Healthcare professionals often report strong intentions to use evidence-based practices to improve patient care, but intention does not always translate into action. Habits, automatic behaviors generated through repeated cue-behavior associations, may help address the intention-behavior gap and enhance adoption of evidence-based practices. As habits form, behavior control shifts from being internally guided to being triggered by external context cues, which can support making the use of evidence-based practice more routine. Despite calls to integrate habit formation in implementation science, habits have not yet been fully leveraged to select and specify implementation strategies. We argue that habits can be explicitly planned for with targeted cues, behavior routines, and rewards to support healthcare professionals in adopting evidence-based practices. We outline core elements of habit formation and provide case examples to illustrate how habit techniques can be used to catalyze implementation in healthcare.

Opioid use disorder (OUD) remains a critical public health crisis across the United States. To address this challenge, the HEALing Measurement Center, funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative, aims to enhance the quality, equity, and sustainment of care delivered in Pennsylvania opioid treatment programs (OTPs) through the implementation of measurement-based care (MBC). This initiative leverages interdisciplinary collaboration among academic researchers, state and community partners, payers, and OTP providers to address critical gaps in OUD treatment and implementation science. Three research projects were designed to address immediate implementation support needs expressed by community partners while simultaneously meeting critical research gaps. Research Project 1 develops an MBC implementation blueprint co-designed with key constituents to address barriers such as paperwork burden and facilitate technical assistance and learning networks. Research Project 2 evaluates the effectiveness and implementation of an enhanced MBC implementation strategy (MBC +) compared to measurement implementation as usual (MAU) through a hybrid type 2 stepped-wedge effectiveness-implementation trial. Research Project 3 focuses on the clinical impact of MBC + on patients with OUD and co-occurring mental health conditions, exploring mechanisms underlying treatment success. This protocol provides an overview of the research design as well as the unique community partnerships leveraged to enhance MBC implementation. Overall, the projects within the HEALing Measurement Center aim to establish a foundation for future MBC scale-up and sustainment across Pennsylvania, provide learnings that can inform other implementation efforts, and enhance the quality of interventions for individuals with OUD. Clinicaltrials.gov, NCT06965010, Registered 11 May 2025, https://clinicaltrials.gov/study/NCT06965010.

Background: The leadership development program (LDP) of the New England Addiction Technology Transfer Center is a novel free professional development training program for addiction behavioral health service providers. The LDP aims to create, develop, and enhance the leadership skills of the addiction behavioral health workforce through multi-component training. The content of the training is scaffolded and covers an array of topics (eg, organizational culture, group development). Instructional content is delivered both virtually and face-to-face and employs various instructional modalities including didactics, behavioral rehearsals, and case studies. Methods: The current article discusses the development of the LDP, the iterative adaptation of the LDP, and feedback from 69 participants across 5 cohorts. Participants from the 5 cohorts were mostly Non-Hispanic White (73%), identified as female (68%), and had fewer than 5 years supervisory experience (71%). Participants were sent a 2-part post-survey querying for their satisfaction and perceived effectiveness of the program assessed through quantitative and qualitative items. Results: Quantitative items were uniformly answered in the above average to excellent range to questions about the programming, instructors, and usefulness. Similarly, qualitative findings suggested that participants had an overwhelmingly positive experience with the LDP and that they were able to enhance their leadership capabilities. Conclusion: Our results provide support for the feasibility and utility of the LDP for addiction behavioral health providers. Additionally, the article provides guidance for the development of leadership training programs to support the leadership development of addiction workforce and the field broadly.

