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Lindsey AC, Deem-Bolton C, Finley E, Potter JS, Lanham H, Fleming S. Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:690-697. [PMID: 38756013 DOI: 10.1177/29767342241252296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges. METHODS Participants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO. RESULTS Training programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs. CONCLUSIONS Early results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.
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Affiliation(s)
- Adrienne C Lindsey
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Carma Deem-Bolton
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Erin Finley
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jennifer Sharpe Potter
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Holly Lanham
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Sanjuana Fleming
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
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Reho K, Agley J, Gassman R, Roberts J, Heil SKR, Katara J. How do the Substance Abuse and Mental Health Services Administration's Technology Transfer Centers Decide What Evidence-Based Practices to Disseminate and Determine How to Do So? A Cross-Sectional Study of a National Network. Eval Health Prof 2024; 47:167-177. [PMID: 38790109 PMCID: PMC11157975 DOI: 10.1177/01632787231225653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
It is important to use evidence-based programs and practices (EBPs) to address major public health issues. However, those who use EBPs in real-world settings often require support in bridging the research-to-practice gap. In the US, one of the largest systems that provides such support is the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Technology Transfer Center (TTC) Network. As part of a large external evaluation of the Network, this study examined how TTCs determine which EBPs to promote and how to promote them. Using semi-structured interviews and pre-testing, we developed a "Determinants of Technology Transfer" survey that was completed by 100% of TTCs in the Network. Because the study period overlapped with the onset of the COVID-19 pandemic, we also conducted a retrospective pre/post-pandemic comparison of determinants. TTCs reported relying on a broad group of factors when selecting EBPs to disseminate and the methods to do so. Stakeholder and target audience input and needs were consistently the most important determinant (both before and during COVID-19), while some other determinants fluctuated around the pandemic (e.g., public health mandates, instructions in the funding opportunity announcements). We discuss implications of the findings for technology transfer and frame the analyses in terms of the Interactive Systems Framework for Dissemination and Implementation.
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Affiliation(s)
- Kaitlyn Reho
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | - Jon Agley
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, USA
| | | | - Jharna Katara
- Biostatistics Consulting Center, Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
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Bart G, Korthuis PT, Donohue JM, Hagedorn HJ, Gustafson DH, Bazzi AR, Enns E, McNeely J, Ghitza UE, Magane KM, Baukol P, Vena A, Harris J, Voronca D, Saitz R. Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder. Addict Sci Clin Pract 2024; 19:29. [PMID: 38600571 PMCID: PMC11007900 DOI: 10.1186/s13722-024-00455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT. METHODS Four state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge. DISCUSSION Initiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals. TRIAL REGISTRATION NCT04921787.
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Affiliation(s)
- Gavin Bart
- Department of Medicine, Hennepin Healthcare and University of Minnesota, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - P Todd Korthuis
- Department of Medicine, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, 97239-3098, Portland, OR, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, 15261, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, University of Minnesota, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Dave H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin, 1513 University Ave., Madison, WI, 53706, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego; La Jolla, CA, USA
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Eva Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, Minneapolis, MN, 55408, USA
| | - Jennifer McNeely
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse (NIDA) Center for the Clinical Trials Network (CCTN), Bethesda, MD, 20892, USA
| | - Kara M Magane
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave, Ste. PP7.700, Minneapolis, MN, 55415, USA
| | - Ashley Vena
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Jacklyn Harris
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Delia Voronca
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
- Currently: Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, Deceased, NY, 10591-6707, USA
| | - Richard Saitz
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
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Agley J, Gassman R, Reho K, Roberts J, Heil SKR, Golzarri-Arroyo L, Eddens K. Organizational Network Analysis of SAMHSA's Technology Transfer Center (TTC) Network. J Behav Health Serv Res 2024; 51:123-131. [PMID: 37872261 PMCID: PMC10733212 DOI: 10.1007/s11414-023-09867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
Technology transfer centers (TTCs) facilitate the movement of evidence-based practices in behavioral healthcare from theory to practice. One of the largest such networks is the Substance Abuse and Mental Health Services Administration's (SAMHSA) TTC Network. This brief report shares findings from an organizational network analysis (ONA) of the network conducted as part of an external evaluation. For non-supervisory TTCs (n = 36) across three focus areas (addiction, prevention, and mental health), the authors computed network density, harmonic closeness, and non-null dyadic reciprocity for five types of interactions (e.g., "collaborated in workgroups"), then, for each interaction type, used Welch's T-test to compare mean harmonic closeness of standalone TTC grantees versus multiple-TTC grantees. ONA identified potentially isolated regional TTCs as well as mismatches between some centers' desired scope and their network centrality and enabled investigation of broader questions around behavioral health support systems. The approach appears useful for evaluating TTCs and similar support networks.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA.
