Table 1 Description of study measures, data source, and timing of measurement

Aim 1

 Reach

Calculates patients’ exposure to contingency management (CM) by dividing the number of newly admitted patients with recent stimulant use (defined as documented patient-reported stimulant use or a positive stimulant urine screen within the first 30 days of treatment) who received 1 or more CM encounters by the total number of newly admitted patients with recent stimulant use.

Electronic medical records (EMR)

CM tracking tool

End of each wedge

 Adoption

Calculates the proportion of providers who have adopted CM by dividing the number of counselors who delivered 1 or more CM encounters divided by the total number of counselors.

EMR

CM tracking tool

End of each wedge

 Implementation

Assesses delivery of CM with fidelity in two ways:

1. Proportion of counselors meeting the fidelity target on the CM Competence Scale (a mean overall score ≥ 4.0), which rates 9 CM elements on a scale from 1 (not at all present) to 7 (fully present)

2. Proportion of CM sessions covering ≥ 7 of 9 of the standard CM elements, as assessed by a self-report checklist in the CM tracking tool.

Observer rating

CM tracking tool

Role play following Preparation phase

End of each wedge

 Maintenance

Measures Reach, Adoption, and Implementation throughout the Sustainment phase.

EMR

CM tracking tool

Observer rating

End of each wedge during Sustainment phase

 Equity

Evaluates whether the above systematically vary based on race/ethnicity, biological sex, gender, and other sociodemographic factors of patients and providers.

EMR

Provider survey

Baseline

Aim 2

 Stimulant abstinence

Calculates abstinence rates as the number of urine screens that are negative for stimulants divided by the total number of urine screens received by patients with recent stimulant use.

EMR

End of each wedge

 Treatment retention

Measures engagement with treatment in three ways for each patient:

1. Duration of time from patient intake to discharge in day

2. Proportion of scheduled encounters that the patient attended

3. Number of CM sessions received

EMR

EMR

CM tracking tool

End of each wedge

Aim 3

 Implementation strategy progress

  Stages of Implementation Completion (SIC) [46]

Evaluates completion of key activities for implementing the contingency management intervention across 8 stages. Two scores are calculated for each stage: proportion calculates the percent of activities completed within a stage and duration calculates time from date of entry through completion.

Process notes

External facilitator report

Ongoing throughout Preparation and Implementation phase for each OTP

  Cost of Implementing New Strategies (COINS) [47]

Calculates the fees, expenses, and person hours necessary to complete the implementation strategy as mapped onto SIC. Customized via a standardized adaptation approach.

Process notes

External facilitator report

Ongoing throughout Preparation and Implementation phase for each OTP

 Inner Setting Factors

  Implementation Climate Scale (ICS) [48]

Measures provider perceptions of the extent to which organizations expect, reward, and support implementation of CM. Scale includes 18 items scored on 5-point scales from 0 (not at all) to 4 (very great extent) divided into 6 subscales.

Provider surveys

Three timepoints for each OTP crossing into active support: Start of Preparation, Midpoint of Implementation, End of Implementation

  Implementation Leadership Scale (ILS) [49]

Measures providers’ report of the extent to which leaders at their organization are aligned and visibly in support of CM. Scale includes 12 items, rated from 0 (not at all) to 4 (very great extent) divided into four subscales.

Provider surveys

Three timepoints for each OTP crossing into active support: Start of Preparation, Midpoint of Implementation, End of Implementation

  Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS)

Assesses barriers and facilitators to implementation via a team-based inventory collaboratively completed by each OTP at a leadership team. Consists of 27 items each scored in two ways: rating, scored on a 5-point scale ranging from 1 (least positive) to 5 (most positive), and importance, scored on a 3-point scale ranging from 1 (not important) to 3 (very important).

Recorded by leadership team

Three timepoints for each OTP crossing into active support: Start of Preparation, Midpoint of Implementation, End of Implementation

 Provider characteristics

  AIM, IAM, FIM [50]

Measures the extent to which providers view CM as acceptable (Acceptability of Intervention Measure [AIM]), appropriate (Intervention Appropriateness Measure [IAM]), and feasible (Feasibility of Intervention Measure [FIM]). Each measure contains 4 items scored on a 5-point scale ranging from 1 (completely disagree) to 5 (completely agree).

Provider surveys

Three timepoints for each OTP crossing into active support: Start of Preparation, Midpoint of Implementation, End of Implementation

  CM Attitudes Scale

Measures provider attitudes and objections towards CM via a 5-item survey; three items range from 1 (strongly disagree) to 7 (strongly agree), one item ranges from 1 (complete unacceptable) to 7 (very acceptable), and the final item ranges from 1 (not at all effective) to 7 (very effective).

Provider surveys

Three timepoints for each OTP crossing into active support: Start of Preparation, Midpoint of Implementation, End of Implementation

  Provider demographics

Assesses a range of sociodemographic variables, including sex/gender, race/ethnicity, age, tenure at the OTP, licensure status, and years in the addiction health services field.

Provider survey

Baseline