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Implementation of Integrated Dual Disorder Treatment in Routine Veterans Health Administration Settings

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Abstract

Integrated dual disorder treatment is an evidence-based practice for coordinating complex care for people with severe mental illnesses and comorbid substance use disorders in a single program. Despite its effectiveness, the program can be difficult to implement and is not routinely implemented in Veterans Health Administration settings. This study sought to better understand factors in implementation of this model using. We evaluated the model in four different programs at two Veterans Health Administration medical centers and documented costs associated with implementation efforts at one site. We used interviews and observations to characterize factors (with initial coding based on the Consolidated Framework for Implementation Research) impacting implementation. Critical factors included the perceived usefulness of the model for patients served by the program, the need for ongoing case-based coaching after initial training, staff openness to stage-wise approaches as opposed to abstinence-only interventions, leadership at both the team and upper-level manager levels, and the need for model adaptation within varied program settings. Costs for implementation were relatively modest for both programs observed. These results should inform future efforts to implement the model in Veterans Administration and are also relevant to implementation challenges in other mental health service settings.

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Acknowledgements

We would like to thank the study participants for making this work possible. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the US government.

Funding

This work was funded by the VA Quality Enhancement Research Initiative (QUERI) RRP 12–504 (PI: Rollins). Drs. Rollins, Eliacin, Kukla, and McGuire were also supported in part by the VA Health Services Research and Development (HSR&D) Center for Health Information and Communication, CIN 13–416. Dr. Eliacin was supported in part by a VA HSR&D Career Development Awards: CDA 16–153 (PI: Eliacin).

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Authors and Affiliations

  1. VA HSR&D Center for Health Information and Communication, Veterans Health Indiana, 1481 W. 10th Street (11-H), Indianapolis, IN, 46202, USA

    Angela L. Rollins, Johanne Eliacin, Marina Kukla, Sara Wasmuth, Michelle P. Salyers & Alan B. McGuire

  2. IUPUI Psychology Department, ACT Center of Indiana, Indianapolis, IN, USA

    Angela L. Rollins, Johanne Eliacin, Marina Kukla, Sara Wasmuth, Michelle P. Salyers & Alan B. McGuire

  3. William H. Tierney Center for Health Service Research, Regenstrief Institute, Inc., Indianapolis, IN, USA

    Angela L. Rollins, Johanne Eliacin, Sara Wasmuth & Alan B. McGuire

  4. Department of Occupational Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, USA

    Sara Wasmuth

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  1. Angela L. Rollins
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  2. Johanne Eliacin
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  3. Marina Kukla
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  5. Michelle P. Salyers
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  6. Alan B. McGuire
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Correspondence to Angela L. Rollins.

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The authors followed the Standards for Reporting Qualitative Research (SRQR).

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All human subject procedures in this study were approved by the Indiana University Institutional Review Board, as well the VA Research and Development Committee of the Richard L. Roudebush VA Medical Center.

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Rollins, A.L., Eliacin, J., Kukla, M. et al. Implementation of Integrated Dual Disorder Treatment in Routine Veterans Health Administration Settings. Int J Ment Health Addiction 22, 578–598 (2024). https://doi.org/10.1007/s11469-022-00891-1

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