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Background:The COVID-19 pandemic shed light on stark racial and ethnic inequities in access to care and accurate health information in the U.S. When COVID-19 vaccines became available, communities of color faced multiple barriers that contributed to low vaccine rates. To address this gap, the Equity-First Vaccination Initiative supported community organizations in five demonstration cities to plan and implement hyper-local strategies to increase COVID-19 vaccine access and uptake among communities of color.Purpose:To draw learnings from the experiences of the participating organizations, we applied a framework that integrated implementation science and health equity principles.Design and sample:In this commentary, we describe how we used this framework to guide qualitative interviews with community organizations, focusing on insights across five implementation elements (reach, design, implementation, adaptation, implementation outcomes).Conclusions:Learnings from this evaluation may help guide future implementation of similarly complex initiatives involving multiple organizations and sites to advance health equity during a public health crisis.

AbstractSexual and gender minority (SGM) individuals experience high rates of homelessness and criminal justice system involvement, underscoring the need for supportive housing services. To explore the service needs of this population, we interviewed providers (n = 11) and clients (n = 10) from eight supportive housing organizations working with SGM populations in Los Angeles County, California, USA. We used the Consolidated Framework for Implementation Research to synthesize interview responses into themes (by domain and cross-cutting). Takeaways included the need for investment in systems of care for vulnerable SGM populations; the particular marginalization of Trans individuals and providers that serve them; the roles of supportive housing staff, residents, and leadership in cultivating an affirming environment; the prevalence of discrimination and stigma within supportive housing programs and broader society; and the complex interrelationships among SGM identity, homelessness, and criminal justice system involvement. These findings have important implications for supportive housing services and related policy.

Contextual factors exert dynamic influences on sustainment of evidence-based practice (EBP) after grant funding ends (ie, funding cliffs), but how these factors change over time remains poorly understood. Exploring the factors that affect EBP sustainment trajectories can help explain how community-based treatment organizations navigate funding cliffs.

We developed a glossary of design techniques, which researchers and providers can use to maximize the usability of health care innovations in everyday practice settings.User-centered design (UCD), a discipline that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation, has great potential to improve the translation of evidence-based practices from behavioral medicine research for implementation in health care settings. UCD is a diverse, innovative field that remains highly variable in terms of language and approaches. Ultimately, we produced a glossary of UCD-related strategies specifically for experts in implementation research and practice, with the goal of promoting interdisciplinary collaboration in implementation efforts. We conducted a focused literature review to identify key concepts and specific strategies of UCD to translate into the implementation field. We also categorized the strategies as primarily targeting one or more levels of the implementation process (i.e., interventions, individuals, inner context, and outer context). Ultimately, we produced a glossary of 30 UCD strategies for implementation experts. Each glossary term is accompanied by a short, yet comprehensive, definition. The strategies and their definitions are illustrated, using a hypothetical behavioral medicine intervention as an example, for each of the four levels of the implementation process. This UCD glossary may prove useful to implementation experts who wish to develop effective collaborations and “shared language” with UCD experts to enhance use of behavioral medicine research in health services. Directions for future research are also discussed.

ABSTRACTYouths with autism spectrum disorder (ASD) often display disruptive behaviors, yet few of the available treatments for such behaviors have been effective with this clinical population. In the present study, the authors examined outcomes for youths with ASD who participated in a randomized clinical trial of multisystemic therapy (MST), a treatment that has previously been adapted for a variety of complex problem behaviors in youths. Participants were youths with an ASD diagnosis and comorbid disruptive behaviors (N= 15) who were randomized to MST or usual community services. Measures of youth-, parent-, and family-level outcomes were obtained at 6 and 12 months postrecruitment. Findings indicated that MST was more effective that usual community services in improving family functioning and ameliorating youth problem behaviors. The present study represents the first clinical trial of MST for youths with ASD and comorbid disruptive behaviors. The results suggest that intensive family-based treatments such as MST hold considerable promise with this clinical population. The implications of these findings for the continued development and evaluation of effective treatments for ASD are discussed.

Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor.

Background: Opioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders. Methods: Our adapted model is called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO). We used the five-step Map of Adaptation Process (McKleroy in AIDS Educ Prev 18:59–73, 2006) to develop the model. For each step, our stakeholder team of research and clinical experts, primary care partners, and patients provided input into adaptation processes (e.g., adaptation team meetings, clinic partner feedback, patient interviews and beta-testing). To document each adaptation and our decision-making process, we used the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman in Implement Sci 14:1–10, 2019). Results: We documented 12 planned fidelity-consistent adaptations to collaborative care, including a mix of content, context, and training/evaluation modifications intended to improve fit with the patient population (co-occurring disorders) or the New Mexico setting (low-resource clinics in health professional shortage areas). Examples of documented adaptations include use of community health workers as care coordinators; an expanded consultant team to support task-shifting to community health workers; modified training protocols for Problem-Solving Therapy and Written Exposure Therapy to incorporate examples of treating patients for depression or PTSD with co-occurring OUD; and having care coordinators screen for patients’ social needs. Conclusions: We completed the first three steps of the Map of Adaptation Process, resulting in a variety of adaptations that we believe will make collaborative care more acceptable and feasible in treating co-occurring OUD and mental health disorders. Future steps include evaluating the effectiveness of CLARO and documenting reactive and/or planned adaptations to the model that occur during its implementation and delivery.

Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.