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Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and
Bryan R Garner1, Sarah B Hunter2, Rodney R Funk3
1RTI International, P. O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
Journal of Substance Abuse Treatment
|June 15, 2016
Summary
This study found that higher adherence to Adolescent Community Reinforcement Approach (A-CRA) procedures predicted better client outcomes in adolescent substance use treatment. Measuring procedure exposure is key for improving implementation of this evidence-based practice.
Area of Science:
- Implementation science
- Clinical psychology
- Public health
Background:
- Developing valid implementation outcome measures is crucial for advancing implementation science.
- Existing measures often lack validation against client outcomes.
- This study focuses on developing evidence-based measures of implementation (EBMIs) for the Adolescent Community Reinforcement Approach (A-CRA).
Purpose of the Study:
- To develop and validate organizational-level EBMIs for A-CRA, an evidence-based practice for adolescent substance use.
- To determine if implementation outcomes predict improvements in client outcomes.
Main Methods:
- Utilized a large dataset from a federally funded initiative (65 organizations, 308 clinicians, 5873 clients).
- Employed multilevel regression analyses to assess the predictive relationship between implementation outcomes and client outcomes at 6-month follow-up.
- Examined four implementation outcomes: fidelity (session and procedure exposure) and penetration (client and staff).
Main Results:
- Higher procedure exposure was significantly associated with lower client substance use at follow-up, after adjusting for baseline substance use and client characteristics.
- None of the other three implementation outcome measures (session exposure, client penetration, staff penetration) predicted client outcomes.
Conclusions:
- Procedure exposure is supported as an organizational-level EBMI for A-CRA.
- Monitoring procedure exposure can enhance A-CRA implementation efforts.
- This study offers a model for developing EBMIs for other behavioral treatments.
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