Facilitation as a Strategy for Implementing the Novel TBI-RECOVER Intervention into Substance Use Treatment: A Mixed Methods Hybrid Type 2 Effectiveness-Implementation Feasibility Trial - PROJECT SUMMARY Approximately 60% of clients who enter substance use disorder (SUD) treatment have had at least one lifetime exposure to traumatic brain injury (TBI). TBI of any severity can result in chronic cognitive and behavioral impairments that, if unaddressed, can undermine the effectiveness of SUD treatment and lead to early treatment termination. The Ohio State University TBI Identification Method is a well-established, validated method for identifying clients with TBI, and neurocognitive accommodations can be used to overcome impairments and optimize client treatment success. However, our preliminary research demonstrates that neither TBI screening nor neurocognitive accommodations have been adopted in outpatient SUD treatment settings due to inadequate provider knowledge and skills to implement these interventions, as well as poor implementation readiness and support. External facilitation is an implementation strategy that can address these barriers to increase the adoption, reach, implementation, and sustainment of these interventions, but few studies have evaluated facilitation on intervention uptake in outpatient SUD treatment. Guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Exploration, Preparation, Implementation, and Sustainment (EPIS) frameworks, I will conduct an embedded mixed methods hybrid type 2 effectiveness-implementation feasibility trial to: [Aim 1] Evaluate facilitation as a strategy for increasing the adoption, reach, implementation, and maintenance of the TBI-RECOVER intervention model (i.e., OSU TBI-ID, symptom screen, and neurocognitive accommodation) in outpatient SUD treatment; [Aim 2] Examine the feasibility and preliminary effectiveness of the TBI-RECOVER intervention model compared to treatment as usual on clients’ treatment self-efficacy, substance use severity, and treatment retention; and [Aim 3] Assess client satisfaction and provider acceptability of TBI-RECOVER, and utility of the facilitation strategy for implementation of TBI-RECOVER. The following training objectives will support these research aims and my career goals: (1) Gain advanced training in dissemination and implementation science, specifically in hybrid effectiveness-implementation trials, and implementation strategy development and evaluation; (2) Acquire training in substance use treatment research for adults with comorbid SUDs and TBI; and (3) Advance my career independence through conceptualizing and leading implementation trial research, R01 grant writing, and leading research teams. This proposal is directly aligned with NIDA’s 2022 – 2026 strategic plan to investigate novel treatment interventions and enhance optimal implementation outcomes in real-world treatment contexts. This NIDA K01 will provide me with the necessary resources to advance and maximize my skills to launch an independent, NIH-funded career and situate me as a leader in implementation science, TBI, and substance use treatment research. The results and training gained through this K01 will inform a fully powered hybrid effectiveness-implementation trial to scale-out TBI-RECOVER using facilitation.
