Hills Holly A, Lengnick-Hall Rebecca, Johnson Kimberly A, Vermeer Wouter, Hendricks Brown C, McGovern Mark
Department of Mental Health Law and Policy (MHC 2636), College of Behavioral and Community Sciences, University of South Florida, Tampa, FL.
Brown School, Washington University in St. Louis, St. Louis, MO.
Implement Res Pract. 2022 Apr 27;3:26334895221096295. doi: 10.1177/26334895221096295. eCollection 2022 Jan-Dec.
Adaptation is an accepted part of implementing evidence-based practices. COVID-19 presented a unique opportunity to examine adaptation in evolving contexts. Delivering service to people with opioid use disorder during the pandemic required significant adaptation due to revised regulations and limited service access. This report evaluated changes to addiction medication services caused by the pandemic, challenges encountered in rapidly adapting service delivery, and initial impressions of which changes might be sustainable over time.
Qualitatively-evaluated structured interviews (N = 20) were conducted in late 2020 with key informants in Pinellas County (FL) to assess the pandemic's impact. Interviewees represented a cross-section of the professional groups including direct SUD/HIV service providers, and sheriff's office, Department of Health, and regional clinical program administrative staff. The interview questions examined significant changes necessitated by the pandemic, challenges encountered in adapting to this evolving context, and considerations for sustained change.
The most significant changes to service delivery identified were rapid adaptation to a telehealth format, and modifying service consistent with SAMHSA guidance, to allow for 'take-home' doses of methadone. Limitations imposed by access to technology, and the retraining of staff and patients to give and receive service differently were the most common themes identified as challenging adaptation efforts. Respondents saw shifts towards telehealth as most likely to being sustained.
COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations identified will only be sustained through multisystem collaboration and validation. Results suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery. Findings will also be integrated with quantitative data to help inform local policy decisions.
Adaptation is an accepted part of implementing evidencebased practices. COVID-19 presented a unique opportunity to examine rapid adaptation necessitated within evolving contexts. Delivering services to people with opioid use disorder required significant adaptation due to changing regulations and limited access to lifesaving services. This study examined changes in service delivery due to the pandemic, challenges encountered in rapid adaptation, and initial impressions of which changes might be sustainable over time. Qualitatively-evaluated structured interviews were conducted with a cross-section of professional groups (direct substance use disorder (SUD) and human immunodeficiency virus (HIV) service providers, and sheriff's office, Department of Health, and clinical program administrative staff) in Pinellas County (FL). The most significant changes to service delivery were rapid adaptation to a telehealth format and increased allowance for 'takehome' doses of methadone medication. Limitations imposed by access to technology, as well as the education of and staff and patients were the most common themes identified as challenges. Respondents saw shifts towards telehealth as most likely to be sustained. COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations will only be sustained through multisystem collaboration and validation. Findings suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery.
适应是实施循证实践的一个公认部分。2019冠状病毒病（COVID-19）为研究在不断变化的环境中的适应情况提供了一个独特机会。在大流行期间为阿片类药物使用障碍患者提供服务，由于法规修订和服务获取受限，需要进行重大调整。本报告评估了大流行导致的成瘾药物服务变化、快速调整服务提供过程中遇到的挑战，以及哪些变化可能随时间持续存在的初步印象。
2020年末，对佛罗里达州皮内拉斯县的关键信息提供者进行了定性评估的结构化访谈（N = 20），以评估大流行的影响。受访者代表了包括直接的物质使用障碍/艾滋病毒服务提供者、警长办公室、卫生部和区域临床项目行政人员在内的专业群体的一个横断面。访谈问题考察了大流行带来的重大变化、适应这一不断变化的环境中遇到的挑战，以及持续变化的考虑因素。
确定的服务提供方面最显著的变化是迅速适应远程医疗模式，并根据美国药物滥用和精神健康服务管理局（SAMHSA）的指导调整服务，以允许“带回家”剂量的美沙酮。技术获取的限制，以及工作人员和患者重新培训以不同方式提供和接受服务，是被确定为具有挑战性的适应工作的最常见主题。受访者认为向远程医疗的转变最有可能持续下去。
COVID-19提供了一个前所未有的机会，来研究在快节奏、动态和不断变化的环境中的适应情况。所确定的适应措施只有通过多系统协作和验证才能持续下去。结果表明，可以在实施框架中增加其他组成部分，以评估在意外事件期间的快速适应情况，例如获取额外资源或影响服务提供的地方决策。
适应是实施循证实践的一个公认部分。COVID-19提供了一个独特机会，来研究在不断变化的环境中所需的快速适应情况。由于法规变化和获取救生服务受限，为阿片类药物使用障碍患者提供服务需要进行重大调整。本研究考察了大流行导致的服务提供变化、快速适应中遇到的挑战，以及哪些变化可能随时间持续存在的初步印象。对佛罗里达州皮内拉斯县的专业群体（直接的物质使用障碍（SUD）和人类免疫缺陷病毒（HIV）服务提供者、警长办公室、卫生部和临床项目行政人员）的一个横断面进行了定性评估的结构化访谈。服务提供方面最显著的变化是迅速适应远程医疗模式，并增加了“带回家”剂量美沙酮药物的许可。技术获取的限制，以及工作人员和患者的培训，是被确定为挑战的最常见主题。受访者认为向远程医疗的转变最有可能持续下去。COVID-19提供了一个前所未有的机会，来研究在快节奏、动态和不断变化的环境中的适应情况。适应措施只有通过多系统协作和验证才能持续下去。研究结果表明，可以在实施框架中增加其他组成部分，以评估在意外事件期间的快速适应情况，例如获取额外资源或影响服务提供的地方决策。