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Kaitlyn Reho
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Susan K R Heil
- American Institutes for Research (AIR), Arlington, VA, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
| | - Kate Eddens
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
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Dopp AR, Hunter SB, Godley MD, González I, Bongard M, Han B, Cantor J, Hindmarch G, Lindquist K, Wright B, Schlang D, Passetti LL, Wright KL, Kilmer B, Aarons GA, Purtle J. Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study. Implement Sci 2023; 18:50. [PMID: 37828518 PMCID: PMC10571404 DOI: 10.1186/s13012-023-01305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Financial barriers in substance use disorder service systems have limited the widespread adoption-i.e., provider-level reach-of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. METHOD A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. RESULTS The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p = .01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). DISCUSSION As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | | | - Michelle Bongard
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Kerry Lindquist
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Blanche Wright
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA
| | - Danielle Schlang
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Gregory A Aarons
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr. (0812), La Jolla, San Diego, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Johnson K, Pinchuk I, Melgar MIE, Agwogie MO, Salazar Silva F. The global movement towards a public health approach to substance use disorders. Ann Med 2022; 54:1797-1808. [PMID: 35792721 PMCID: PMC9262358 DOI: 10.1080/07853890.2022.2079150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Drug misuse is a global problem. Markets that supply illegal drugs often span international borders. However, each country has different primary drugs of use, populations that are using and consequences of use. The policy approach of each country to addressing substance use disorders can be characterized along a continuum between purely public health approaches and purely law enforcement approaches. Historically, a law enforcement approach has been the primary strategy in much of the world. However, there is a growing movement towards use of a public health approach. This article provides four case examples, Ukraine, Philippines, Nigeria and Peru, where there is movement to develop addiction public health infrastructure. The work varies by country, but includes regulatory changes, workforce development and resource allocation all of which are supported by the United Nations Office on Drugs and Crime (UNODC) and multi-national organizations that provide training and technical assistance, funded primarily by the European Union and United States governments. All four countries highlighted have barriers to moving towards a more public health approach which may include popularity of the law enforcement approach, turbulent government environments, and economics of being a drug producing nation. However, whether starting from the top down with changed policies, such as Ukraine or from the bottom up with training community members as in the Philippines, each country provides an example of how donor resources can be applied to make the transition towards a more humane and evidence-based approach to addressing substance use disorders.Key MessagesWhile the primary approach to addressing drug use has focussed resources on law enforcement for over 100 years, many countries are adopting elements of a public health approach including prevention and treatment of the harms of drug use including substance use disorders.There is a growing global movement to make policy towards drugs and drug users more humane and evidence-based.Donor nation resources can be applied in a variety of combinations to improve care and outcomes for people who use drugs in low- and middle-income countries.
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Affiliation(s)
- Kimberly Johnson
- International Consortium of Universities for Drug Demand Reduction, University of South Florida, Tampa, FL, USA
| | - Irina Pinchuk
- Institute of Psychiatry of Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
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Powell KG, Chaple MJ, Henry M, Morton C, Becker SJ, Gotham HJ, Hagle HN, Helle AC, Krom LJ, Martin R, Molfenter TD, Roget N, Rutkowski BA, Velez-Echevarria II, Yanez R. Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions. BMC MEDICAL EDUCATION 2022; 22:575. [PMID: 35897014 PMCID: PMC9326150 DOI: 10.1186/s12909-022-03598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.
