Looking for more info on D&I research and cutting-edge D&I methods applicable to addiction? Join the weekly C-DIAS PSMG Virtual Grand Rounds. If you miss one, the presentations and chat are archived below. The Grand Rounds will be eligible for CME/CE credits, details to follow. Recommendations for speakers are welcomed. They can be submitted using the Contact Us form below.
The Center for Dissemination and Implementation At Stanford (C-DIAS) is a partner to the HD2A RASC, and is dedicated to improving the science of implementation in addiction treatment through designing and testing measures and tools for the field, and training the next generation of addiction D&I experts (P50DA05402).
Jessica Magidson, PhD and Sarah Kattakuzhy, MD, MPH | December 5, 2024: There is a severe shortage of providers to treat opioid use disorder (OUD), which is further exacerbated in rural areas. Similar to the shortage of prescribers, there is also a severe shortage of trained behavioral health providers to meet the needs of patients with OUD. This talk will provide an overview of a newly launched NIDA-funded R01 trial “Peer Recovery to Improve Polysubstance Use and Mobile Telemedicine Retention” (PRISM)–a randomized Type 1 hybrid effectiveness-implementation trial (n=180) to examine a peer recovery specialist-delivered behavioral intervention to improve retention and polysubstance use on a mobile telemedicine treatment unit in rural Maryland. We will describe a novel telemedicine mobile treatment unit approach to expand access to OUD treatment in hard hit rural areas, as well as how our team is integrating an evidence-based, peer-delivered behavioral activation intervention to support retention and polysubstance use outcomes.
Bethany M. Kwan, PhD, MSPH, FSBM | January 30, 2024: Designing for dissemination and sustainability (D4DS) refers to the process of ensuring that the products of research are likely to be adopted, implemented, and sustained in the context of intended use. D4DS involves use of methods such as participatory co-design, active dissemination planning, and pragmatic trial designs to develop evidence that “fits the context” and can be readily adopted in real-world settings. This presentation will provide an overview of the rationale, principles, methods, and frameworks for D4DS. The Fit to Context Framework for D4DS is a novel process framework to guide planning, conduct, and dissemination of research, based on a narrative review of the literature on D4DS. Tools to support application of the Fit to Context Framework, including https://dicemethods.org/ and https://app.d4dsplanner.com/, will be demonstrated. A case example will describe D4DS applications in the Invested in Diabetes study, a pragmatic, type II hybrid implementation-effectiveness trial of two models of diabetes shared medical appointments.
Donald Warne, MD, MPH | January 23, 2024: American Indians and Alaska Natives (AI/ANs) endure some of the worst health disparities in the nation. The history of marginalization and exclusion of Indigenous voices from setting the research agenda, determining priorities, and conducting research will be explored. We will also define American Indian, Alaska Native, Native American, and Indigenous populations in the US; and we will describe the impact of preventable conditions on Indigenous health equity. We will also explore and identify opportunities to promote prevention science, methods, and implementation in AI/AN populations to improve outcomes.
