Table 2.
Exploration, planning, implementation, sustainability (epis) constructs, definition, and representative quotesa.
| Constructs | Definition | Representative Quote |
|---|---|---|
| OUTER CONTEXT | ||
| Service Environment | State and federal sociopolitical factors that impact implementation and delivery of MOUD in the service environment (i.e., jails). | [H]aving the legislat[ion] in place certainly helped… it wasn’t just treatment people in the facility saying, ‘this is what we are going to be doing.’ It’s now the government involved in saying this is an option that we want to offer to everybody. |
| Funding | Fiscal support provided by external systems necessary for implementation to occur. | …[N]ow [the jails] have money to provide these services…It’s very good for the community.[Y]ou can continue this throughout the state…We don’t have to worry about if a person goes from one place to the other. They don’t have to interrupt their treatment. |
| Systemic-Based Characteristics of Service Recipients | Characteristics of individuals who are incarcerated, which are grounded in systemic issues, that impact delivery of MOUD. | [P]retrial was a big challenge, because these individuals… could be getting released at court. So, it was really important that we have, in the community, places that they could go same day, latest next day, for their next dose. So, that was one of our challenges, because we had to put a system in place so that if somebody does get released at court, do they know what they need to do? Are there the resources in the community for them to go to those places, drop in, and get their doses? |
| INNER CONTEXT | ||
| Organizational characteristics | Structures and standard operational processes in jails that impact implementation of treatment. | In here, it’s been interesting to adjust to different time frames for things. The assessment process… can be a couple of hours that we’re meeting with somebody. So it’s being able to find that time in the day, where they’re not eating, where it’s not freeze count, where there’s not rec, they don’t have a visit, or they’re not at court… There’s… all of these different factors that aren’t factors in the community. So being able to be flexible and really learn all of those different aspects has been interesting, challenging and just something to get used to. |
| Fidelity monitoring | Procedures undertaken to ensure adherence to active delivery of MOUD. | If all of that [data required to be collected] is long term public health data to support funding for the same- it’s killing us upfront. It’s killing folks at the beginning of this.The forms are really geared towards a community-based setting, too. They’re not geared towards a correctional setting. |
| Organizational Leadership | Characteristics and behaviors of individuals involved in oversight and decision-making about MOUD implementation in jails. | They’re [senior leadership] open to suggestions, which helps a lot. And they’ll come to each one of us. [Corrections captain] will come to each one of us, and say ‘What are your thoughts on that? This is what MAT [is] suggested, what do you think? Do you think that would work’ And it does, it helps. It helps us down here [in the clinic] run things smoothly.’ |
| Staff Perspectives and Hiring Processes | Description of staff perspectives on MOUD and organizational hiring processes around training of staff involved in the delivery of MOUD and its implementation. | You can tell the ones that ask a lot of good questions like they want to understand is a withdrawal or is that a detox is that the [delirium tremens]? … They ask about medical. They come to you and they’ll be interested in maybe going to trainings on their own or reading about what’s going on… [W]hen they show that extra layer of interest and they approach staff…and you say, ‘Okay… this is what’s going on, they’re not feeling well…’ and they seem receptive, then those are the ones that you’re picking. |
| BRIDGING FACTORS | ||
| Inter- Organizational Networks | Relationships between organizations through which knowledge of MOUD is shared and MOUD goals about implementation are developed and established. | [I]t’s been a real support. It’s been great to be able to [say to other jails], ‘Hey how are you guys gonna do this?’…or we’re dealing with [state agency]…’How did you do it?’ and trying not to reinvent the wheel. If someone got a policy from someone else, let’s share it, so we can all just update it. |
| Intra-Organizational Collaborations | Structures and processes that exist and aid in development of relations between policy and practice entities, formal and informal influence and directives, and work of intermediaries. | I’ve been here 19 years, and the last year and a half, we’ve worked with more departments than I ever have. It’s just been seamless. Like, I can go down to Programs or Classification or Security, and everybody – we’re all on the same page. We know what the process is. We know what the plan is. |
| Relationships with Community Providers | Desciption of collaboration and working relationships with community based MOUD agencies. | Contracting, I don’t think we would have gotten close to meeting the [mandate] deadline without bringing in that expertise. |
a
Adapted from Aarons et al. (2011).