Author/Authors :
Hartzler, Bryan Alcohol and Drug Abuse Institute - University of Washington, USA , Peavy, K. Michelle Alcohol and Drug Abuse Institute - University of Washington, USA , Jackson, T. Ron Alcohol and Drug Abuse Institute - University of Washington, USA , Carney, Molly Alcohol and Drug Abuse Institute - University of Washington, USA
Abstract :
Background: Pragmatic trials of empirically-supported behavior therapies may inform clinical and policy decisions
concerning therapy sustainment. This retrospective trial design paper describes and discusses pragmatic features
of a hybrid type III implementation/effectiveness trial of a contingency management (CM) intervention at an opioid
treatment program. Prior reporting (Hartzler et al., J Subst Abuse Treat 46:429–438, 2014; Hartzler, Subst Abuse Treat
Prev Policy 10:30, 2015) notes success in recruiting program staff for voluntary participation, durable impacts of CM
training on staff-level outcomes, provisional setting implementation of the intervention, documentation of clinical
effectiveness, and post-trial sustainment of CM.
Methods/design: Six pragmatic design features, and both scientific and practical bases for their inclusion in the trial,
are presented: (1) a collaborative intervention design process, (2) voluntary recruitment of program staff for therapy
training and implementation, (3) serial training outcome assessments, with quasi-experimental staff randomization to
either single or multiple baseline assessment conditions, (4) designation of a 90-day period immediately after training
in which the setting implemented the intervention on a provisional basis, (5) inclusive patient eligibility for receipt of
the CM intervention, and (6) designation of two staff as local implementation leaders to oversee clinical/administra-
tive issues in provisional implementation.
Discussion: Each pragmatic trial design feature is argued to have contributed to sustainment of CM. Contribu-
tions implicate the building of setting proprietorship for the CM intervention, culling of internal staff expertise in its
delivery, iterative use of assessment methods that limited setting burden, documentation of setting-specific clinical
effectiveness, expanded penetration of CM among staff during provisional implementation, and promotion of setting
self-reliance in the oversight of sustainable implementation procedures. It is hoped this discussion offers ideas for
how to impact local clinical and policy decisions via effective behavior therapy dissemination.
