title: Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.
abstract: Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO).
  
  
  
  This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview.
  
  
  
  No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet.
  
  
  
  This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet.
  
  
  
  ClinicalTrials.gov NCT01430741.
authors.affiliation: VISN 4 Mental Illness Research and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. Chinman@rand.org.|RAND Corporation, Pittsburgh, PA, USA. Chinman@rand.org.|VA National Center on Homelessness Among Veterans, Philadelphia, PA, USA. Chinman@rand.org.
authors.forename: Matthew
authors.identifier: 0000-0001-5390-8723
authors.initials: M
authors.lastname: Chinman
authors.affiliation: VISN 4 Mental Illness Research and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: McCarthy
authors.affiliation: VISN 4 Mental Illness Research and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Hannah
authors.affiliation: VA National Center on Homelessness Among Veterans, Philadelphia, PA, USA.|Boston University School of Social Work, Boston, MA, USA.|VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
authors.forename: Thomas Hugh
authors.initials: TH
authors.lastname: Byrne
authors.affiliation: VA National Center on Homelessness Among Veterans, Philadelphia, PA, USA.|VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA.|Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Smelson
mesh_terms: D019090:Case Management / Q000706:statistics & numerical data; D016000:Cluster Analysis; D055317:Evidence-Based Practice / Q000379:methods*; D006284:Health Plan Implementation / Q000379:methods; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D015397:Program Evaluation / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Co-occurring disorders; Fidelity; Implementation support; Technical assistance; Training