Establishing the Effectiveness of Enhanced Implementation Methods in Preventative Behavioral Health

BackgroundMore than 20 million Americans ages 12 and older have a past-year substance use disorder. Majority-minority cities, including Flint, MI, suffer disproportionately from higher rates of substance use and are less likely to have access to evidence-based prevention and treatment interventions relative to predominately White and wealthier cities. Thus, identifying approaches that can improve implementation of evidence-based substance use practices is a critical public health goal. In the current report, we provide a detailed protocol for the implementation and evaluation of the Strengthening Flint Families initiative, a community-based implementation study of a multi-level behavioral health intervention that includes peer recovery coaching, the Strengthening Families Program, and a multimedia campaign. Our goal is to improve family resilience and reduce behavioral health disparities in the Flint community, as an example of how this could be done in other communities. Our overall strategy includes community-informed implementation enhancements to increase adoption and sustainment of evidence-based behavioral health services. MethodsThis project has 4 phases that align with study aims-1) a systematic assessment of behavioral health organizations in the Flint Area to understand organizational needs and strengths in Flint; 2) tailoring implementation strategies for one individual-level evidence-based practice, peer recovery coaching, and one family-level evidence-based program, the Strengthening Families Program; 3) building capacity and promoting sustainability; and 4) evaluating primary (implementation) and secondary (effectiveness) outcomes. Implementation outcomes are derived from the RE-AIM framework and effectiveness outcomes will be assessed at the individual, family, and community levels. DiscussionUnderstanding and addressing the behavioral health organizational needs, strengths, and barriers to program adoption and referral in Flint offers great promise to strengthen the behavioral health network of providers serving Flint residents. Moreover, understanding barriers to accessing and implementing behavioral health services in low-resource communities may prove to be a valuable tool for discovering the most effective implementation methods tailored to specific organizations. These evidence informed approaches may prove useful for cities outside of Flint. Contributions to the literatureMore research is needed on how best to improve community capacity for substance use services, especially in low-income communities This study will examine implementation strategies for improving community adoption and sustainment of a multilevel suite of substance use interventions Study findings will contribute to improved community-wide implementation of evidence-based behavioral health services and increased access to and participation in these services in low-resource communities