Understanding the Relationship Between Staff-Reported Mechanisms of Change and Implementation Integrity
Dr. Bryan R. Garner from RTI International presented the relationship between staff-reported mechanisms of change and implementation integrity. The Substance Abuse Treatment to HIV Care (SAT2HIV) Project successfully addresses National HIV/AIDS Strategy Goals and related needs through various measures like Implementation Climate, Leadership Engagement, and Readiness. Key services provided include HIV testing and brief intervention for substance abuse.
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The relationship between several staff-reported mechanism of change measures and an independently rated measure of implementation integrity Presented by Dr. Bryan R. Garner RTI International
Opening Pandoras Box Performing an action that may seem small or innocent, but that turns out to have severely detrimental and far-reaching negative consequences.
The relationship between several staff-reported mechanism of change measures and an independently rated measure of implementation integrity Presented by Dr. Bryan R. Garner RTI International
The Substance Abuse Treatment to HIV Care (SAT2HIV) Project
The relationship between several staff-reported mechanism of change measures and an independently rated measure of implementation integrity Presented by Dr. Bryan R. Garner RTI International
SAT2HIV Projects Logic Model Successfully Address National HIV/AIDS Strategy Goals Successfully Address HIV-related needs Implementation Climate & Leadership Engagement Implementation Readiness Implementation Effectiveness Effectiveness of BI HIV/AIDS Organizations Provide Key Services - HIV Testing - Medical Case-Management - Non-Medical Case-management - Brief Intervention for Substance Abuse (NEW) Key Dependent Measure for this Project
SAT2HIV Projects Logic Model Successfully Address National HIV/AIDS Strategy Goals Successfully Address HIV-related needs Implementation Climate & Leadership Engagement Implementation Readiness Implementation Integrity Effectiveness of BI HIV/AIDS Organizations Provide Key Services - HIV Testing - Medical Case-Management - Non-Medical Case-management - Brief Intervention for Substance Abuse (NEW) Key Dependent Measure for this Presentation
SAT2HIV Projects Logic Model Successfully Address National HIV/AIDS Strategy Goals Key Independent Measures for this Presentation Successfully Address HIV-related needs Implementation Climate & Leadership Engagement Implementation Readiness Implementation Integrity Effectiveness of BI HIV/AIDS Organizations Provide Key Services - HIV Testing - Medical Case-Management - Non-Medical Case-management - Brief Intervention for Substance Abuse (NEW) Key Dependent Measure for this Presentation
Implementation Climate 6 items; Alpha = .76; Mean = 4.39; SD = .62 During the past 6-months, staff working on this project 1. Were expected to use brief intervention for substance use with a certain number of clients. 2. Were expected to help our HIV/AIDS organization meet its goals for implementing brief intervention for substance use. 3. Got the support they needed to identify potentially eligible clients for a brief intervention for substance use 4. Got the support they needed to use brief intervention for substance use with a certain number of clients. 5. Received recognition for using brief intervention for substance use with eligible clients 6. Received appreciation for using brief intervention for substance use with eligible clients
Leadership Engagement 4 items; Alpha = .94; Mean = 3.67; SD = 1.36 1. To what extent during the last 6-months was the leadership of this organization COMMITED to the implementation of brief intervention for substance use with HIV-infected clients at this HIV/AIDS organization? 2. To what extent during the last 6-months was the leadership of this organization INVOLVED in the implementation of brief intervention for substance use with HIV- infected clients at this HIV/AIDS organization? 3. To what extent during the last 6-months was the leadership of this organization ENGAGED in the implementation of brief intervention for substance use with HIV- infected clients at this HIV/AIDS organization? 4. To what extent during the last 6-months was the leadership of this organization ACCOUNTABLE for the implementation of brief intervention for substance use with HIV-infected clients at this HIV/AIDS organization?
Implementation Readiness 12 items; Alpha = .94 Mean = 3.85; SD = .87 Change Commitment example items Example item 1: Staff working on this project want to implement this change. Example item 2: Staff working on this project are committed to implementing this change. Change Efficacy example items Example item 1: Staff working on this project feel confident that the organization can get people invested in implementing this change. Example item 2: Staff working on this project feel confident that they can handle the challenges that might arise in implementing this change
Methods Data for the current presentation was limited to study participants that had been randomized to receive the SAT2HIV Project s motivational interviewing-based BI for substance use. The analytic sample included 214 client participants living with comorbid HIV/AIDS and substance use, which were clustered within 35 staff that were clustered within 21 AIDS Service Organizations. Mplus software was used for all analyses
Results: Implementation Climate Implementation Integrity Implementation Climate = .20, p = .027 Implementation Integrity
Results: Leadership Engagement Implementation Integrity Leadership Engagement = .18, p = .039 Implementation Integrity
Results: Implementation Readiness Implementation Integrity Implementation Readiness = - 0.003, p = .98 Implementation Integrity
Discussion of Practical Implications Successfully Address National HIV/AIDS Strategy Goals Awesome! Successfully Address HIV-related needs Implementation Climate & Leadership Engagement Implementation Readiness Implementation Integrity Effectiveness of BI HIV/AIDS Organizations Provide Key Services - HIV Testing - Medical Case-Management - Non-Medical Case-management - Brief Intervention for Substance Abuse (NEW) Hmm .
The relationship between several staff-reported mechanism of change measures and an independently rated measure of implementation integrity Presented by Dr. Bryan R. Garner RTI International
Discussion of Practical Implications Successfully Address National HIV/AIDS Strategy Goals ? Successfully Address HIV-related needs Implementation Climate & Leadership Engagement ? Implementation Readiness Implementation Integrity Effectiveness of BI HIV/AIDS Organizations Provide Key Services - HIV Testing - Medical Case-Management - Non-Medical Case-management - Brief Intervention for Substance Abuse (NEW)
The relationship between several staff-reported mechanism of change measures and an independently rated measure of implementation integrity Presented by Dr. Bryan R. Garner RTI International
Future Research Successfully Address National HIV/AIDS Strategy Goals What makes this implementation strategy work? Successfully Address HIV-related needs Implementation Climate & Leadership Engagement Implementation Readiness Implementation Effectiveness Effectiveness of BI HIV/AIDS Organizations Provide Key Services - HIV Testing - Medical Case-Management - Non-Medical Case-management - Brief Intervention for Substance Abuse (NEW)
Acknowledgements National Institute on Drug Abuse (NIDA) Substance Abuse Treatment to HIV Care (SAT2HIV) Project (R01-DA038146; PI: Garner) Co-authors David Kaiser, Michael Bradshaw, Elizabeth Ball, Alyssa Wolfe, James Ford, Mark Zehner, Heather Gotham, Traci Rieckmann, Michael Chaple, Kathryn Speck, Denna Vandersloot, Mat Roosa, and Steve Martino The participating AIDS Service Organizations, their staff, and their clients