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Affiliation(s)
- Kristen G Powell
- Rutgers University School of Social Work, New Brunswick, NJ, USA.
| | | | - Maxine Henry
- National Latino Behavioral Health Association, Peña Blanca, NM, USA
| | - Cory Morton
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Sara J Becker
- Brown University School of Public Health, Providence, RI, USA
| | - Heather J Gotham
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Holly N Hagle
- University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | - Ashley C Helle
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Laurie J Krom
- University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | | | | | - Nancy Roget
- University of Nevada, Reno, Reno, Nevada, USA
| | - Beth A Rutkowski
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
| | | | - Ruth Yanez
- National Latino Behavioral Health Association, Peña Blanca, NM, USA
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Dopp AR, Hunter SB, Godley MD, Pham C, Han B, Smart R, Cantor J, Kilmer B, Hindmarch G, González I, Passetti LL, Wright KL, Aarons GA, Purtle J. Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study. Implement Sci Commun 2022; 3:51. [PMID: 35562836 PMCID: PMC9099033 DOI: 10.1186/s43058-022-00298-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. METHOD We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types' outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. DISCUSSION The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health-while advancing implementation science through the use of novel methods to study financing strategies and sustainment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Isabelle González
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Gregory A Aarons
- Department of Psychiatry, 9500 Gilman Dr. (0812), University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Knowledge and Technology Transfer Influencing the Process of Innovation in Green Supply Chain Management: A Multicriteria Model Based on the DEMATEL Method. SUSTAINABILITY 2019. [DOI: 10.3390/su11123485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
After performing a systematic review of the literature, it was noticeable that the discussion regarding Green Supply Chain Management (GSCM) along with Knowledge and Technology Transfer (KTT) and Innovation is scarce. To address this issue, the objective of this paper is to analyze the relationship between GSCM, KTT, and Innovation. To achieve this purpose, we developed a conceptual framework based on the literature review, which raised some hypotheses. In order to verify the hypotheses and validate the framework, we designed a multicriteria model called the KTT-GSCM Multicriteria Model, composed of two stages. The first stage describes factors that are relevant to GSCM, KTT, and Innovation, ascertaining which ones have influence over the others and which ones are influenced by the others, through the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. The second stage of the model analyzes the level of each perspective in each company and in the supply chain as a whole, thus verifying the hypotheses. This model was applied in 13 firms of a supply chain that has a rotomolding firm as a focal company. Through the development and application of the model, it was possible to verify the hypotheses raised and conclude that the perspectives of GSCM, KTT, and Innovation are, in fact, influenced by one another and that both Innovation and KTT promote greater development in GSCM.
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Lord SE, Seavey KM, Oren SD, Budney AJ, Marsch LA. Digital Presence of a Research Center as a Research Dissemination Platform: Reach and Resources. JMIR Ment Health 2019; 6:e11686. [PMID: 30950800 PMCID: PMC6473206 DOI: 10.2196/11686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based platforms can be powerful tools for research dissemination. By leveraging the advantages of mass media and interpersonal channels of communication, Web-based dissemination platforms may improve awareness about, and subsequent adoption of, evidence-based practices (EBPs). Digital dissemination strategies can augment traditional dissemination models, improving stakeholder access to digestible and actionable information and promoting translation of EBPs. OBJECTIVE This study aimed to describe the reach and content of the Web presence of a National Institute on Drug Abuse Center of Excellence and how it is used to disseminate research related to digital behavioral health approaches. METHODS The Center for Technology and Behavioral Health (CTBH) has a website and regularly updated Facebook and Twitter accounts. The website features include summaries of digital behavioral health approaches and related empirical literature, a blog feed focused on the state of the science and technology concerning digital health care approaches, and a newsletter about Center activities. We extracted website usage metrics from Google Analytics and follower counts from social media accounts for the period from March 1, 2013, to July 17, 2018. RESULTS Since the implementation of analytic tracking, 70,331 users have initiated 96,995 sessions on the CTBH website. The website includes summaries of 86 digital therapeutic programs, encompassing 447 empirical articles. There are 1160 posts in the CTBH blog feed, including 180 summaries of scholarly articles. The Twitter and Facebook accounts have 577 and 1500 followers, respectively. The newsletter has reached a growing subscriber network and has a high open rate relative to industry standards. CONCLUSIONS The CTBH Web presence serves as a model for how to leverage accessible and easily updatable digital platforms as research dissemination channels. Digital dissemination tools can augment traditional dissemination strategies to promote awareness about evidence-based digital therapeutic approaches for behavioral health and health care more broadly.
