Much attention has been paid to the persistent gap between the development of effective, evidence-based practices (EBPs) for substance use disorders (SUDs) and their routine delivery in real-world clinical and community settings. The struggle to routinely implement and sustain EBPs with fidelity has been attributed to a combination of systemic, organizational and provider-level barriers. These barriers are compounded by high rates of staff turnover, as behavioral health systems must continuously reinvest in professional development despite their limited resources. Intermediary Purveyor Organizations (IPOs) such as the Addiction Technology Transfer Centers (ATTCs) have been engaged to support capacity building within agencies or systems to implement and sustain EBPs but must also contend with these challenges. As we expand implementation science efforts to explore the contextual factors that influence EBP implementation, including the impact of IPOs, it is important to consider that failure to improve staff turnover rates will only undermine these scientific investments. From the perspective of purveyors of technical assistance, the authors first reflect on the landscape of staff turnover, then offer system- and organization-level strategies for improving staff retention rates.

Given the high prevalence of substance use disorders (SUDs) among people with HIV, integration of evidence-based SUD services within HIV service settings is needed. Federally-funded training and technical assistance centers, such as the Health Resources and Services Administration-funded AIDS Education and Training Center (AETC) network, are part of the support system that deliver strategies to promote the uptake of evidence-based interventions. Previously, our program of research supported (1) the effectiveness of facilitation for improving both the implementation and effectiveness of a motivational interviewing-based brief intervention for SUDs in HIV service organizations (HSOs), (2) motivational interviewing as having the best setting-intervention fit for HSOs, and (3) distributing educational materials as having the best setting-strategy fit for AETCs. Because exploration and adoption/preparation are phases that must occur before implementation and sustainment, we seek to test the effectiveness of facilitation to augment an initial distributing educational materials dissemination strategy. Using a multi-cohort cluster-randomized adaptive parallel-groups superiority experiment design, our aim is to test the effectiveness of augmenting a standard distributing educational materials dissemination strategy with a brief exploration facilitation dissemination strategy to support implementation of a motivational interviewing-based brief intervention. For each rollout, HSOs not responding to the distributing educational materials strategy will be randomized to either (a) receive no further intervention or (b) receive the exploration facilitation strategy. Assessed 4-months post-dissemination, the primary dissemination outcome is organizational-level adoption/preparation of the intervention (i.e., 1 + HSO staff downloads the manual and/or enrolls in the online asynchronous training). The secondary dissemination outcome is organization-level exploration of the intervention (i.e., 1 + HSO staff opens the dissemination email). Before evidence-based interventions are implemented in practice to improve health outcomes, they must first be successfully disseminated and then explored and adopted by service organizations and providers. Because training and technical assistance centers have limited resources for dissemination efforts, effective adaptive dissemination strategies that utilize limited resources are needed. If we find the exploration facilitation strategy to be an effective adjunct to the distributing educational materials strategy, we hope that this adaptive dissemination strategy can be widely adopted and implemented by training and technical assistance centers. Open Science Framework: https://osf.io/urgzd . Registered 1/30/2025. 1/30/2025 Version 1.

Objective: Community colleges serve diverse students who often face substance use challenges. Policies may perpetuate stigma and deter help-seeking. This study examined the availability and comprehensiveness of substance use resources on community college websites in Health and Human Services Region IX and their association with punitive policy responses. Methods: A content analysis of 158 community college websites was conducted, followed by logistic regression to assess relationships between resource comprehensiveness, engagement opportunities, and punitive responses. Results: There was notable variability in resource availability. Overdose prevention and opioid-specific resources were limited. Comprehensive overdose prevention and treatment resources were associated with fewer punitive measures, as were engagement opportunities. Conclusion: Findings highlight the need to expand overdose prevention education, examine the punitive nature of policies, and assess the impact punitive policies have on student help-seeking behaviors. Results will inform the Region IX Pacific Southwest Addiction Technology Transfer Center's HOPES Project training and technical assistance.

Introduction: Due to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California's Contingency Management Benefit. Methods: The Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch. Results: The present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program. Conclusion: The California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.

Background:The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was "Will telehealth ever take hold for SUD services?" Now that social distancing guidelines have been lifted, the question is "Will telehealth remain a commonly used care modality?" Objective:The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods:An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25-35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results:A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] -0.23; P=.002), but not for video-based telehealth (MD -0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD-0.35; P<.001), but no difference was found for phone-based telehealth (MD -0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions:Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations.

In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.

