Abstract
BackgroundThis article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care.Methods/designAdapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5–8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes.DiscussionStudy contributions to implementation science and considerations of MTFS-I sustainability are discussed.Trial registrationClinicalTrials.govNCT03342872. Registered 10 November 2017
Highlights
This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery
Enhancing sustainability: applying Core Training and Facilitation strategies to boost MTFS-I implementation in usual care To implement measurement feedback system (MFS) successfully in behavioral healthcare settings, supportive strategies are needed: conducting on-site MFS training aimed at improving user attitudes and self-efficacy, incentivizing regular MFS use, engaging leadership and identifying local champions to bolster MFS use, and providing technical assistance [34,35,36]
MTFS-I leverages user-centered online training methods designed to strengthen the fidelity of family-based services (FBS) and increase the accuracy with which therapists report on their own implementation of FBS
Summary
Key study innovations This study has several innovations that advance the science of ASU services research. The manual-driven strategy has encountered barriers to implementing FBS models in routine care: high consultation costs, limited flexibility for selective treatment planning favored by clinicians, and sustainability limitations due to vicissitudes in local regulatory practices, purveyor commitment, and provider stamina to honor quality procedures [6, 27]. The weekly time investment is 20 min for clinical staff for online training, plus another 15 min per week for therapists to enter ITT-ABP data and review feedback reports These commitments appear feasible given the expected benefits of increased FBS quality. This study’s collaborative implementation activities will enable us to shape MTFS-I components according to local user needs [31] These motivational processes can heighten provider commitment to adopting MTFS-I procedures, when they are sanctioned by state regulatory agencies in support of government priorities for improved treatment quality and accountability.
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