Table 2.

Facilitators of MRT sustainment

Themes	Sample quotations
Buy-in among VHA colleagues and leadership	I’d go to a monthly behavioral health staff meeting and we have a monthly social work staff meeting. I went to both of those meetings and presented MRT when we decided to open up and accept referrals…just to educate staff on what it was and who would be an appropriate referral. [Site ID: 309–Sustainer] It was supported by my immediate leaders. And then also the person who went with me from our site was from my substance abuse clinic, so her supervisor and chain was supportive as well. We’ll go back every now and then just to say, hey, we still have this program, don’t forget about us. [Site ID: 303–Sustainer] We sent out emails initially…and I made a lot of effort, so I tried to initiate staff, made myself available for Veterans if they were interested. I’ve done presentations too, of the social workers at our medical center. I did a lunchtime presentation about our program as well. [Site ID: 324–Sustainer]
Multiple co-facilitators	[The VJOs] we co-facilitate one group together so that we can try to maintain that fidelity with each other and at least, just to keep that cohesion. [Site ID: 309–Sustainer] We added a second group that was run by myself and a co-facilitator that went to the same training I did. He joined and started a new group and co-facilitated. I think it had us communicating to make sure we had a consistent message. [Site ID: 321–Sustainer]
Partnerships with the criminal justice system	They’re making it a requirement in their court that everyone participate in MRT. [Site ID: 309–Sustainer] Two of the courts actually require the Veteran to complete MRT prior to graduation. [Site ID: 327–Sustainer] I made it mandatory that any Veterans who are in the drug court have to do MRT during phase 2 because that’s when [they] have few obligations. And this keeps them on track for me to help them through the drug court. [Site ID: 304–Sustainer]
Screening referrals	The way we do that in Veterans Court…it’s in phases. When they’re in Phase 1 of Veteran’s Court, they do not participate in MRT until they’re at least in Phase 2 because they need to get used to Veterans court first and then have some time of sobriety. We want them to have 90 days of recovery before starting MRT. [Site ID: 309–Sustainer] We realized that some of those Veterans were not ready for MRT and needed a level of motivational interviewing at first to identify just even a behavior or a goal that might be able to be targeted or addressed within MRT. So we changed resident referrals…a consult process to get a sense of what supports the referrals. [Site ID: 327–Sustainer]
Adaptations to intervention content and delivery	We have a fishbowl, and in the fishbowl we have a mixture of inspirational quotes, as well as gift cards. Every time they complete a step they draw from the fishbowl…We also started an evening group to accommodate people who had to work. [Site ID: 309–Sustainer] We do a group that is ‘MRT informed.’ [MRT] is more shame-based than strengths-based. [MRT workbook]…I really like the activities, but some of the wording in the chapters is [shame-based]. I like to focus more on the positive…Some patients after they graduate call in and do it over the phone. [Site ID: 337–Sustainer] Not every veteran was going to be able to be face-to-face in person. Our medical center made the agreement to offer video health available at every one of our outpatient clinics to allow Veterans to appear closest to their residence and do it telephonically or through webcam to our site. [Site ID: 327–Sustainer] My Veterans court is a ways from the medical center and some of the Veterans live in outer parts of the county, so it was next to impossible for them to attend face to face meetings. We addressed that by starting a video on demand group. [Site ID: 324–Sustainer]