BACKGROUND:"Food is Medicine (FIM)" programs can improve diet-related health outcomes. Produce prescription programs (PRxs), a type of FIM program, entail healthcare providers "prescribing" free or reduced-cost vegetables. Previous studies have identified multilevel barriers to implementing FIM programs. However, there is scant research examining how implementation strategies can influence FIM implementation outcomes. PURPOSE:Assess changes in implementation outcomes following the introduction of tailored implementation strategies to support the delivery and uptake of a PRx in four participating clinics. METHODS:VeggieRx is a 6-month PRx in Rhode Island. This single-arm pilot study measured implementation outcomes according to the Consolidated Framework for Implementation Research Outcomes Addendum before and after tailored implementation strategies were applied for the 2023 VeggieRx season. Adoption was measured as the number of VeggieRx referrals. Implementation was measured by the number of individuals and households receiving produce. Patient acceptability was measured via text message after each delivery. Patient food security status and vegetable intake were assessed before and after VeggieRx participation. RESULTS:From 2022 to 2023, following the introduction of the implementation strategies, VeggieRx referrals increased by 57.9% and the number of households receiving vegetables increased by 86.2%. Study participants (n = 44) used Most to all vegetables in each delivery (median = 88.6% of weekly responses, interquartile range = 78.4%, 95.5%). The proportion of participants classified as High or marginal food security increased from 18.2% at baseline to 36.6% at follow-up (Cohen's h = 0.42). CONCLUSION:This study demonstrates the value of tailored implementation strategies and their potential to expand the delivery of future PRx programs. CLINICAL TRIAL INFORMATION:The Clinical Trials Registration #NCT05941403.

Food insecurity increases the risk of chronic disease, yet scalable approaches to address nutrition-related needs remain limited. Produce prescription programs, in which healthcare providers refer patients to receive subsidized fruits and vegetables, are expanding but lack clear implementation guidance to support long-term delivery. We partnered with an accountable care organization, a nonprofit produce supplier, and primary care clinics in a Northeastern United States state to develop a practical implementation blueprint. Guided by the Consolidated Framework for Implementation Research, we conducted qualitative interviews with patients and providers to identify barriers related to clinic workflows, patient participation, and resource availability. A community advisory board then reviewed and prioritized these barriers and selected strategies to address them, including workflow integration, provider training, and creation of patient education materials in English and Spanish. We describe the process of operationalizing these strategies into a context-specific blueprint to inform adaptation and scale-up. This work provides a structured example of how health systems can design and refine produce prescription programs to strengthen implementation efforts.

BACKGROUND:Adolescents treated in trauma centers are frequently prescribed opioid pain medication for pain management at hospital discharge. There has been an increase in adolescent opioid overdose deaths requiring additional education on risks associated with opioid pain medication use in this population. OBJECTIVES:The objective of this analysis was to assess the implementation at ten US pediatric trauma centers of an opioid pain medication prevention education intervention and whether implementation of the intervention was also associated with an increase of delivery of pain medication education and a reduction in opioid prescribing. RESULTS:Across all sites during the study period, 4,371 adolescent patients received an opioid pain medication at discharge. Opioid pain medication education increased from 20.9% before the intervention's implementation to 37.3% (p = 0.0001) after implementation. There was also a significant increase in adolescent patients with positive screens on admission for alcohol or drugs in getting opioid pain medication education after the implementation. Additionally, there was a modest decrease in opioid prescribing at discharge from pre- to post-implementation of the intervention: 54.7% to 48.8% (p < 0.0001). CONCLUSION:An intervention that includes training staff on delivery of opioid pain medication education for adolescents and family members can improve education provided to patients being prescribed opioid pain medication at discharge from pediatric trauma centers.

Background : Injury severity classification is crucial for trauma-related clinical care, quality improvement, and research. This study compared injury severity score (ISS) values derived from the abbreviated injury scale (AIS) scores assigned by trauma registry coders (trauma registry ISS) to those mapped from the International Classification of Diseases (ICD) codes (map-derived ISS) in adolescents. Methods : Data were collected from electronic health records of 1259 adolescent trauma patients from ten US paediatric trauma centres. Trauma registry ISS values served as the gold standard, while map-derived ISS values were calculated using ICD-10 codes mapped to AIS scores. ISS values were compared using descriptive analyses, Wilcoxon tests, and correlation assessment. Results : Median ISS values were similar between the trauma registry (median: 8.0 and IQR: 4–13) and map-derived ISS (median: 9.0 and IQR: 4–10), with significant differences observed at two of the ten centres. Exact match accuracy between trauma registry and map-derived ISS values was 27.2%, increasing to 69.3% when a ±5-point range was considered. The overall correlation was moderate (r=0.48, p<0.001), and there was decreased concordance with increasing injury severity. Conclusions : There were discrepancies between trauma registry and map-derived ISS, especially for more severe injuries.

