Table 1.
Application of the Enhanced REP framework to Re-Engage.
| Enhanced REP component | Key processes | Re-Engage activities |
|---|---|---|
| Preimplementation | ||
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| Customize the evidence-based practice | Conduct organizational needs assessment of key personnel Working with facilitators, collaborate to make site-specific intervention adaptations (i) Organizational structure (ii) Impetus to transform (iii) Perceptions of the identified problem (iv) Site-specific adaptations Creation of packaged, user-friendly implementation manual/tool kit |
Reviewed VA Office of the Medical Inspector QI Project report findings Created demonstration collaborative to pilot Re-Engage protocols (i) “Lead from middle” model (ii) Draft of VA program directive and operational plan (iii) Formative assessment of pilot stakeholders' perceptions (iv) Specified core versus modifiable elements Revised, expanded, and enhanced QI implementation manual/form |
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| Identify champions | Facilitators work with national and local leaders to identify early adopters, past performance | Five LRCs and sites identified based on leader input |
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| Implementation | ||
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| Training | (i) Facilitators and VA leaders provide targeted presentations to key leaders and early adopters (ii) Facilitators provide site-specific and staff level appropriate customized training |
(i) Conference calls with national, regional, and facility-level leaders (ii) Lead program overview to local recovery coordinators and local leaders at conferences or on conference calls |
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| Orientation | Facilitators organize resources to support implementation with provider input: (i) Staff handbook (ii) Service agreements (iii) Service line leaders Advertise and publicize the program local stakeholders (i) Make an empirical case for program (administrators, staff) (ii) Highlight the potential benefits of the program to the Veterans, VAMC, and VSOs (iii) Advertise (newsletters, poster boards, etc.) |
Created Re-Engage handbook with implementation checklists to promote interdisciplinary coordination: (i) referral scheduling, service agreements, and service line leaders/facility directors Developed advertising resources that enabled the LRCs to “lead from the middle” and encourage support for Re-Engage through the following means: (i) Present data from original study project regarding mortality reductions (ii) Educate clinic personnel of program benefits-information sheet (iii) Make in-service presentations—talking points sheet (iv) Share flyers with community partners and patients |
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| Facilitation | Start program Utilize local resources and sustain advertising. Facilitators continue to provide technical assistance to frontline providers to problem solve implementation issues Collect data to measure program impact and to enhance program delivery |
(i) Provide adaptable marketing tools and coordinate with services with similar goals (e.g., homelessness) (ii) Facilitators hold regular calls with frontline LRCs (iii) Continuous data collection and implementation of monthly reports and online feedback interface for local providers and policy leaders |
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| Evaluation and sustainability | Reevaluate program successes and ways the program could be further adapted to improve outcomes and customer satisfaction at the site. |
Pilot findings reviewed with demonstration sites and national LRC network to: (i) Enhance implementation guide and advertising resources (ii) Provide examples of best practices of local communication and coordination (iii) Revised assessment form and feedback tool (iv) Review business case for ongoing programming |