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2015 HSR&D/QUERI National Conference Abstract

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1127 — Substance Use Disorder Treatment Staff Acceptance of Intensive Referral to 12-Step Groups: Adoption, Implementation, and Maintenance

Young LB, Western Illinois University-Quad Cities; Grant KM, VA Nebraska-Western Iowa Health Care System; Tyler KA, University of Nebraska-Lincoln; Pulido RD, VA Nebraska-Western Iowa Health Care System; Meeks MV, VA Nebraska-Western Iowa Health Care System; Beaumont CA, VA Nebraska-Western Iowa Health Care System; Simpson JL, Midland University;

Objectives:
Veterans receiving substance use disorder (SUD) treatment in VA treatment centers typically are encouraged to supplement efforts to attain recovery through affiliation with a 12-Step group such as Alcoholics Anonymous. Evidence supports the effectiveness of 12-Step groups in sustaining recovery, but clinical referrals vary widely in substance and style of delivery. An Intensive Referral Intervention (IRI) standardizes the referral process and has proven effective in increasing abstinence rates at 6-month and 12-month post-treatment. This study investigates whether the intervention is acceptable to the staff charged with implementing it.

Methods:
Our team adapted the IRI by adding family outreach and tailoring it to accommodate rural veterans. We trained staff at six VISN 23 SUD treatment facilities in its use. Approximately six months following training, we conducted structured qualitative interviews (ongoing) using the RE-AIM program evaluation approach as our conceptual framework. The interviews focused on the final three components: adoption, implementation, and maintenance. We sought to determine the barriers to implementation and the opportunities to further adapt the IRI to enhance both clinical effectiveness and staff acceptability.

Results:
Thirteen interviews (at present) with site leaders, addiction therapists, and peer support specialists were transcribed and thematically analyzed using QSR nVivo. Regarding adoption, participants approved of the training, but voiced some resistance to the unilateral imposition of the intervention. Implementation responses evaluated the overall intervention and its seven components. Participants praised the intervention, finding the brochures most helpful and the 12-Step meeting identification most satisfactory. Client follow-up and the self-help journal were least helpful and satisfactory, respectively. Maintenance responses noted the difficulty of rural veterans in finding meetings to attend and suggested the IRI might be better delivered in a group setting rather than one-on-one. Participants also mentioned that the intervention may be less effective with chronic relapsers than with those undergoing treatment for the first or second time.

Implications:
As originally conceptualized, the IRI receives adequate evaluations on adoption, implementation, and maintenance, but minor modifications could improve staff acceptance of this intervention.

Impacts:
IRI is a feasible, low-cost option for standardizing and enhancing post-treatment referral to social networks supportive of sobriety.