Objective: The role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the treatment of individuals with stimulant use disorder (StimUD). Outside the Veteran's Administration, the Recovery Incentives Program: California's Contingency Management Benefit is the first large scale implementation of contingency management (CM). CM is the behavioral treatment with the most evidence and largest effect sizes for StimUD. Methods: The Program uses a CM protocol where participants can receive a maximum of $599 over a six-month period, contingent upon 36 stimulant-negative urine test results. Urine tests are conducted using a set of approved, CLIA-waived, point-of-care urine drug tests (UDTs). To ensure fidelity to the CM protocol and to prevent fraud, waste, and abuse, all aspects of incentive accounting and distribution are managed electronically via a custom-developed software system. Incentive distribution utilizes electronic gift cards. A significant innovation of the project is the conceptualization of the CM Coordinator, a designated and highly trained and supervised individual responsible for all aspects of CM operation in a specific site. Results and conclusions: The California Department of Health Care Services contracted with UCLA to develop and implement a robust evaluation of the Program; goals include evaluating the effectiveness of real-world implementation and facilitating quality improvement. The project will likely significantly impact the use of CM for StimUD nationally and may well reduce stimulant-related drug poisoning deaths.

The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers.

The current study draws upon data collected over a 4-year period by a regional addiction technology transfer center (ATTC) to better understand the learning patterns and methods of learning engagement among behavioral health professionals. Training participants were found to be predominately female and ethnically diverse, evenly split on attaining a graduate degree, with a third of the participants possessing less than a 4-year college degree. More than one-half reported working in non-health/non-behavioral healthcare settings. Individuals who attended more ATTC events were found to possess less than a master’s degree, work in non-behavioral health settings, and identify as Hispanic or other races. In addition, individuals who initially accessed training through an ATTC conference or online asynchronous learning events were found to become engaged learners.

The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers.

Introduction: Methadone maintenance therapy (MMT) has been a pillar of opioid addiction treatment. Opioid treatment programs (OTPs) have been faced with an escalating threat of stimulant use and related overdose deaths among patients. We know little about how providers currently address stimulant use while maintaining treatment for opioid use disorder. Methods: We conducted 5 focus groups with 36 providers (n = 11 prescribers; 25 behavioral health staff), and collected an additional 46 surveys (n = 7 prescribers; 12 administrators; 27 behavioral health staff). Questions focused on perceptions of patient stimulant use and interventions. We applied inductive analysis to identify themes relevant to identification of stimulant use, use trends, intervention approaches, and perceived needs to improve care. Results: Providers indicated a trend of rising stimulant use among patients, especially those experiencing homelessness or comorbid health conditions. They reported a range of approaches to patient screening and intervention, including medication and harm reduction, improving treatment engagement, increasing level of care, and providing incentives. Providers expressed less agreement as to which of these interventions were effective, and though providers saw stimulant use as a common and severe problem, they reported little problem recognition and interest in treatment from their patients. A particular concern of providers was the prevalence and danger of synthetic opioids, such as fentanyl. They sought more research and resources to identify effective interventions and medications to address these issues. Also notable was an interest in contingency management (CM) and use of reinforcements/rewards to encourage stimulant use reduction. Conclusion: Providers face challenges in treating patients who use both opioids and stimulants. Although methadone is available to treat opioid use, no such "silver bullet" exists for stimulant use disorder. The rise in stimulant and synthetic opioid (e.g., fentanyl) combination products is presenting an extraordinary challenge for providers whose patients are at unprecedented risk for overdose. Providing OTPs with more resources to address polysubstance use is critical. Existing research indicates strong support for CM in OTPs, but providers reported regulatory and financial barriers to implementation. Further research should develop effective interventions that are accessible to providers in OTPs.

COVID-19 social distancing policies have triggered a historic shift in the delivery of behavioral health prevention and treatment services. Among the first responders to this monumental workforce development challenge were the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers (TTCs), which are charged with building the behavioral health workforce's capacity to provide evidence-based prevention, treatment, and recovery services. TTCs documented unprecedented attendance at their events in the early months of the pandemic. This study applied content analysis to identify the most common COVID-related technical assistance (TA) topics and examine attendance by topic from March to July 2020. Across 393 events, TA topics explicitly related to COVID-19 encompassed eight emergent themes: (a) delivering services via telehealth, (b) providing support and services to behavioral health consumers, (c) promoting workforce self-care, (d) understanding new laws/policies, (e) delivering evidence-based practices, (f) advancing racial equity, (g) offering networking spaces, and (h) altering organizational management and communication infrastructure. The most heavily attended events focused on the TA themes "Advancing Racial Equity" (average = 352) and "Telehealth Service Delivery" (average = 271). There was a documented shift from more intensive TA to briefer, more targeted TA provision. The TTCs rapidly virtualized training and TA offerings to address workforce needs and serve as a model for providing remote workforce development support during the COVID-19 pandemic and future national crises.

As part of the State Targeted Response to the opioid epidemic, California has adopted the Hub and Spoke model to expand access to medications for opioid use disorder, particularly buprenorphine, throughout the state. By aligning opioid treatment programs as hubs with primary care, office-based practitioners, and other health care settings as spokes, a broader treatment model can reach more people with opioid use disorder, improve access to medications for opioid use disorders, and decrease overdose deaths. Expanding access requires expanding knowledge and intensive implementation support of new practices. This paper describes the rationale, specific activities and anticipated impact of the implementation plan in California’s Hub and Spoke system. Training and technical assistance are designed to: increase the number and capacity of waivered prescribers; enhance skills of prescribers and multidisciplinary teams; and create systems change. Activities include buprenorphine waiver trainings and provider support, a practice facilitator program, Project ECHO sessions, webinars, clinical skills trainings, and regional learning collaboratives. This overview highlights the steps California is taking to build treatment capacity to address the opioid epidemic.

