By Rosemarie Martin, PhD and Sara Becker, PhD, New England ATTC
The New England ATTC at the Center for Alcohol and Addiction Studies of Brown University has been continuously funded since the ATTC network’s inception in 1993. The mission of the Center for Alcohol and Addiction Studies is to promote the identification, prevention and effective treatment of addiction and its problems through research, education, training, and advocacy. Having a home in a world-class addiction research center, the New England ATTC fills a unique niche that sets us apart. Our role as technical assistance purveyors, paired with our home in a center dedicated to advancing science, makes us ideally suited to advance the study of implementation science. We are well poised to close the lengthy gap between the development of research-based addiction health services and their adoption to clinical practice.
The New England ATTC has leveraged our academic partnerships with community providers to improve the standard in the field for rolling out evidence-based practices (EBPs). The centerpiece of the New England ATTC’s training efforts for the past two decades has been the Science to Service Laboratory. The SSL is a comprehensive, state-of-the-art multi-component implementation strategy that facilitates technology transfer.
What is unique about the SSL is the inclusion of three key implementation strategies designed to better support the broad process of technology transfer: didactic workshop, performance feedback, and external facilitation.
Using contingency management as test case, our ATTC first applied for funding in 2008 to evaluate the SSL strategy compared to the standard at the time, didactic workshop delivered by a national expert, Nancy Petry.
We offered the SSL multi-component implementation strategy to seven opioid treatment programs within our region and compared that to 11 opioid treatment programs outside of our region that received a didactic workshop. Opioid treatment program staff in both conditions reported on their delivery of contingency management every two weeks for a year. We found that those organizations trained with the SSL model had higher odds of adoption (odds ratios up to times higher than the didactic workshop), higher speed of adoption, and higher overall frequency of adoption.
Still, we thought there was room for improvement. Could we help accelerate the uptake of contingency management in clinics? Could we help sustain its use? We asked opioid treatment providers from 11 programs in our region how we could more effectively help them to integrate contingency management into their treatment approach and used their feedback to enhance the SSL. With R01 funding from the National Institute on Drug Abuse, our ATTC is partnering on a large-scale cluster randomized trial with 28 opioid treatment programs throughout the region to test our standard SSL strategy versus an enhanced SSL strategy that layers in provider incentives and external facilitation targeting sustainment.
This five-year project is wrapping up and we are excited to share the results soon.
In the meantime, we are using the lessons learned to partner with the Rhode Island Department of Health to help them rollout contingency management to opioid treatment programs state-wide. Our SSL model has also informed the multi-component implementation strategy currently being used across California in their rollout of contingency management as a Medicaid-reimbursable service.
The SSL continues to evolve as we integrate new scientific findings in behavior change at both individual and organizational levels. The science to service influence is bidirectional: we learn from scientific research to improve our technical assistance, and we learn from our work in the field providing technical assistance to improve our science.
In recent years, the most popular EBPs for which the New England ATTC receives intensive technical assistance requests include contingency management, motivational interviewing, and Screening, Brief Intervention, and Referral to Treatment. We look forward to continuing to apply the SSL to help organizations implement EBPs and improve the quality of care offered to persons with or in recovery from substance use disorders.
About the authors:
Rosemarie A. Martin, PhD, is Director of the New England ATTC. Dr. Martin is an Associate Professor at the Center for Alcohol and Addiction Studies at the BRown University School of Public Health.
Sara J. Becker, PhD is Co-Director of New England ATTC. Dr. Becker is the Inaugural Director of the Center for Dissemination and Implementation Science at the Northwestern Feinberg School of Medicine.