Antonio Morgan-Lopez, PhD | January 16, 2024: In the majority of randomized controlled trials (RCTs) the focus is on differences in the average change over time on outcomes across intervention conditions, with variation in individual trajectories often treated as nuisance. In contrast, a primary focus on inferences regarding the improvement (or worsening) of individual participants is best represented by clinical significance or clinically significant change (CSC). One of the primary tools in the assessment of CSC is Jacobson and Truax (1991’s) Reliable Change Index (RCI). The RCI is still very popular, as evidenced by 12,000 total citations and over 300 citations in 2023 alone. However, three specific limitations have been identified with the RCI: a) the RCI estimate is based on a pre-post difference score, b) the scores upon which the RCI estimate is based (typically total scores) often contain both measurement bias and measurement error and c) the RCI standard error of measurement (SEM) is erroneously assumed to be constant across participants and time. We present an approach that addresses all three limitations simultaneously: a) scale score and SEM estimation using moderated nonlinear factor analysis and b) RCI estimation using a modification of a three-level multilevel model with modeling
Lauren K. Whiteside, MD, MS | November 14, 2023: The opioid epidemic is rapidly evolving with the proliferation of nonpharmaceutical fentanyl. Simultaneously, researchers, public health officials, and clinicians are working to develop and implement interventions to improve clinical care for patients with opioid use disorder (OUD). The Emergency Department Longitudinal Integrated Care (ED-LINC) randomized clinical trial harnesses the Collaborative Care model to reduce illicit opioid use and improve initiation and retention of evidence-based medications for opioid use disorder (MOUD) for patients that visit the ED with OUD. The original ED-LINC intervention was developed and pilot-tested prior to the overwhelming availability of fentanyl in our community. We present information on a systematic rapid qualitative approach leveraging real-time clinical observations related to fentanyl use among the initial n=30 ED-LINC intervention participants. This method was used to systematically produce and document protocol modifications and intervention adaptations required to ensure successful implementation of an intervention that is relevant to the target population amidst the rapidly intensifying fentanyl epidemic. As an implementation practitioner, there is an unavoidable urgency in treating patients with OUD due to fentanyl now and it is crucial that research does not lag behind the current state given the rapidly evolving epidemic.
Justin Knox, PhD, MPH | October 10, 2023: We recently proposed the observational-implementation hybrid approach, or the incorporation of implementation science elements into observational studies in order to collect information that will allow for anticipation, estimation, and/or inference about the effects of interventions and implementation strategies. We describe this approach, including examples of how we are applying it to an ongoing observational study among n=600 Black sexual minority (SMM) men in order to collect relevant implementation data regarding the use of evidence-based practices to support drinking reductions. An initial step for employing an observational-implementation hybrid approach is knowing about the state of the research on relevant interventions or policies that aim to address the modifiable constructs relevant to the research questions of the study, including their implementation. Evidence-based practices that have been shown to help individuals reduce their alcohol use that we will focus on include: electronic screening and brief intervention, motivational interviewing, HealthCall (an mHealth intervention for people living with HIV), and naltrexone. We will employ various approaches to collect information on how to deliver these alcohol interventions to Black SMM. We are using survey measures to collect factors related to transportability of the alcohol interventions that we selected
Moira McNulty, MD and Maria Pyra, MEd, MPH, PhD | October 3, 2023: A daily pill, PrEP, has changed HIV prevention and could help end the HIV epidemic in the U.S. Thus far, use of PrEP has not been evenly or effectively distributed. Much of the focus to date on PrEP delivery has been on linkage and initiation of PrEP. We know that effectiveness of PrEP depends not only on initiation, but also on adherence, which typically requires retention in care for ongoing monitoring and prescriptions per the CDC guidelines; i.e., persistence on PrEP. While the annual number of PrEP users has been increasing, improvement in retention and adherence has lagged, with many individuals who initiate PrEP no longer adherent or retained at 6 months, despite the likelihood that risk of exposure to HIV continues. Furthermore, some of the most vulnerable populations such as young Black MSM are more likely to fall out of PrEP care than their non-Black peers. Yet, measuring persistence has been challenging, particularly in a way that is standardized and can be used across patient populations and PrEP programs. Dr. Moira McNulty, from the University of Chicago, and Dr. Maria Pyra, from Northwestern University, will present
Jeffrey De Flavio, MD | September 26, 2023: Across medicine clinical innovations take years to disseminate widely into practice, while some best practices in addiction medicine fail to ever gain widespread adoption. This presentation describes two private medical practices (Groups Recover Together and Affect Therapeutics) which have brought underutilized and evidence-based interventions to scale across the United States. The presentation will focus on the clinical models, patient outcomes, workforce considerations, revenue models and capital formation which was required to scale these effective care programs.