BACKGROUND:Parents of undiagnosed children (POUC) experience significant psychosocial challenges, including anxiety, uncertainty, and isolation, that stem from parenting medically complex children while facing obstacles throughout the diagnostic journey. Despite these well-described challenges, a mental health intervention designed to meet the unique needs of POUC, which is necessary to promote the psychological and overall wellbeing of this population, does not exist. Acceptance and Commitment Therapy (ACT) has proven effective in a wide range of populations and shows promise for POUC. With the goal of designing and implementing an ACT-based intervention tailored to POUC, this pre-implementation study aimed to understand their psychosocial needs and prior mental health support experiences, explore their reactions towards ACT, and determine their anticipated barriers, facilitators, and preferences for participating in an ACT skills group, guided by the Consolidated Framework for Implementation Research (CFIR). METHODS:Semi-structured, individual interviews were conducted with 18 POUC, including an experiential portion that exposed participants to key ACT concepts and exercises. Inductive coding based on participant responses and deductive coding based on the CFIR were employed to code interview transcripts. Reflexive thematic analysis was performed to identify key findings. RESULTS:Isolation was a psychosocial challenge for which all participants desired support. Many participants reported inadequacies in their prior mental health support, primarily due to lack of understanding from therapy providers regarding their unique circumstances. Although most participants indicated that ACT could help them manage difficult thoughts and emotions and act in alignment with their values, they also described achievability, collaboration, and accountability as key elements that could support their uptake. The main barriers, facilitators, and preferences that participants highlighted were related to group design (accessibility, flexibility) as well as their own characteristics as recipients (capability, need, and motivation). CONCLUSIONS:This pre-implementation study affirmed the potential value of ACT for POUC and identified key opportunities for tailoring an ACT skills group to meet their needs. Future research, including pilot implementation studies, are needed to evaluate the effectiveness of a tailored ACT skills group and further refine both the intervention and its implementation strategy.

Context: Inter-ICU transfer of patients with acute respiratory failure occurs between hospitals to facilitate specialized care or treatment options. However, no uniform guidance exists to help clinicians decide why or when patients should be transferred. This lack of guidance contributes to inequities in transfers leading to negative impacts on quality of care and patient-centered outcomes. Objective: 1) To examine ICU clinicians’ perception on the transfer processes within a large health system, 2) To develop a novel Structured Transfer Escalation: Proactive and Unified Process (STEP-UP) for inter-ICU transfer of ARF patients, and 3) To gather feedback on the relevance of STEP-UP for future work. Methods: We employed Consolidated Framework for Implementation Research (CFIR) 2.0 as a framework throughout this mixed-methods study. Results: Eighty-six ICU clinicians from 7 hospitals responded to a survey about perceptions on inter-ICU transfers. 72% of participants felt that it was feasible to identify patients that would benefit from transfer and 91% felt that an earlier decision would be ideal for patient outcomes. An expert panel utilized the survey data to develop STEP-UP with two components (a) a time-based decision-making query regarding transfer and (b) a checklist of key tasks to facilitate shared decision-making, collaborative discussion, and standardized sign out to accomplish a transfer. Qualitative interviews of 19 clinicians revealed the lack of structure during transfers as a recurring theme and the majority of clinicians perceived STEP-UP as comprehensive and easy to apply. Conclusion: We identified facilitators (e.g. health system with a network of hospitals, positive clinician attitudes and hospital culture around transfers) and barriers (e.g. limited bed availability, asymmetric communication) to be considered in future work around a structured system for transfers.