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Affiliation(s)
- Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Katherine M Seavey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sonia D Oren
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Horigian VE, Marín-Navarrete RA, Verdeja RE, Alonso E, Perez MA, Fernández-Mondragón J, Berlanga C, Medina-Mora ME, Szapocznik J. Technology transfer for the implementation of a clinical trials network on drug abuse and mental health treatment in Mexico. Rev Panam Salud Publica 2015; 38:233-42. [PMID: 26758002 PMCID: PMC6896211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 04/16/2015] [Indexed: 06/05/2023] Open
Abstract
Low- and middle-income countries (LMIC) lack the research infrastructure and capacity to conduct rigorous substance abuse and mental health effectiveness clinical trials to guide clinical practice. A partnership between the Florida Node Alliance of the United States National Drug Abuse Treatment Clinical Trials Network and the National Institute of Psychiatry in Mexico was established in 2011 to improve substance abuse practice in Mexico. The purpose of this partnership was to develop a Mexican national clinical trials network of substance abuse researchers and providers capable of implementing effectiveness randomized clinical trials in community-based settings. A technology transfer model was implemented and ran from 2011-2013. The Florida Node Alliance shared the "know how" for the development of the research infrastructure to implement randomized clinical trials in community programs through core and specific training modules, role-specific coaching, pairings, modeling, monitoring, and feedback. The technology transfer process was bi-directional in nature in that it was informed by feedback on feasibility and cultural appropriateness for the context in which practices were implemented. The Institute, in turn, led the effort to create the national network of researchers and practitioners in Mexico and the implementation of the first trial. A collaborative model of technology transfer was useful in creating a Mexican researcher-provider network that is capable of changing national practice in substance abuse research and treatment. Key considerations for transnational technology transfer are presented.
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Affiliation(s)
- Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | | | - Rosa E Verdeja
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | - Elizabeth Alonso
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | - María A Perez
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | | | - Carlos Berlanga
- Instituto Nacional de Psiquiatría Ramón de La Fuente, Mexico City, Mexico
| | | | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
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Moullin JC, Sabater-Hernández D, Fernandez-Llimos F, Benrimoj SI. A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Res Policy Syst 2015; 13:16. [PMID: 25885055 PMCID: PMC4364490 DOI: 10.1186/s12961-015-0005-z] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/19/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementation science and knowledge translation have developed across multiple disciplines with the common aim of bringing innovations to practice. Numerous implementation frameworks, models, and theories have been developed to target a diverse array of innovations. As such, it is plausible that not all frameworks include the full range of concepts now thought to be involved in implementation. Users face the decision of selecting a single or combining multiple implementation frameworks. To aid this decision, the aim of this review was to assess the comprehensiveness of existing frameworks. METHODS A systematic search was undertaken in PubMed to identify implementation frameworks of innovations in healthcare published from 2004 to May 2013. Additionally, titles and abstracts from Implementation Science journal and references from identified papers were reviewed. The orientation, type, and presence of stages and domains, along with the degree of inclusion and depth of analysis of factors, strategies, and evaluations of implementation of included frameworks were analysed. RESULTS Frameworks were assessed individually and grouped according to their targeted innovation. Frameworks for particular innovations had similar settings, end-users, and 'type' (descriptive, prescriptive, explanatory, or predictive). On the whole, frameworks were descriptive and explanatory more often than prescriptive and predictive. A small number of the reviewed frameworks covered an implementation concept(s) in detail, however, overall, there was limited degree and depth of analysis of implementation concepts. The core implementation concepts across the frameworks were collated to form a Generic Implementation Framework, which includes the process of implementation (often portrayed as a series of stages and/or steps), the innovation to be implemented, the context in which the implementation is to occur (divided into a range of domains), and influencing factors, strategies, and evaluations. CONCLUSIONS The selection of implementation framework(s) should be based not solely on the healthcare innovation to be implemented, but include other aspects of the framework's orientation, e.g., the setting and end-user, as well as the degree of inclusion and depth of analysis of the implementation concepts. The resulting generic structure provides researchers, policy-makers, health administrators, and practitioners a base that can be used as guidance for their implementation efforts.
