A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
Authors
Simmons, Molly M.Gabrielian, Sonya
Byrne, Thomas Hugh
McCullough, Megan B.
Smith, Jeffery L.
Taylor, Thom J.
O'Toole, Thomas P.
Kane, Vincent
Yakovchenko, Vera
McInnes, D. Keith
Smelson, David A.
Document Type
Journal ArticlePublication Date
2017-04-04Keywords
Co-occurring disordersfacilitation
step wedge design
vulnerable populations
Health Services Administration
Mental and Social Health
Military and Veterans Studies
Psychiatry
Psychiatry and Psychology
Metadata
Show full item recordAbstract
BACKGROUND: Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. DESIGN: Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation across seven HPACT teams in three sites in the greater Los Angeles VA system. This is a cluster randomized trial. DISCUSSION: Integrating MISSION-Vet within HPACT has the potential to improve the health of thousands of veterans, but it is crucial to implement the intervention appropriately in order for it to succeed. The lessons learned in this protocol could assist with a larger roll-out of MISSION within HPACT. This protocol is registered with clinicaltrials.gov and was assigned the number NCT 02942979.Source
Implement Sci. 2017 Apr 4;12(1):46. doi: 10.1186/s13012-017-0563-2. Link to article on publisher's siteDOI
10.1186/s13012-017-0563-2Permanent Link to this Item
http://hdl.handle.net/20.500.14038/40341PubMed ID
28376839Related Resources
Rights
© The Author(s). 2017Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.1186/s13012-017-0563-2