Implementation of a triadic network case management intervention for care engagement - We will conduct a Hybrid Type II effectiveness-implementation randomized controlled trial of a Case Management Dyad (CM2) intervention, an evidence-based triadic social work intervention that uses a case manager dyad to engage patients in economic stability services. CM2 innovates on existing care continuum engagement models by (1) prioritizing resource counseling to improve care and prevention continuum outcomes, and (2) utilizing a triadic network approach where a client meets with a dyadic case management team in tandem–forming a triad with the client–which provides additional supports for the client and the case managers. CM2 is timely given that intensive interventions are critical for engaging community members most impacted by disease. CM2 will also test robust implementation strategies to support CM2 implementation and to enhance the professional development and prevent burnout in the front-line workforce. The CM2 intervention and associated implementation strategies emerge from prior work conducted by the Investigative Team. We will build upon these experiences, infrastructures, and relationships to evaluate the effectiveness and implementation of CM2 among N=180 patients. Data collection, at baseline, and every 6 months over 18 months, will include surveys and electronic medical record data. To study implementation, we will use the Consolidated Framework for Implementation Research as the determinant framework and RE-AIM as the evaluation framework. The specific aims are to: (Aim 1a) Evaluate the primary (financial well-being, food security) and secondary (care engagement) effectiveness of CM2 vs routine Non-Medical Case Management; (Aim 1b). Evaluate the effectiveness (time to successful resource referral completion, CM job satisfaction, CM burnout and CM-client relationship) of the CM2 intervention vs. routine Case Management among case manager study participants; (Aim 2a) Determine the extent to which financial well-being and food security mediate the relationship between CM2 and downstream 18-month integrated care continuum outcomes; (Aim 2b) Explore potential differential effects of CM2 on primary (resource) and secondary (care continuum) outcomes, based on mental health, substance use, housing and employment; and (Aim 3) Evaluate implementation strategies and outcomes at both patient and case manager levels using RE- AIM to study reach, adoption, implementation, and maintenance. Implementation strategies include individual and dyadic supervision, team consultation, and a train-the-trainer model, and implementation outcomes are acceptability, feasibility, appropriateness, feasibility, fidelity and cost. If successful, CM2 will intensify existing case management resource support systems, which will not only impact the lives and care continua of patients, but also fulfill a priority of revitalizing and sustaining the frontline workforce.
