Implementing a "Naloxone Hub With Many Spokes" Model in Kentucky: Partner Agency Perspectives on Implementation...

Overdose education and naloxone distribution (OEND) is a vitally important evidence-based practice for addressing the ongoing opioid epidemic. During the HEALing Communities Study in Kentucky, OEND was dramatically scaled up in eight counties using a "hub with many spokes" model and multifaceted implementation strategies. This aim of this manuscript is to describe qualitative perspectives of partner organizations regarding the utility of the implementation strategies used to expand OEND.

Twenty small-group and 24 individual qualitative interviews were conducted with staff from 44 agencies that implemented OEND through partnerships with the study team. Interviews were conducted 6-8 months after the study's Communities That HEAL intervention had ended, allowing participants the ability to reflect on their experiences. Inductive coding in NVivo 12 and thematic analysis were used to identify themes regarding agencies' perspectives regarding the implementation strategies deployed during the study.

In describing implementation strategies that supported their efforts to implement OEND, interview participants largely focused on strategies that provided resources, such as shipments of no-cost naloxone and overdose education tools. Flexibility in how the requisite overdose education was delivered allowed agencies to identify an educational approach that fit their workflow and addressed OEND recipients' needs. Participants also viewed implementation facilitation and technical assistance provided by study staff as helpful in facilitating the implementation process.

These qualitative data highlight the importance of multifaceted implementation strategies in the process of scaling up EBPs in communities. Future efforts should continue to explore how implementation strategies can be optimized to meet the needs of diverse types of organizations seeking to implement OEND and other evidence-based practices that can mitigate the harms of the opioid epidemic.