Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy

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Abstract

Background

Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking—Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO).

Methods

This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview.

Results

No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet.

Conclusions

This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet.

Trial registration

ClinicalTrials.gov NCT01430741

Related collections

Most cited references 28

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Russell A Kitson, Dominic Harvey, B McCormack (1998)

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An exploration of the factors that influence the implementation of evidence into practice.

Jo Rycroft-Malone, Gill Harvey, Kate Seers … (2004)

The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry. The aim of the study was to address the following questions: * What factors do practitioners identify as the most important in enabling implementation of evidence into practice? * What are the factors practitioners identify that mediate the implementation of evidence into practice? * Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice? The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n = 17). A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources. The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence-based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves. Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.

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Outcomes of a partnered facilitation strategy to implement primary care-mental health.

JoAnn Kirchner, Mona Ritchie, Jeffery A Pitcock … (2014)

Implementing new programs and practices is challenging, even when they are mandated. Implementation Facilitation (IF) strategies that focus on partnering with sites show promise for addressing these challenges.

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All references

Author and article information

Contributors

Matthew Chinman:

ORCID: http://orcid.org/0000-0001-5390-8723

412 360-2438 , Chinman@rand.org

Sharon McCarthy: Sharon.McCarthy@va.gov

Gordon Hannah: Gordon.Hannah@va.gov

Thomas Hugh Byrne: tbyrne@bu.edu

David A. Smelson: David.Smelson@umassmed.edu

Journal

Journal ID (nlm-ta): Implement Sci

Journal ID (iso-abbrev): Implement Sci

Title: Implementation Science : IS

Publisher: BioMed Central (London )

ISSN (Electronic): 1748-5908

Publication date (Electronic): 9 March 2017

Publication date PMC-release: 9 March 2017

Publication date Collection: 2017

Volume: 12

Electronic Location Identifier: 34

Affiliations

[1 ]ISNI 0000 0004 0420 3665, GRID grid.413935.9, VISN 4 Mental Illness Research and Clinical Center and the Center for Health Equity Research and Promotion, , VA Pittsburgh Healthcare System, ; Pittsburgh, PA USA

[2 ]ISNI 0000 0004 0370 7685, GRID grid.34474.30, , RAND Corporation, ; Pittsburgh, PA USA

[3 ]VA National Center on Homelessness Among Veterans, Philadelphia, PA USA

[4 ]ISNI 0000 0004 1936 7558, GRID grid.189504.1, , Boston University School of Social Work, ; Boston, MA USA

[5 ]VA Center for Healthcare Organization and Implementation Research, Boston, MA USA

[6 ]ISNI 0000 0001 0742 0364, GRID grid.168645.8, Department of Psychiatry, , University of Massachusetts Medical School, ; Worcester, MA USA

Author information

Matthew Chinman http://orcid.org/0000-0001-5390-8723

Article

Publisher ID: 565

DOI: 10.1186/s13012-017-0565-0

PMC ID: 5345223

PubMed ID: 28279207

SO-VID: ac7ff17f-d1f1-4fe7-9d8d-20bcf39d1ca8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 3 September 2016

Date accepted : 1 March 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100007217, Health Services Research and Development;

Award ID: SDP 11-240

Award Recipient : Matthew Chinman Sharon McCarthy Gordon Hannah Thomas Hugh Byrne David A. Smelson

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: implementation support,co-occurring disorders,fidelity,training,technical assistance

Data availability: