Heather J. Gotham

Background: Strategies that improve integration of evidence-based substance use disorder (SUD) innovations within HIV service organizations (HSOs) are needed. Building on research supporting the effectiveness of facilitation to improve HSOs’ implementation of a motivational interviewing-based brief intervention (MIBI) for SUDs, this dissemination research sought to test the effectiveness of brief exploration facilitation to improve organization-level MIBI adoption/preparation (primary outcome) and exploration (secondary outcome) after an initial distributing educational materials strategy. Methods: HSOs that did not transition to adoption/preparation within one week of the initial distributing educational materials strategy were randomized to either (a) continue in the distributing educational materials condition or (b) receive exploration facilitation. Outcomes were assessed four months post-dissemination. The primary dissemination outcome was organizational-level adoption/preparation, defined as 1+ HSO staff downloading the manual and/or enrolling in online asynchronous training. The secondary dissemination outcome was organization-level exploration of the intervention (i.e., 1+ HSO staff opened the dissemination email). Results: At the end of week 1 after the initial distributing educational materials strategy, 327 (46.7%) of 700 HSOs had transitioned to exploration and an additional 15 HSOs (2.1%) had transitioned to adoption/preparation. After randomization, no additional HSOs achieved adoption as a function of being in either study condition. Of 341 HSOs randomized to exploration facilitation, only 11 HSOs (3.2%) received the single facilitation session delivered by our team of facilitators. Conclusion: The project’s initial distributing educational materials dissemination strategy led to minimal MIBI adoption by HSOs. Despite several phone attempts per HSO, the project’s facilitators were generally unsuccessful in engaging HSOs and unable to deliver the exploration facilitation strategy; thus, the exploration facilitation strategy was not effective. Future research should consider testing alternative dissemination strategies, such as incentivization, which has demonstrated effectiveness as an implementation strategy.

Background: NIH-funded research has been increasingly conducted in collaborative consortia of investigators with the support of coordinating centers. However, the extent to which such initiatives help to accomplish NIH goals and objectives with respect to the translation of research to practice remains unclear. We evaluated implementation barriers and facilitators experienced by the individual Helping to End Addiction Long-term ^® Initiative or HEAL Initiative ^® Data2Action (HD2A) Program projects targeting overdose reduction, opioid use disorder treatment, and pain management and the feasibility, acceptability, and appropriateness of HD2A Program components to address these barriers and facilitators. Methods: Data were collected from semi-structured group interviews and interview transcripts were analyzed using thematic content analysis. Principal investigators and key personnel ( n = 36) for each of the 10 NIDA-funded HD2A projects annually beginning in March 2023. Members of the three support centers ( n = 8) were also interviewed in January 2025. Results: Two overall themes with several subthemes were identified: (1) implementation barriers, facilitators, and strategies of individual projects; and (2) assessment of the HD2A Program and its four distinctive features as a multifaceted implementation strategy. The R61/R33 mechanism was regarded as feasible, acceptable and appropriate for addressing barriers and planning for full implementation. Interactions with other HD2A projects was limited but viewed favorably by all grantees. All projects obtained needed guidance and support from the three research support centers in addressing barriers and planning for implementation, particularly through supplemental funding to support rapid data infrastructure projects. However, some investigators reported their interactions with the centers as burdensome and a distraction from more immediate needs, Harmonization of data across the projects was not evident due to a lack of guidance and coordination prior to submission of applications for funding, specific nature being collected by each project, and restrictions to data sharing by organizations providing data. Conclusions: Initiatives to bring together diverse projects having a common aim or theme create opportunities for accessing needed support for implementation and collaboration across projects as intended. Nevertheless, greater engagement between those providing technical assistance and those receiving it and stipulating common data elements should occur prior to submission of applications for funding.

Background: To describe the contextual factors that affect patients’ acceptability and feasibility of alcohol and substance use-related service implementation in family planning (FP) clinics in Massachusetts. Materials and Methods: We conducted a qualitative study of patients at an FP clinic in Massachusetts. Through semistructured interviews ( N = 11), we asked participants about their perspectives regarding receiving substance use screening, patient preferences for care and referral, barriers and facilitators to receiving care, and their acceptability of receiving screening, brief intervention, and referral to treatment (SBIRT) implementation within the FP clinic context. Interview data was analyzed through content thematic analysis utilizing Dedoose software. Results: Patients shared insightful knowledge about the barriers and facilitators to their acceptance of SBIRT implementation within FP clinics in Massachusetts. Patients emphasized the need for SBIRT implementation efforts to be contextually rooted within FP care while also considering how best to alleviate barriers to accessing care. Facilitators to SBIRT implementation included provider trust, psychological safety, provider congruence, varied care modalities, and selectivity by appointment type. Barriers to SBIRT implementation included stigma, transportation, funding, scheduling, and staffing scarcity. Conclusions: Despite persistent structural and systemic barriers, participants expressed broad support for integrating SBIRT into FP settings when delivered in ways that felt affirming, trauma-informed, and individualized to patient needs. Findings revealed critical opportunities for integrating alcohol and/or substance use-related care into FP settings.

