Table 1.
Description of Core and Enhanced intervention components
| Intervention component | Study condition | Description | Timing | Participant investment |
|---|---|---|---|---|
| Leadership orientation | Core | RC meets with site leadership to describe overall project aims and activities (including the Cascade). | Month 1 | 1 h |
| Needs assessment: systems mapping exercise/focus group interview | Core | RC meets with site inter-agency workgroup to (a) create a systems map of case-processing in their jurisdiction depicting “linkages” with community behavioral health partners and (b) explore strengths and limitations of local practices corresponding to each step in the Cascade. | Month 3 (baseline) | 1 h for systems mapping exercise and 2 h for focus group |
| Month 21 (post-experiment) | ||||
| Line staff orientation | Core | Almost identical to the leadership orientation described above, with more emphasis on staff participation and expectations. | Month 5 (baseline) | 1 h |
| Site feedback report | Core | Transcripts from the needs assessment discussion, data from site’s management information system, and National Survey responses form the basis of the site feedback report. RC presents the 25-page site feedback report to site inter-agency workgroup. | Month 7 (baseline) | 1 h |
| Month 26 (project end) | ||||
| Behavioral health training: Charting a Course to Care | Core | Participants participate in four self-paced online didactic tutorials, plus four live skills supervision sessions delivered online via webinar. | ||
| Module 1 (online) | Substance use and correlated conditions: | Month 6 (baseline) | 45 min, self-paced | |
| Reviews co-occurring conditions that go along with adolescent substance use, prevention programs and their importance in adolescent SU, STI and HIV risks for adolescent SU, and the importance of integrated treatment. | ||||
| Module 2 (online) | Behavioral Health Cascade: | Month 6 (baseline) | 45 min, self-paced | |
| Reviews the Cascade, how it can be used to identify strengths and targets for change, common breakdowns in agency communication, and how EB instruments and programs can be used. | ||||
| Module 3 (online) | Family engagement: | Month 6 (baseline) | 45 min, self-paced | |
| Focuses on strategies to engage parents, or other caregivers and adolescents as they access behavioral health services, communicating to the parents about JJ recommendations for their child and why this care is important (to help secure their active participation or “buy-in”). | ||||
| Module 4 (online) | Case planning across agencies: | Month 6 (baseline) | 45 min, self-paced | |
| Reviews strategies for sharing expectations and information with behavioral health partners, understand the rationale behind agency accreditation, and learn how to identify the best behavioral health agencies and providers in the area. | ||||
| Live activity 1 (webinar) | Family engagement: | Month 7 (baseline) | 2. 1-h sessions | |
| Live supervision format that builds on information from unit 3 helping JJ to develop skills to share screening results and evidence that gets the family to commit to initiating and engaging in treatment services. | ||||
| Live activity 2 (webinar) | Case planning across agencies: | Month 7 (baseline) | 2. 1-h sessions | |
| Live supervision format that builds on information from unit 4 and discusses tools, techniques, and communication practices (to share information across agencies and increase linkage to treatment). | ||||
| Goal achievement training | Core | Onsite training where members of the inter-agency workgroup learn about and select a “goal” to work on given the information contained in their site feedback report. Following goal selection, teams are trained on how to review and use data to inform the decisions they make during efforts to improve identification of substance use needs and linkage to services (e.g., plan-do-study-act and SMART goal activities). | Month 7 (baseline) | 6 h over 1 or 2 days |
| Part 1: goal selection support | ||||
| Part 2: data-driven decision-making | ||||
| Monthly site check-ins | Core | Telephone conversation with the site liaison about activities toward their selected goal in the previous month | Months 8–19 (experiment) | 9 h over 12 months |
| Quarterly reports | Core and Enhanced | RC generates quarterly reports that are emailed to the site liaison. The report presents data on retention in the Cascade (screening, assessment, referral, treatment initiation, treatment engagement, continuing care) at 3-month intervals. | Months 11, 13, 15, and 17 (experiment) | 2 h over 12 months |
| Interagency workgroup meetings | Core | Periodic meetings to work toward achieving the selected goal using PDSA and other strategies learned through the goal achievement training | Months 8–19 (experiment) | At sites’ discretion |
| Facilitator-local champion calls/meetings | Enhanced | Calls and meetings (between RC and site) designed to (1) prepare for upcoming local change team (LCT) meetings, (2) debrief from previous LCT meetings, and (3) transition from external facilitator to internal facilitator | Months 8–19 (experiment) | 6–24 h total; projected average of 15 h over 12 months |
| Local change team (LCT) meetings | Enhanced | Monthly meetings principally organized around the following activities: goal selection; plan phase of PDSA; study phase of PDSA; strategies for acquisition, utilization, and interpretation of agency data; and sustainment of new practices | Months 8–19 (experiment) | 14–21 h total over 12 months |
| LCT transition to sustainment meeting | Enhanced | Single close-out meeting as facilitation ends (note: not formally called “close-out” to avoid undermining sustainment) | Month 19 (at conclusion of experiment) | 1.5 h |
| Study close-out meeting | Core and Enhanced | RC meets with site inter-agency workgroup (or LCT in Enhanced) at project end | Month 26 (at conclusion of sustainment) | 1.5 h |