causes and opportunities: a. Facilitate discussions with the implementation team to review the SSP’s service structure and draw process maps documenting the flow of participants through the naloxone delivery cascade to understand (i) why there are drop-offs or inequities in distribution at different points (root causes of participant attrition) and (ii) what it would take to address those issues (opportunities to streamline workflows and address key points of attrition) b. Assist team in developing consensus about programmatic modifications based on their importance and feasibility 3. Conduct CQI: a. Support and mentor the implementation team in operationalizing programmatic modifications b. Present follow-up data on the naloxone delivery cascade for the implementation team to assess changes resulting from programmatic modifications c. Repeat above actions after conclusion of the cycle | |
Action target | Leverage programmatic data to facilitate CQI and foster a learning climate | |
Temporality | After training the implementation team on the SAIA process and integrating enhanced instruments to collect program data into workflows to track naloxone delivery cascade indicators | |
Fidelity | Content: Specialist completes actions 1–3 with SSPs Coverage: Relevant SSP staff are present during actions 1–3 Duration: Actions 1, 2, and 3 take ~ 60min each Frequency: Specialist visits SSPs in person during months 1, 4, 7, and 10. Specialist meets SSPs virtually during all other months in active phase Quality: Specialist forms rapport with SSP staff, flexibly attends to their unique needs, and motivates SSP staff to engaged with actions 1–3 Participant responsiveness: SSP staff like working with the specialist and like participating in actions 1–3 | |
Targeted implementation outcomes | 1. Implementation effectiveness relative to IAU a. Reach: Number of participants screened for naloxone engagement b. Fidelity (to the naloxone cascade): Number of participants who receive naloxone 2. Equitable implementation effectiveness relative to IAU a. Reach: Number of BIPOC and other key groups screened for naloxone engagement b. Fidelity (to the naloxone cascade): Number of BIPOC and other key group participants who receive naloxone | |
Justification | SAIA-Naloxone combines a broad view of the service system with iterative improvement cycles in a user-friendly way; by leveraging SAIA-Naloxone, SSPs can identify fillable gaps in the naloxone delivery cascade and apply locally generated solutions that have a higher likelihood of leading to measurable and sustained improvements in fidelity to the cascade and penetration of naloxone | |