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Affiliation(s)
- Joanna C Moullin
- Graduate School of Health, Pharmacy, University of Technology Sydney, Broadway, PO Box 123, Ultimo, 2007, NSW, Australia.
| | - Daniel Sabater-Hernández
- Graduate School of Health, Pharmacy, University of Technology Sydney, Broadway, PO Box 123, Ultimo, 2007, NSW, Australia. .,Academic Centre in Pharmaceutical Care, Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, 18071, Granada, Spain.
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.UL), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Avda. Prof. Gama Pinto, 1649-019, Lisbon, Portugal.
| | - Shalom I Benrimoj
- Graduate School of Health, Pharmacy, University of Technology Sydney, Broadway, PO Box 123, Ultimo, 2007, NSW, Australia.
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Knudsen HK, Roman PM. Innovation attributes and adoption decisions: perspectives from leaders of a national sample of addiction treatment organizations. J Subst Abuse Treat 2015; 49:1-7. [PMID: 25218918 PMCID: PMC4277913 DOI: 10.1016/j.jsat.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/30/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Abstract
Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year ("recent adoption"), (2) plans to adopt an innovation in the upcoming year ("planned adoption"), or (3) no actual or planned adoption ("non-adoption"). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n=93) or planned adoption (n=62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program's treatment philosophy (mean=4.47, SD=1.03), improvement in the program's reputation with referral sources (mean=4.00, SD=1.33), reputational improvement with clients and their families (mean=3.98, SD=1.31), and reductions in treatment dropout (mean=3.75, SD=1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may enhance efforts to increase subsequent adoption.
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Affiliation(s)
- Hannah K Knudsen
- University of Kentucky, Department of Behavioral Science, 141 Medical Behavioral Science Building, Lexington, KY 40536-0086.
| | - Paul M Roman
- University of Georgia, Owens Institute for Behavioral Research and Department of Sociology, 106 Barrow Hall, Athens, GA, 30602-2401.
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Knudsen HK, Roman PM. The transition to medication adoption in publicly funded substance use disorder treatment programs: organizational structure, culture, and resources. J Stud Alcohol Drugs 2014; 75:476-85. [PMID: 24766760 DOI: 10.15288/jsad.2014.75.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. METHOD Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. RESULTS Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. CONCLUSIONS Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Paul M Roman
- Owens Institute for Behavioral Research and Department of Sociology, University of Georgia, Athens, Georgia
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Szapocznik J, Muir JA, Duff JH, Schwartz SJ, Brown CH. Brief Strategic Family Therapy: implementing evidence-based models in community settings. Psychother Res 2013; 25:121-33. [PMID: 24274187 DOI: 10.1080/10503307.2013.856044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To review a 40-year collaborative partnership between clinical researchers and clinicians, in developing, investigating and implementing Brief Strategic Family Therapy (BSFT). METHOD First, to review theory, practice and studies related to this evidenced-based therapy intervention targeting adolescent drug abuse and delinquency. Second, to present the BSFT Implementation Model created for the BSFT intervention-a model that parallels many of the recommendations from the implementation science literature. RESULTS Specific challenges encountered during the BSFT implementation process are reviewed, along with ways of conceptualizing and addressing these challenges from a systemic perspective. CONCLUSION The BSFT implementation uses the same systemic principles and intervention techniques as those that underlie the BSFT clinical model. Building on our on-the-ground experiences, recommendations are proposed for advancing the field of implementation science.
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Affiliation(s)
- José Szapocznik
- a Public Health Sciences , University of Miami , Miami , FL , USA
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Novotná G, Dobbins M, Jack SM, Sword W, Niccols A, Brooks S, Henderson J. The influence of lived experience with addiction and recovery on practice-related decisions among professionals working in addiction agencies serving women. DRUGS-EDUCATION PREVENTION AND POLICY 2012. [DOI: 10.3109/09687637.2012.714015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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