Rinad Beidas, MA, PhD | September 19, 2023: This presentation will describe efforts to apply the tools and insights from behavioral economics to improve upon implementation of evidence-based practices.
Gregory Simon, MD, MPH | September 12, 2023: This presentation will consider specific considerations in the design and implementation of embedded pragmatic trials, including: eligibility criteria, unit of allocation, method of allocation, standardization of “active” interventions, standardization of “control” interventions, blinding, and analytic strategy. For each of these design decisions, investigators must focus on the specific study question and consider scientific rigor, practical constraints, and ethical obligations to potential study participants.
Erika Crable, PhD | May 16, 2023: The ‘research to policy gap’ describes the failure to translate research findings into real-world, evidence-informed policies. This gap is dangerous to health systems and population health, but dissemination and implementation science (D&I) is poised to address this pervasive problem by designing effective strategies that promote evidence-informed policy and policy implementation success. To be most efficient while advancing science, policy D&I efforts must meaningfully draw from lessons learned in other fields. This presentation will discuss: (1) how different social science disciplines have studied the research to policy gap, (2) how those theories and methods can be incorporated into policy D&I efforts, and (3) highlight an example of a current policy dissemination study at this multidisciplinary intersection. We hope to foster a discussion about challenges in studying policy and policy-level factors, and practical multidisciplinary research approaches to advance policy D&I.
Todd Wagner, PhD | May 9, 2023: Efficiency is upheld as a cornerstone of high-quality care. Unfortunately, the term efficiency is used in different contexts, creating substantial confusion about what it means. In this talk, I define efficiency as it relates to the delivery of health care. I then review different frameworks for measuring it and common strategies that can be used to improve it.
Lilian Perez, PhD and James Merle, PhD | May 2, 2023: As evidence-based innovations (EBIs) are translated into clinical and community settings, implementation determinant frameworks can help understand the factors that impede or facilitate implementation outcomes. Use of different frameworks across implementation initiatives can impede shared learning. To develop a framework for shared learning in the DECIPHeR Alliance (decipheralliance.org), we conducted a crosswalk of three determinant frameworks used in the Alliance: 1) Exploration, Preparation, Implementation, and Sustainment (EPIS); 2) Practical, Robust Implementation and Sustainability Model (PRISM); and 3) Consolidated Framework for Implementation Research (updated CFIR). To operationalize health justice and equity considerations, we also incorporated elements of the Health Equity Implementation Framework (HEIF). In this talk, we will discuss the process for developing the integrated framework, called “IM4Equity,” and describe our user-centered feedback process to improve the framework’s understandability and usefulness across the Alliance. IM4Equity can help guide evaluations of EBIs and implementation outcomes across diverse contexts. Compared to any single framework, it has the potential to better identify the myriad of implementation determinants with a focus on health equity considerations. It can also aid in common data elements and cross-project synthesis.
Beth McGinty, PhD | April 25, 2023: Policy implementation is a key but often-ignored aspect of policy effectiveness. Public policy research typically considers the effects of having versus not having a policy on outcomes, without considering whether and how the policy was implemented – even though the effects of policies on their intended outcome depend upon degree of implementation. Experimental approaches to studying policy dissemination and implementation are challenging, given that policies are difficult to randomly assign, but not impossible. Natural experiments in policy implementation abound, as states, localities, and organizations consider, adopt, and implement – with varying degrees of implementation success, and intensity – a range of policies over time. Rigorous nonexperimental methods for studying policy dissemination and implementation in these types of natural experiments are critical, but methodological advances are needed. This presentation will motivate the importance of studying policy implementation, provide examples of current approaches, and discuss promising future directions.
Gustavo Carlo, PhD | April 18, 2023: Drawing upon a strengths-based, cultural assets perspective, I will present evidence on the growth properties of prosocial behaviors and assert the need to incorporate prosocial behaviors as a marker of health and well being. The presentation will focus on risk and protective correlates and consequences of prosocial behaviors in U.S. Latine youth. Implications for prevention and intervention research and programs will be briefly discussed.