BACKGROUND:Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs) despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation. METHODS:Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. A detailed review of implementation facilitation meeting notes was conducted to examine how the IFASIS was used to guide facilitation. RESULTS:Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts. CONCLUSIONS:The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that can identify adolescents who use alcohol and other drugs and support proper referral to treatment. Despite an American College of Surgeons mandate to deliver SBIRT in pediatric trauma care, trauma centers throughout the United States have faced numerous patient, provider, and organizational level barriers to SBIRT implementation. The Implementing Alcohol Misuse Screening, Brief Intervention, and Referral to Treatment Study (IAMSBIRT) aimed to implement SBIRT across 10 pediatric trauma centers using the Science-to-Service Laboratory (SSL), an empirically supported implementation strategy. This manuscript aimed to assess trauma center staff preferences and experience with the didactic training, performance feedback, and ongoing coaching elements of the SSL via a retrospective qualitative process evaluation. Nurses, social workers, and site leaders that participated in IAMSBIRT were recruited to complete qualitative exit interviews guided by the Consolidated Framework for Implementation Research. Qualitative interviews were recorded, transcribed, and analyzed by two coders using a directed content analysis approach in NVivo software. Codes were then translated into frequently endorsed themes by the IAMSBIRT study research team. Thirty-six exit interviews were conducted with site leaders, social workers, and nurses across the 10 IAMSBIRT pediatric trauma centers. Findings revealed key strengths as well as areas for improvement across the IAMSBIRT preparation phase and the three elements of the SSL: didactic training, performance feedback, and ongoing coaching. Trauma center staff generally reported that all three elements of the SSL were high quality and helpful for supporting SBIRT implementation. However, staff also noted that performance feedback and ongoing coaching were generally only available to center leadership or to individuals selected by leadership, making it challenging for non-leaders to troubleshoot SBIRT delivery. Findings from the qualitative process evaluation revealed discrepancies in the experience of the SSL strategy between those in leadership roles and those involved in direct care delivery. These results suggest the need for several modifications to the SSL strategy, including increasing engagement of direct care staff in all elements of the SSL throughout the implementation process. Clinicaltrials.gov NCT03297060 . Registered 29 September 2017.

OBJECTIVE:Timely initiation of postoperative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC) is associated with improved survival, but rates of timely PORT initiation are low. To support uptake in a tertiary academic center, we aimed to identify implementation determinants (eg, barriers and facilitators) to timely PORT initiation and to design context-specific implementation strategies. METHODS:We created an implementation blueprint through a sequential mixed-methods study where we (1) identified determinants by fielding a 15-item survey based on the Theoretical Domains Framework (TDF), (2) prioritized determinants through focus groups with relevant stakeholders, (3) mapped barriers to implementation strategies using the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) matching tool, and (4) operationalized strategies using the Action, Actor, Context, Target, Time (AACTT) framework. RESULTS:Twenty-three participants from three departments (61% Radiation Oncology, 35% Otolaryngology, 4% Medical Oncology) in a variety of roles (35% physicians, 39% nurses or advanced practice providers, 22% radiation therapists or dosimetrists, and 4% research coordinators) completed surveys. Participants identified 10 determinants affecting timely PORT initiation. After strategy selection and operationalization by focus group participants (n = 13), three ERIC strategies were selected for clinical implementation: remind clinicians, conduct educational meetings, and facilitate relay of clinical data to providers. DISCUSSION:This work developed a menu of implementation strategies for future deployment to support timely PORT initiation. Codesign centered the voice of frontline workers, increasing the likelihood of successful implementation. IMPLICATIONS FOR PRACTICE:The systematic approaches to development can serve as a model for process improvement in other contexts.

Implementation science aspires to equitably accelerate the uptake of clinical research into practice to improve population health. The focus of implementation science includes individual behavior change mechanisms that are similar to those that drive the field of clinical psychology. For this reason, clinical psychologists are well-suited to take up implementation science methods in pursuit of improving the quality of behavioral health care. To do so, clinical psychologists must expand beyond individual behavior change to include a focus on organizations and systems. In this review, we reflect on ways that clinical psychologists can lead in the integration of implementation science principles and approaches into clinical psychology research and practice. We discuss the role clinical psychologists play in closing know-do gaps in behavioral health and describe how clinical psychologists can build implementation science competencies. We end with current controversies and opportunities for innovation to further improve the quality of behavioral health care.

Hospitalization presents a critical opportunity to initiate medications for opioid use disorder (MOUD) and improve long-term outcomes for patients with opioid use disorder (OUD). While inpatient MOUD initiation significantly reduces mortality and relapse, many patients lack appropriate follow-up care after discharge. This scoping review synthesizes evidence from 52 studies on hospital discharge practices for patients with OUD initiated on MOUD to identify best practices that support continued treatment and recovery. Inpatient addiction consultation services, standardized protocols, and clinician education emerged as key facilitators of MOUD initiation. Transitional care strategies, such as bridge clinics, peer navigation, telemedicine, and structured discharge planning, were associated with increased outpatient linkage, reduced readmissions, and improved retention in treatment. Despite policy advances including X-waiver elimination, systemic barriers persist and disproportionately affect rural and minoritized populations. Multidisciplinary, patient-centered discharge pathways that integrate medical treatment with social support are critical. Effective linkage strategies must address both structural and individual barriers to care. We propose six pillars of MOUD continuity, including early initiation, warm handoffs, peer support, bridge care models, telemedicine integration, and attention to social determinants. Implementing these strategies is essential to closing care gaps and improving outcomes in the evolving landscape of MOUD treatment.

