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RRP 14-192 – HSR&D Study

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RRP 14-192
Evaluation of Implementation of Intensive Referral Intervention to Support Groups
Kathleen M Grant MD
Omaha VA Nebraska-Western Iowa Health Care System, Omaha, NE
Omaha, NE
Funding Period: August 2014 - December 2015

BACKGROUND/RATIONALE:
Social networks are associated with alcohol and drug use, but also with abstinence. Community-based 12-Step support groups are one of the most accessible sources of social support for recovery. Evidence consistently shows that those who participate in 12-Step groups are significantly more likely to maintain abstinence over time. As clients transition from substance use disorder (SUD) treatment to home environments, clinical staff often recommend seeking sober support, but efforts and emphases are variable. The 3-session Intensive Referral Intervention (IRI) standardizes the evidence-based elements most likely to succeed in engaging clients in a sober support network.




OBJECTIVE(S):
Aim 1: Quantitatively evaluate protocol fidelity as we train Peer Support Specialists (PSS) to perform the IRI in additional SUD treatment sites.
Aim 2: Quantitatively and qualitatively evaluate PSS satisfaction with the IRI by measuring perceived effectiveness and acceptability.
Aim 3: Quantitatively and qualitatively evaluate treatment site leaders' satisfaction with the IRI by measuring perceived effectiveness and acceptability.

METHODS:
Peer Support Specialists were trained in the IRI in three SUD programs in Iowa and Minnesota. Clinical staff were trained in sites that did not have PSS on staff. Prior VA Office of Rural Health funding resulted in training of clinical staff at three sites in Nebraska. Research staff performed face-to-face on-site interviews lasting between 18 and 67 minutes with 10 site leaders, 8 addiction therapists, 8 peer support specialists, and 2 research staff. The semi-structured interview included 46-48 questions. Eighteen were Likert-style questions and the remainder were open-ended questions. SPSS was utilized to analyze quantitative data. Qualitative interview analysis of the summary data and thematic analysis was conducted using QSR nVivo software.


FINDINGS/RESULTS:
Specific elements of staff training, assisting staff with meeting and liaison identification, role playing interactive sessions and items for patients such as brochures were perceived by PSS, clinical staff and site leaders as Effective and Satisfactory. Specific scores (0-10 scale): Preparation & Training (8.6), Meeting Identification (8.6), Brochures (8.3), Client Follow-Up (8.0), Overall Assessment (7.9), Liaison Identification (7.8), Interactive Sessions (7.4), Family Outreach (7.4) and Self-Help Journal (6.3). Staff recommended preserving specific elements of Preparation & Training (Use role-play techniques for resistant patients); Brochures (Reduce/consolidate & broaden beyond 12-step); Meeting Identification (Host on-site meetings and use technology). Staff recommended enhancing Client Follow-Up (Clarify staff assignments and confirm client interest) and Liaison Identification (Base on client need and shift responsibility to client). They recommended reconsidering Interactive Sessions (Integrate into schedule and accommodate program); Family Outreach (Mail rather than phone and release of information obtained in second session or later); and Self-Help Journal (Make optional and do not require signatures).

IMPACT:
The Intensive Referral Intervention is perceived as generally acceptable among staff, but modifications could enhance perceived effectiveness and staff satisfaction. Training staff in VHA SUD treatment sites in the Intensive Referral Intervention will result in a more systematic referral to community-based sober support groups and increased sobriety.

PUBLICATIONS:

Conference Presentations

  1. Grant KM, Young LB, Tyler KA, Pulido RD, Meeks MV, Beaumont CA, Simpson JL. Substance Use Disorder Treatment Staff Acceptance of Intensive Referral to 12-Step Groups: Adoption, Implementation, and Maintenance. Presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2015 Nov 5; Washington, DC.
  2. Young LB, Grant KM, Tyler KA, Pulido RD, Meeks M, Beaumont C, Simpson JL. Substance Use Disorder Treatment Staff Acceptance of Intensive Referral to 12-Step Groups: Adoption, Implementation, and Maintenance. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.


DRA: Substance Abuse and Addiction
DRE: Prevention
Keywords: Implementation Science
MeSH Terms: none

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