Table 4.
Adoption of Evidence-Based Practices: Barriers and Facilitating Factors
| Barriers | Facilitating Factors | |
|---|---|---|
| Screening and brief intervention | Lack of funding for implementation; inability to obtain grants to support SBIRT | Collaborating with provider agencies to develop and strengthen grant ideas |
| Disinterest of the medical community; minimal support from Medicaid; stigma about patients with SUDs and hesitation of physicians | Building relationships with primary care providers to increase education around SBIRT; holding conferences and trainings | |
| Workforce constraints due to time commitment and intimidation of implementing SBIRT; need for training | Restructure intra-agency organization to support implementation; coordinate internal strategic planning meetings to increase support | |
| Psychosocial interventions | Lack of funding for services and resources; loss of workforce due to financial constraints; perceived costs | Utilize data systems to track progress on any particular psychosocial intervention |
| Incongruent practices for some client populations; geography | Allowing the use of targeted case management services within substance abuse treatment | |
| Time restrictions of the implementation process | Contract with trainers and outreach for opportunities such as use of local ATTC offices and use of SAMHSA resources | |
| Workforce and staffing needs; difficulty meeting the demands of continuous staff turnover | Infrastructure changes that support training divisions as well as conferences within the department to highlight success and promote ongoing trainings | |
| Need for clinical supervision and fidelity monitoring | Increase clinical supervision and monitoring | |
| Medication-assisted treatment | Lack of financial resources and cost of medications; reimbursement complexities | Large proportion of counseling workforce with Masters-level education |
| Lack of doctors willing to provide medications | Maximized state-wide distribution of physicians prescribing buprenorphine | |
| Workforce and community ideology and attitudes | Absence of regulatory or legislative barriers that prevent use of MAT | |
| Client-level discomfort about “swapping addictions” and potential shame from the public and patients about being a client of such a clinic | Established workgroups and trainings for physicians and counselors about appropriateness of MAT |