Andrew Quanbeck, PhD | April 11, 2023: This presentation reports the cost-effectiveness analysis from a fully powered randomized clinical trial that featured a head-to-head comparison between telemedicine and digital health interventions for providing continuing care for patients with alcohol use disorder. A telemedicine intervention (telephone monitoring and counseling: TMC) and a mobile health intervention (Alcohol Comprehensive Health Enhancement Support System: A-CHESS) were examined in a 2×2 factorial randomized trial that enrolled 262 participants from two Philadelphia area intensive outpatient programs. Intervention costs and effectiveness (in terms of number of risky drinking days) were assessed for each group with respect to the control group. The effectiveness of reduced days heavy drinking for all 3 treatment groups (TMC, A-CHESS, and TMC+A-CHESS) were statistically significant compared to the control group. However, no treatment group was more effective than the others in terms of statistical significance. Compared to the control group, where participants averaged 43.75 days of heavy drinking over 12 months, participants in the treatment groups had significantly fewer average heavy drinking days over the 12-month intervention (TMC: 15.78 days heavy drinking, P)
Lisa Saldana, PhD | March 31, 2023: FAIR (Families Actively Improving Relationships) is an evidence-based practice for parents referred to the child welfare system. Treatment addresses substance use (primarily opioids and/or methamphetamine), mental health, parenting, and ancillary needs. FAIR is community-based and relies on collaboration with service and community partners. As part of the NIH Helping to End Addiction Long-term (HEAL) initiative, FAIR was adapted for upstream prevention to be evaluated for clinical effectiveness in a Hybrid Type 2 trial in four rural counties. Counties were selected in collaboration with state leadership. A clearly defined implementation process was followed at the county, clinic, and provider levels. Challenges and opportunities related to the outer context of a staggering increase in opioid and methamphetamine use in the participating regions and the COVID-19 pandemic will be highlighted. Implementation process (using the Stage of Implementation Completion) and the resources used to complete it (measured using the Cost of Implementing New Strategies) will be presented in relation to these different contexts.
Ana Baumann, PhD | March 14, 2023: Equity continues to garner attention in the field of implementation science. Coming from a learner perspective, this presentation will offer some recommendations and suggestions as to how to embed equity in implementation studies, with a focus on processes and outcomes.
Bradley Wagenaar, PhD | March 7, 2023: Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This talk will summarize our work on adapting, implementing, and now testing the effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) implementation strategy to optimize the primary mental healthcare treatment cascade in government health facilities in Mozambique.
Brian Mittman, PhD | February 28, 2023: Full realization of the societal benefits of our work in implementation science requires high levels of successful sustainment (maintenance) and scale-up/spread of our implementation strategies and the effective practices we strive to implement. This presentation offers a series of questions we should ask, and recommendations for actions we can – and should – take, to enhance our societal contributions as implementation scientists.
Theresa Matson, PhD and Joseph Glass, PhD | February 21, 2023: Background: Clinicians and community health workers may wish to use digital interventions to reach more patients with unhealthy substance use, optimize costs of care, and improve outcomes. However, digital interventions have unique implementation considerations (e.g., technology infrastructure, digital literacy, monitoring and follow-up) and may not fit traditional care pathways. Effectiveness and implementation trials are needed to understand how well digital interventions work and how to best deploy them in the real-world. This presentation presents a framework to help researchers design their trials in such a way that maximizes scientific understanding. Methods: This framework draws from the literature on trial design, expert perspectives on the use of digital interventions, and lessons learned from implementation science research programs. It outlines three major steps for designing trials of digital interventions: 1) framing the research question; 2) delineating components of the intervention, implementation strategy, and delivery approach; and 3) specifying the experiment and other elements of trial design. Results: In Step 1 of this framework, researchers frame the research question in terms of the goals or activities to be tested (i.e., features of the digital intervention itself, specific implementation strategies, or level of
Velma McBride Murry et al | February 14, 2023: The authors of the article, Re-envisioning, Retooling, and Rebuilding Prevention Science, will engage in a conversation to describe the team approach in writing this paper, as well as take away message from this effort. Following this fireside chat format, the authors will engage attendees in a reflective and projective dialogue on how to advance equity and social justice in our own work.
