Table 5 Extent to which these factors influence the program's ability to involve families in opioid use disorder treatment for AYA
CFIR domains, subdomains, factors | Total sample | Respondents who work for programs that can treat adolescents & young adults | Respondents who work for programs that ONLY treat young adults** | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
None | Somewhat | A lot | None | Somewhat | A lot | None | Somewhat | A lot | ||||||||||
n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | |
Intervention characteristics | ||||||||||||||||||
Evidence Strength & Quality | ||||||||||||||||||
●Staff do not consider family involvement to be effective for AYA | 60 | 63.20% | 27 | 28.40% | 8 | 8.40% | 13 | 54.2% | 7 | 29.2% | 4 | 16.7% | 47 | 66.2% | 20 | 28.2% | 4 | 5.6% |
●Staff do not consider family-based treatment to be effective for AYA | 61 | 64.20% | 28 | 29.50% | 6 | 6.30% | 13 | 54.2% | 9 | 37.5% | 2 | 8.3% | 48 | 67.6% | 19 | 26.8% | 4 | 5.6% |
Costs | ||||||||||||||||||
●Lack of funding for staff to attend training for family-based approaches | 23 | 24.00% | 38 | 39.60% | 35 | 36.50% | 4 | 16.7% | 12 | 50.0% | 8 | 33.3% | 19 | 26.4% | 26 | 36.1% | 27 | 37.5% |
●Issues with insurance reimbursement for services for family members | 33 | 34.70% | 37 | 38.90% | 25 | 26.30% | 5 | 20.8% | 9 | 37.5% | 10 | 41.7% | 28 | 39.4% | 28 | 39.4% | 15 | 21.1% |
Inner setting | ||||||||||||||||||
Culture | ||||||||||||||||||
●The culture of adult treatment models does not fit with family-based treatment models | 38 | 40.00% | 41 | 43.20% | 16 | 16.80% | 9 | 37.5% | 10 | 41.7% | 5 | 20.8% | 29 | 40.8% | 31 | 43.7% | 11 | 15.5% |
Implementation climate | ||||||||||||||||||
Organizational incentives & rewards | ||||||||||||||||||
●Family treatment is not prioritized in staff productivity requirements | 22 | 22.90% | 34 | 35.40% | 40 | 41.70% | 6 | 25.0% | 9 | 37.5% | 9 | 37.5% | 16 | 22.2% | 25 | 34.7% | 31 | 43.1% |
Relative priority | ||||||||||||||||||
●Staff lack of interest in increasing family involvement in treatment | 48 | 51.10% | 29 | 30.90% | 17 | 18.10% | 10 | 41.7% | 6 | 25.0% | 8 | 33.3% | 38 | 54.3% | 23 | 32.9% | 9 | 12.9% |
●Staff lack of interest in family-based treatment approaches* | 49 | 51.60% | 30 | 31.60% | 16 | 16.80% | 11 | 45.8% | 4 | 16.7% | 9 | 37.5% | 38 | 53.5% | 26 | 36.6% | 7 | 9.9% |
Readiness for implementation | ||||||||||||||||||
Leadership engagement | ||||||||||||||||||
●Staff not receiving support and encouragement from the agency for increasing family-involvement in treatment | 32 | 33.70% | 46 | 48.40% | 17 | 17.90% | 8 | 33.3% | 11 | 45.8% | 5 | 20.8% | 24 | 33.8% | 35 | 49.3% | 12 | 16.9% |
●Program leaderships’ lack of interest in increasing family involvement in treatment | 48 | 50.50% | 31 | 32.60% | 16 | 16.80% | 10 | 41.7% | 8 | 33.3% | 6 | 25.0% | 38 | 53.5% | 23 | 32.4% | 10 | 14.1% |
●Program leaderships’ lack of interest in increasing family involvement in treatment | 48 | 50.5% | 31 | 32.60% | 16 | 16.80% | 10 | 41.7% | 8 | 33.3% | 6 | 25.0% | 38 | 53.5% | 23 | 32.4% | 10 | 14.1% |
