Feature | Feature | Intended benefit |
---|---|---|
1. Collaborative intervention design process involving both the study investigator (a CM purveyor) and the OTP director | Shared design responsibility allowed intervention to be theoretically-informed and matched to setting-specific fiscal and logistical implementation capacities | Enhanced ‘ownership’ of intervention by setting management and staff; increased likelihood of post-trial sustainment |
2. Voluntary recruitment of OTP staff for therapy training and subsequent delivery to patients on a provisional basis | ‘Real-world’ conditions would require that this CM intervention be delivered by direct-care staff amidst their regular contact with patients in usual care | Culling of internal expertise in the setting; greater opportunity to identify barriers and contextual adaptations for the intervention |
3. Serial training outcome assessments, with quasi-experimental staff randomization to single versus multiple baseline conditions | Longitudinal assessment of staff-based outcomes (i.e., skills, knowledge, adoption readiness) was needed, but with means to account for assessment reactivity | Sufficient staff data collection absent undue setting burden; avoidance of contamination concerns given training of intact staff group |
4. Provisional 90-day implementation period for CM-trained staff to deliver the focal intervention to their caseload patients | An interim period during which setting staff would form experience-based impressions of intervention feasibility as well as determine site-specific clinical effectiveness | Setting able to make proximal, and informed decisions about the feasibility, effectiveness, and sustainability of the intervention |
5. Broadly inclusive patient eligibility during provisional implementation, comparison to matched group of historical control patients | Heterogeneity of OTP setting patients suggested need to maximize generalizability in documenting the feasibility | Meaningful conclusions about site-specific intervention utility; more expedient accrual and effectiveness of the intervention of staff implementation experiences |
6. Designation of local implementation leaders, included in consultative planning discussions with purveyor and OTP director | The OTP was well-positioned for autonomous period of provisional implementation, and this was expected to better inform setting decision about therapy sustainment | Internal support for implementation efforts integrated into supervision-as-usual instead of a resource-intensive fidelity rating system |