System-level Implementation of Intervention to Improve the Quality of Family-Based Services for Adolescent Substance Use

This study is first focused on developing procedures to increase the adoption and quality of empirically supported family-based services (FBS) for adolescent substance use (ASU) in usual care.

FBS have achieved the strongest evidence base for treating ASU and are a prime candidate for upgrading the quality of ASU services in various systems of care. FBS comprise both family participation in services, the systemic parameters wherein family members are included in assessment and treatment activities; and family therapy techniques, the specific interventions that clinicians use to directly target family members and family functioning for change.

For FBS to fulfill their potential to enhance ASU treatment systems, FBS implementation must be supported by effective quality assurance procedures. To promote high-fidelity FBS, this study built upon existing quality metrics to develop Measurement Training and Feedback System for Implementation (MTFS-I), an evidence-based method for increasing FBS quality. MTFS-I provides monthly feedback on therapist-reported FBS delivery along with brief online FBS training modules.

Comparing two system-level implementation strategies

Phase two will experimentally compare two system-level implementation strategies designed to foster MTFS-I utilization in usual care for ASU.

Core Training will contain two 3-hour training sessions. The first is mapping existing FBS and identifying site goals for FBS improvement. The second is installing and sustaining the MTFS-I.

Core + Facilitation is an additive strategy. It begins with the Core Training sessions and then continues with monthly facilitation meetings for one year to promote MTFS-I use and progress toward FBS improvement.

The study will feature a two-group cluster randomized trial testing Core Training Only versus Core + Facilitation in 10 ASU clinics across New York State. Before Core Training activities, all sites will provide FBS quality data on family participation and family therapy technique use (via therapist-report forms and audiotaped treatment sessions) to establish Baseline levels of FBS delivery.

After Core Training, MTFS-I utilization and FBS quality data will be collected for one-year follow-up. Observational coding methods will verify therapist reports of FBS quality, and client outcome data for all sites will be retrieved from administrative data warehouses over one-year baseline and one-year follow-up. These data will enable within-site and between-condition comparisons of FBS delivery and client outcomes.

If study aims are achieved, investigators would be positioned to mount a fully powered RCT to test the effectiveness of these FBS quality improvement procedures at scale.

• University of Miami
• Sam Houston State University