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BMC Health Serv Res. 2018 Jun 8;18(1):431. doi: 10.1186/s12913-018-3241-4.

Using NIATx strategies to implement integrated services in routine care: a study protocol.

Author information

1
School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, 777 University Ave, Madison, WI, 53705, USA. jhfordii@wisc.edu.
2
Office of Behavioral Health and Managed Care, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA, 98504, USA.
3
Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, 94304, USA.
4
School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, 777 University Ave, Madison, WI, 53705, USA.
5
Office of Behavioral Health and Prevention, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA, 98504, USA.
6
Washington State Health Care Authority, Olympia, WA, 98501, USA.
7
Division of Public Mental Health & Population Sciences, Department of Psychiatry & Behavioral Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1520 Page Mill Road MC5265, Palo Alto, CA, 94304, USA.

Abstract

BACKGROUND:

Access to integrated services for individuals with co-occurring substance use and mental health disorders is a long-standing public health issue. Receiving integrated treatment services are both more effective and preferred by patients and families versus parallel or fragmented care. National policy statements and expert consensus guidelines underscore the benefits of integrated treatment. Despite decades of awareness, adequate treatment for individuals with co-occurring substance use and mental health disorders occurs infrequently. The underlying disease burden associated with alcohol, illicit and prescription drug problems, as well as mental health disorders, such as depression, posttraumatic stress disorder and schizophrenia, is substantial.

METHODS:

This cluster randomized controlled trial (RCT) is designed to determine if the multi-component Network for the Improvement of Addiction Treatment (NIATx) strategies are effective in implementing integrated services for persons with co-occurring substance use and mental health disorders. In this study, 50 behavioral health programs in Washington State will be recruited and then randomized into one of two intervention arms: 1) NIATx implementation strategies, including coaching and learning sessions over a 12-month intervention period to implement changes targeting integrated treatment services; or 2) wait-list control. Primary outcome measures include: 1) fidelity - a standardized organizational assessment of integrated services (Dual Diagnosis in Addiction Treatment [DDCAT] Index); and 2) penetration - proportion of patients screened and diagnosed with co-occurring disorders, proportion of eligible patients receiving substance use and mental health services, and psychotropic or substance use disorder medications. Barriers and facilitators, as determinants of implementation outcomes, will be assessed using the Consolidated Framework for Implementation Research (CFIR) Index. Fidelity to and participation in NIATx strategies will be assessed utilizing the NIATx Fidelity Scale and Stages of Implementation Completion (SIC).

DISCUSSION:

This study addresses an issue of substantial public health significance: the gap in access to an evidence-based practice for integrated treatment for individuals with co-occurring mental health and substance use disorders. The study utilizes rigorous and reproducible quantitative approaches to measuring implementation determinants and strategies, and may address a longstanding gap in the quality of care for persons with co-occurring disorders.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT03007940 . Registered 02 January 2017 - Retrospectively Registered.

KEYWORDS:

Co-occurring disorders; DDCAT; Integrated treatment; NIATx implementation strategies

PMID:
29884164
PMCID:
PMC5994046
DOI:
10.1186/s12913-018-3241-4
[Indexed for MEDLINE]
Free PMC Article

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