According to phasic models of implementation, a Preparation phase designed to enhance the implementation climate should be completed prior to the Implementation phase. Yet preparatory activities and outcomes are rarely reported or assessed in implementation research. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was a hybrid type 3 effectiveness-implementation trial that compared two multi-component, phasic strategies to implement contingency management (CM) in opioid treatment programs. The current secondary analysis assessed the comparative effectiveness of the two strategies on 5-month Preparation phase outcomes: attainment of knowledge and fidelity benchmarks, implementation climate at the end of the Preparation phase, and time required for providers to complete the final preparatory/pre-implementation activity of enrolling and scheduling their first CM patient. Twenty-eight opioid treatment programs and 186 staff were cluster-randomized to receive the Addition Technology Transfer Center (ATTC) control strategy (didactic workshop + performance feedback + consultation) or the theory-driven Enhanced-ATTC (E-ATTC) experimental strategy. During the Preparation phase, the E-ATTC strategy consisted of the ATTC strategy plus monthly Implementation Sustainment Facilitation sessions rooted in principles of team-based motivational interviewing to cultivate a strong implementation climate and accelerate successful completion of the Preparation phase. Across the 28 OTPs and 186 staff, attainment of knowledge and fidelity benchmarks favored the E-ATTC but did not differ significantly by condition. Implementation climate ratings after the Preparation phase were high in both conditions with no conditional differences. Providers randomized to E-ATTC completed their final preparatory activity at significantly higher rates than those randomized to ATTC. Cox regression revealed that receipt of the E-ATTC strategy was also associated with significantly faster completion of the final Preparation activity. Consistent with hypotheses, the theory-driven implementation strategy was associated with higher levels of and faster time to completion of preparatory activities, a key indicator of readiness for implementation. Counter to expectations, this was not driven by differences in implementation climate. High ratings of implementation climate at baseline limited our ability to detect change over time, highlighting a need for alternate strategies to measure putative mechanisms of change. This analysis adds to the scant literature reporting Preparation phase strategies and outcomes, which are strong predictors of successful implementation. This study is registered in Clinicaltrials.gov (NCT03931174).

Background: ICU transfers from a regional to a tertiary-level hospital are initiated typically for a higher level of care. Extended transfer wait times can negatively affect survival, length of stay (LOS), and cost. Methods: In this prospective single-center study, the subjects were adult ICU patients admitted to regional hospitals between January and October 2022, for whom a request was made to transfer to a tertiary-level medical ICU. The authors developed and implemented an interdisciplinary transfer huddle intervention (THI) with the goal of reducing wait times by providing a consistent channel of communication between key stakeholders. The primary outcome was the number of hours elapsed between transfer request and the time of transfer to the tertiar y hospital. Secondar y outcomes included in-hospital mortality, discharge to home, ICU LOS, and hospital LOS. Data were abstracted from electronic health records and periods before (January to June 2022) and after (June to October 2022) the intervention were compared. Data were analyzed using logistic regression or negative binomial regression, adjusting for patient demographic and clinical characteristics. ICU fellows also completed a daily survey about barriers they perceived to the THI application. Results: During the study period, 76 patients were transferred. The THI was completed 75.0% of the time. There were no statistically significant differences in the primary and secondary outcomes before and after the intervention. The top perceived barriers to transfer were lack of physical beds (50.0%) and staffing limitations (37.5%). Conclusion: The authors successfully developed and implemented a transfer huddle to ensure consistent interdisciplinary communication for patients being transferred between ICUs and identified barriers to such transfer. However, transfer times and patient outcomes were not significantly different after the change. Future studies should consider staffing challenges, hospital capacity, and the role of dedicated transfer teams in in decreasing inter-ICU transfer wait times.