Booil Jo, PhD | February 7, 2023: Despite its potentials benefits, using prediction targets generated based on latent variable (LV) modeling is not a common practice in supervised learning, a dominating framework for developing prediction models. In supervised learning, it is typically assumed that the outcome to be predicted is clear and readily available, and therefore validating outcomes before predicting them is a foreign concept and an unnecessary step. The usual goal of LV modeling is inference, and therefore using it in supervised learning and in the prediction context requires a major conceptual shift. This study lays out methodological adjustments and conceptual shifts necessary for integrating LV modeling into supervised learning. It is shown that such integration is possible by combining the traditions of LV modeling, psychometrics, and supervised learning. In this interdisciplinary learning framework, generating practical outcomes using LV modeling and systematically validating them based on clinical validators are the two main strategies. In the example using the data from the Longitudinal Assessment of Manic Symptoms (LAMS) Study, a large pool of candidate outcomes is generated by flexible LV modeling. It is demonstrated that this exploratory situation can be used as an opportunity to tailor desirable prediction targets taking
Keith Humphreys, PhD | January 31, 2023: Many people hope that evidence — be it lived experience, clinical know how, or scientific research findings – can be used to improve policies towards addictive drugs, addiction, treatment, and recovery. But public policymaking can seem mysterious and irrational, such that many are cynical that evidence can matter. This presentation describes how even though many factors other than evidence shape public policy, evidence can exert some influence and sometimes a great deal of influence. After detailing what counts as evidence and how evidence is different than opinions and values, this presentation walks through actually policy changes in which they author was involved, including the 2008 campaign for mental health and addiction parity in health insurance and the 2010 passage of the Affordable Care Act. Each case study illuminates when evidence mattered and in what way, emphasizing that while evidence can’t and shouldn’t carry the day in a democracy, it has unique value both for the design and passage of policy as well as its implementation.
Daniel Almirall, PhD | January 24, 2023: Evidence-based practices often fail to be implemented or sustained due to barriers at multiple levels of an organization (e.g., system-level, practitioner-level). A growing cadre of implementation strategies can help mitigate challenges at these multiple levels, but significant heterogeneity exists in whether, and to what extent, organizations—and the practitioners who deliver treatment within them—respond to different strategies. However, it is impractical to provide all (or even most) of these strategies to all levels, at all times. This suggests the need for an approach that sequences and adapts the provision of implementation strategies to the changing context and needs of practitioners within the multiple levels of an organization. A multi-level adaptive implementation strategy (MAISY) offers a replicable, approach to precision implementation that guides implementers in how best to adapt and re-adapt (e.g., augment, intensify, switch) implementation strategies based on the changing context and changing needs at multiple levels.
Mark McGovern, PhD and Helene Chokron Garneau, PhD, MPH | September 27, 2022: This presentation will introduce the new Center for Dissemination and Implementation At Stanford (C-DIAS), a NIDA P50 Center of Excellence. C-DIAS’ overarching mission is to expand equitable access to the most effective treatments available for addiction. It unites experts from implementation science and addiction treatment services research, and hosts three innovative, synergistic research projects at the PREPARATION, IMPLEMENTATION and SUSTAINMENT phases of the implementation process. In addition, C-DIAS aims to increase the expert capacity of D&I science in addiction, and will offer a stratified range of education, training and mentoring opportunities based on need. Audience will learn how to access C-DIAS open resources and programs, and understand how research findings can be integrated across the 3 C-DIAS research projects, as well as other D&I investigations with an addiction content focus.