Available resources | ||||||||||||||||||
●Lack of staff availability to lead groups for families | 26 | 27.10% | 29 | 30.20% | 41 | 42.70% | 4 | 16.7% | 6 | 25.0% | 14 | 58.3% | 22 | 30.6% | 23 | 31.9% | 27 | 37.5% |
●Lack of funding to support expansion of services to families | 17 | 17.70% | 40 | 41.70% | 39 | 40.60% | 3 | 12.5% | 7 | 29.2% | 14 | 58.3% | 14 | 19.4% | 33 | 45.8% | 25 | 34.7% |
●Insufficient space for family groups to meet | 32 | 33.30% | 31 | 32.30% | 33 | 34.40% | 8 | 33.3% | 9 | 37.5% | 7 | 29.2% | 24 | 33.3% | 22 | 30.6% | 26 | 36.1% |
●Insufficient space for family therapy sessions | 31 | 32.30% | 38 | 39.60% | 27 | 28.10% | 7 | 29.2% | 12 | 50.0% | 5 | 20.8% | 24 | 33.3% | 26 | 36.1% | 22 | 30.6% |
●Lack of time in staffs' schedule for family sessions | 22 | 22.90% | 41 | 42.70% | 33 | 34.40% | 4 | 16.7% | 10 | 41.7% | 10 | 41.7% | 18 | 25.0% | 31 | 43.1% | 23 | 31.9% |
●Lack of time for staff to attend trainings for family-based approaches | 30 | 31.30% | 34 | 35.40% | 32 | 33.30% | 6 | 25.0% | 8 | 33.3% | 10 | 41.7% | 24 | 33.3% | 26 | 36.1% | 22 | 30.6% |
●Lack of staff trained in family-based treatment | 16 | 16.70% | 50 | 52.10% | 30 | 31.30% | 3 | 12.5% | 11 | 45.8% | 10 | 41.7% | 13 | 18.1% | 39 | 54.2% | 20 | 27.8% |
Access to knowledge and information | ||||||||||||||||||
●Lack of staff knowledge regarding how to involve family members in opioid use disorder treatment for AYA patients | 21 | 21.90% | 54 | 56.30% | 21 | 21.90% | 4 | 16.7% | 11 | 45.8% | 9 | 37.5% | 17 | 23.6% | 43 | 59.7% | 12 | 16.7% |
●Staff are unsure of how to document family sessions | 46 | 47.90% | 34 | 35.40% | 16 | 16.70% | 9 | 37.5% | 8 | 33.3% | 7 | 29.2% | 37 | 51.4% | 26 | 36.1% | 9 | 12.5% |
Characteristics of individuals | ||||||||||||||||||
Knowledge & Beliefs about the Intervention | ||||||||||||||||||
●Staff concerns that families enable loved ones substance use* | 33 | 34.70% | 44 | 46.30% | 18 | 18.90% | 10 | 41.7% | 6 | 25.0% | 8 | 33.3% | 23 | 32.4% | 38 | 53.5% | 10 | 14.1% |
●Lack of staff who are comfortable working with patients and their family together | 35 | 36.50% | 43 | 44.80% | 18 | 18.80% | 7 | 29.2% | 11 | 45.8% | 6 | 25.0% | 28 | 38.9% | 32 | 44.4% | 12 | 16.7% |
●Staff concerns that family involvement in treatment will perpetuate enabling dynamics | 43 | 45.30% | 37 | 38.90% | 15 | 15.80% | 14 | 58.3% | 5 | 20.8% | 5 | 20.8% | 29 | 40.8% | 32 | 45.1% | 10 | 14.1% |
●Staff beliefs that family-based treatment is not in the best interest of AYA patients | 56 | 58.90% | 33 | 34.70% | 6 | 6.30% | 10 | 41.7% | 11 | 45.8% | 3 | 12.5% | 46 | 64.8% | 22 | 31.0% | 3 | 4.2% |
Individual stage of change | ||||||||||||||||||
●Staff resistance to changing clinical practice to increase family involvement | 41 | 43.20% | 32 | 33.70% | 22 | 23.20% | 8 | 33.3% | 6 | 25.0% | 10 | 41.7% | 33 | 46.5% | 26 | 36.6% | 12 | 16.9% |
Other personal attributes | ||||||||||||||||||
●Lack of staff motivation to increase family member involvement in treatment* | 45 | 47.40% | 42 | 44.20% | 8 | 8.40% | 9 | 37.5% | 10 | 41.7% | 5 | 20.8% | 36 | 50.7% | 32 | 45.1% | 3 | 4.2% |