Introduction: Clinical and Translational Science Awards (CTSAs) are positioned to enhance the integration of rigorous implementation research methods into projects across their networks, but lack a systematic, standardized process to do so. This study introduces the Dissemination and Implementation Research Capability Self Survey (DIRC-SS), a pragmatic instrument to evaluate and integrate implementation science methods in traditional research activities. Methods: We developed the 15-item DIRC-SS to assess researchers’ use of implementation research methods across five key constructs. Its reliability (inter-rater agreement and internal consistency) and sensitivity (change over time) were examined in 10 NIH-funded research projects via ratings assigned by the research teams and by implementation science experts at baseline and one year later. Results: The DIRC-SS total score demonstrated good internal consistency and inter-rater reliability increased over one year. Although the research team ratings did not change significantly over time, the expert ratings significantly increased, and effect sizes across research teams and expert raters were large in this small sample study. Conclusions: The DIRC-SS demonstrated good internal consistency reliability and moderate inter-rater reliability. It effectively distinguished between different levels of implementation research methods integration. Unlike tools focused on grant proposals or final reports, the DIRC-SS can be used at any point in the research process by a research team as a self-survey, by implementation science experts in a consultation process, or across a CTSA program to characterize the implementation science methods employed across projects and highlight targeted areas for researcher education and training.

Background: People with HIV are more likely than the general population to have a substance use disorder (SUD), which can impact the HIV care continuum. HIV service organizations (HSOs) can implement SUD interventions but may need assistance from support systems like the AIDS Education and Training Center (AETC) network. We assess the fit of strategies AETCs may use to help HSOs integrate SUD interventions. Method: We invited 74 of 91 AETCs (81.3%) to participate. Using a real-time Delphi approach, 64 AETCs (86.5% of those invited) rated the (a) importance of, (b) feasibility of, (c) readiness to offer, (d) scalability of, (e) pressure to offer, and (f) current need for 10 strategies their AETC could use to help HSOs integrate SUD interventions. Items were examined via confirmatory factor analyses. Responses were summed to create the Setting-Strategy Fit index score. We conducted pairwise t-tests to examine differences in scores between strategies, plotted the mean importance ratings for each strategy against the mean ratings for other criteria to review the strategies’ relative viability, and conducted bivariate and multiple regression analyses to examine correlates of the scores. Results: The items of the Setting-Strategy Fit index showed good internal consistency and model fit. Generally, strategies were considered somewhat important but AETCs felt very little pressure to offer them. Two strategies (disseminating information, providing access to asynchronous training) exceeded the “important” threshold. One strategy (disseminating information) was considered viable for also having high feasibility. Overall, AETCs were only somewhat ready to provide the strategies, which were perceived as only somewhat feasible or currently needed. Conclusions: Although AETCs recognized the importance of several strategies for helping HSOs integrate SUD interventions, their responses resulted in only one having good fit. These findings can guide efforts to further prepare AETCs to support HSOs and to end the HIV epidemic. Plain Language Summary: Strategies AIDS Education and Training Centers Could Use to Help HIV Service Organizations Implement Substance Use Interventions. Why was the study done?: Having a substance use disorder (SUD) can complicate care for people with HIV by reducing their engagement in services. HIV service organizations (HSOs) serve people with HIV but not all of them offer services to address SUD. We assessed the fit of different strategies that AIDS Education and Training Centers (AETCs), which provide technical assistance to HSOs, could use to help HSOs implement SUD interventions. What did the researchers do?: We engaged 74 AETC representatives nationally to rate 10 strategies. They were asked about (a) the importance of the strategies, (b) the feasibility of offering them, (c) their readiness to offer them, (d) the scalability of the strategies, (e) pressure they receive to offer them, and (f) the current need for them. Responses were summed into an index score reflecting the strategies’ fit for AETCs to help HSOs integrate SUD interventions. We looked for differences in scores between strategies and plotted the scores for each strategy to identify which are most promising. What did the researchers find?: Two of the strategies (sharing information about the SUD interventions and providing access to asynchronous trainings) exceeded the threshold for being “important.” One of those (sharing information) was also considered “feasible” for AETCs to offer, making it the only potentially viable strategy. Overall, AETCs were only somewhat ready to provide the strategies, which they felt very little pressure to offer. What do the findings mean?: Although AETCs recognized the importance of different strategies for helping HSOs implement SUD interventions, they only identified one strategy as having good fit. These findings can guide future efforts to further prepare AETCs to support HSOs and to end the HIV epidemic.

Educators and school staff are critical to recognizing and supporting students' mental health, but frequently do not have the training to confidently bring mental health literacy into the classroom or assist students who experience distress. Moreover, few free, easily accessible trainings are available for this audience. Classroom Well‐being Information and Strategies for Educators (Classroom WISE) is a free, K‐12 mental health literacy training package that includes a self‐paced online course, video library, and resource collection. Using pre‐ and postcourse anonymous surveys from over 2000 educators, school mental health professionals, and school staff who completed Classroom WISE, this study found high levels of satisfaction, significant increases in mental health literacy knowledge, high perceived importance of mastering skills to promote student well‐being, and increased preparedness to implement mental health‐related strategies. Participants reported intentions to bring mental health literacy into the classroom, and identified barriers and facilitators to using Classroom WISE that leaders can respond to or employ when moving to implement Classroom WISE across a school or district. School district or school‐wide use of Classroom WISE can assist in building a safe and supportive school environment and help students in need to access mental health services.

Learning collaboratives are increasingly used in behavioral health. They generally involve bringing together teams from different organizations and using experts to educate and coach the teams in quality improvement, implementing evidence-based practices, and measuring the effects. Although learning collaboratives have demonstrated some effectiveness in general health care, the evidence is less clear in behavioral health and more rigorous studies are needed. Learning collaboratives may contain a range of elements, and which elements are included in any one learning collaborative varies widely; the unique contribution of each element has not been established. This commentary seeks to clarify the concept of a learning collaborative, highlight its common elements, review evidence of its effectiveness, identify its application in behavioral health, and highlight recommendations to guide technical assistance purveyors and behavioral health providers as they employ learning collaboratives to improve behavioral health access and quality.