Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
Subst Abuse Treat Prev Policy. 2018 Sep 21;13(1):32. doi: 10.1186/s13011-018-0172-3.
This paper discusses the initial testing of the Housing First Training and Technical Assistance (HFTAT) Program, a multifaceted, distance-based strategy for the implementation of the Housing First (HF) supportive housing model. HF is a complex housing intervention for serving people living with serious mental illness and a substance use disorder that requires significant individual- and structural-level changes to implement. As such, the HFTAT employs a combined training and consultation approach to target different levels of the organization. Training delivered to all organizational staff focuses on building individual knowledge and uses narrative storytelling to overcome attitudinal implementation barriers. Consultation seeks to build skills through technical assistance and fidelity audit and feedback.
We employed a mixed method design to understand both individual-level (e.g., satisfaction with the HFTAT, HF knowledge acquisition and retention, and HF acceptability and appropriateness) and structural-level (e.g., fidelity) outcomes. Quantitative data were collected at various time points, and qualitative data were collected at the end of HFTAT activities. Staff and administrators (n = 113) from three programs across three states participated in the study.
Satisfaction with both training and consultation was high, and discussions demonstrated both activities were necessary. Flexibility of training modality and narrative storytelling were particular strengths, while digital badging and the community of practice were perceived as less valuable because of incompatibilities with the work context. HF knowledge was high post training and retained after 3-month follow-up. Participants reported training helped them better understand the model. Attitudes toward evidence-based interventions improved over 6 months, with qualitative data supporting this but demonstrating some minor concerns related to acceptability and appropriateness. Fidelity scores for all programs improved over 9 months.
The HFTAT was a well-liked and generally useful implementation strategy. Results support prior research pointing to the value of both (a) multifaceted strategies and (b) combined training and consultation approaches. The study also provides evidence for narrative storytelling as an approach for changing attitudinal implementation barriers. The need for compatibility between specific elements of an implementation strategy and the work environment was also observed.
本文讨论了住房优先培训和技术援助（HFTAT）计划的初步测试，这是一种多方面、基于距离的实施住房优先（HF）支持性住房模式的策略。HF 是一种为患有严重精神疾病和药物使用障碍的人提供服务的复杂住房干预措施，需要在个人和结构层面进行重大变革才能实施。因此，HFTAT 采用了综合培训和咨询方法来针对组织的不同层次。向所有组织员工提供的培训侧重于建立个人知识，并使用叙事故事讲述来克服态度实施障碍。咨询旨在通过技术援助和保真度审计和反馈来建立技能。
我们采用混合方法设计来了解个人层面（例如，对 HFTAT、HF 知识获取和保留以及 HF 的可接受性和适当性的满意度）和结构层面（例如，保真度）的结果。在不同时间点收集定量数据，并在 HFTAT 活动结束时收集定性数据。来自三个州的三个项目的员工和管理人员（n=113）参与了这项研究。
对培训和咨询的满意度都很高，讨论表明这两项活动都是必要的。培训模式的灵活性和叙事故事讲述是特别的优势，而数字徽章和实践社区则被认为价值较低，因为它们与工作环境不兼容。培训后 HF 知识水平较高，3 个月随访后仍能保留。参与者报告说培训帮助他们更好地理解了该模型。对循证干预措施的态度在 6 个月内有所改善，定性数据支持这一点，但也表明了一些与可接受性和适当性相关的小问题。所有项目的保真度得分在 9 个月内都有所提高。
HFTAT 是一种受欢迎且通常有用的实施策略。结果支持先前的研究，指出了（a）多方面策略和（b）综合培训和咨询方法的价值。该研究还为叙事故事讲述作为改变态度实施障碍的方法提供了证据。还观察到实施策略的特定要素与工作环境之间的兼容性的必要性。