IntroductionProject Extension for Community Healthcare Outcomes (ECHO™) is a hub-and-spoke knowledge-sharing network, led by expert teams who use multipoint videoconferencing to conduct virtual clinics with community providers in order to improve the quality of care. For this project, members of the Addiction Technology Transfer Center network applied this model in order to enhance workforce capacity to deliver clinical supervision for the treatment of substance use disorders.MethodsClinical supervisors (n=66) employed in substance use disorder treatment programs were recruited to participate in this pilot study. The virtual ECHO clinic consisted of 12 total sessions, each lasting 1 hour and comprising a 15-minute mini-lecture on a clinical supervision topic and a 45-minute case presentation and review. All data were collected and analyzed between September 2016 and June 2017.ResultsForty-eight staff attended at least one ECHO session (mean=6.38) and results are presented for 20 staff who completed the follow-up survey. Participants were highly satisfied with the overall intervention, organization of the clinic and the facilitation of Hub experts, relevance of the technical assistance to their work, and with the impact of the intervention on their effectiveness as a supervisor. Results also indicate that there were significant self-reported improvements in clinical supervision self-efficacy following participation in the ECHO clinic.ConclusionsResults from this pilot study suggest that ECHO virtual clinics are feasible to implement for the purpose of workforce development, are well liked by participants, and can enhance clinical supervision self-efficacy among participants. Further research should explore the impact of self-efficacy on the effective implementation of clinical supervision practices.Supplement informationThis article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

Racial/ethnic minority young men who have sex with men (YMSM)-particularly African Americans and Hispanics/Latinos-are at particularly high risk for HIV infection. Devising strategies to improve engagement and retention in HIV prevention services among minority YMSM is critical if the United States is going to achieve the National HIV/AIDS Strategy goal of reducing HIV health-related disparities. This article presents findings from a national summit on racial/ethnic YMSM services convened by the Substance Abuse and Mental Health Services Administration-funded Center of Excellence on Racial and Ethnic Minority Young Men Who Have Sex with Men and Other Lesbian, Gay, Bisexual, and Transgender Populations (YMSM + LGBT CoE) in September 2015. The summit included (1) subgroup discussions focused on issues related to treatment access, outreach/engagement/retention, continuing care/recovery support, and health literacy for minority YMSM; and (2) a ranking process, where the NIATx Nominal Group Technique was used to identify the strategies and approaches that summit participants believed to be most promising for engaging and retaining minority YMSM in HIV prevention services. Analyses of results from summit activities highlight four key cross-cutting strategies-utilizing peers, providing holistic care, making services fun, and utilizing technology-as critical for engaging minority YMSM in HIV prevention care. Examples of programs that utilize these strategies and implications of these findings for policy and practice are discussed.

In this paper, we propose and analyze the design notion of dual-region mobility management (DrMoM) for achieving scalable, efficient location management of mobile nodes in ad hoc networks. The basic idea is to employ local regions to complement existing home region based location service schemes that assign a home region through hashing to a mobile node and have mobile nodes in both the home and local regions serve as location servers for that node. The most salient feature of DrMoM is that the optimal home region size and local region size can be dynamically determined per mobile user based on mobility and service characteristics of individual mobile nodes to minimize the overall network cost incurred by location management and data packet delivery. Moreover, DrMoM is completely distributed. Each node determines its optimal home region size and local region size autonomously. A performance analysis is performed to demonstrate the benefit of DrMoM over existing region-based location management schemes.

The California Substance Abuse Research Consortium (SARC) has, for nearly 30 years, documented (1) California’s developing and evolving substance abuse trends; (2) critical research efforts within the state conducted to raise awareness of and increase knowledge about local and regional substance abuse problems; and (3) relevant policy decisions and initiatives. The SARC meeting series offers an opportunity for professionals from a variety of disciplines to come together in a face-to-face setting to discuss the latest promising prevention and treatment strategies, emerging and continued criminal justice and social service partnerships, and other relevant substance use disorder-related topics. SARC is sponsored by the California Department of Alcohol and Drug Programs (ADP) and the Pacific Southwest Addiction

Although some practices clearly have stronger supporting evidence than others, a single authoritative list of evidence-based practices (EBPs) that can be applied in the treatment of criminal justice clients does not exist. Nationally, use of EBPs is low, and such practices are generally only implemented under certain circumstances. To clarify these issues, experts from around the nation were invited to California for two research-to-policy meetings focused on EBP identification and implementation. Their presentations and the resulting series of articles in this special theme issue describe the current state of EBP research for criminal justice clients. To advance the field beyond the compilation of EBP lists, which can only represent a partial solution at best, next steps should include a greater focus on quality of implementation, intensity of quality assurance and monitoring, and training for underlying skills and principles.