The eCliPSE Project: implementing evidence-based eHealth interventions for comorbid mental health and alcohol/other drug use problems into health and community settings

This study will compare a direct-to-consumer (DtC) marketing strategy and an Integrated Translation and Engagement Model (ITEM) of implementation designed to engage 'users' (i.e., consumers and health services) with the eCliPSE tool, which is an online clinical portal to facilitate access to evidence-based eHealth treatments for mental health and substance use comorbidity. The study duration is anticipated to last approximately 18 months, with each strategy to be implemented in parallel to each other. The eCliPSE tool is available the public with no anticipated end date. At the start of the trial, eCliPSE will house up to 10 evidence-based eHealth treatment programs that are targeted towards different needs. These include anxiety and alcohol use, trauma and substance use, supporting friends and family who care for a loved one who uses substances, smoking cessation, depression and substance use, depression and alcohol use. These programs are structured as short modules with interactive activities. The usage of eCliPSE will be monitored using website analytics to track how users move throughout the eCliPSE portal and their use of the tailored treatment programs. The study will be implemented across all 15 local health districts (LHDs) in New South Wales (NSW). All fifteen LHDs will receive the DtC marketing strategy, however, only seven LHDs will received the ITEM Model of implementation (e.g. 7 LHDs receive DtC and ITEM vs 8 LHDs receive DtC alone). Intervention: The ITEM Model The ITEM model is an evidence-based model of effective implementation that synthesises evidence on facilitators and barriers to translation and focuses on the various disorderly interactions between researchers and users at different stages of knowledge production, dissemination, and utilisation. Seven of the fifteen LHDs will receive the ITEM model, which is focused on engaging consumers, clinicians, service leaders and policy makers across all stages of implementation. The implementation of the ITEM model will be coordinated by the principal investigator and chief investigators responsible for the development of the strategy. Each phase of the ITEM model will be administered by these investigators in conjunction with research staff (research assistants and project officers) where necessary to assist in data collection. The ITEM Model is comprised of three distinct phases, each estimated to last approximately 6 months: Phase 1 - Engagement, Knowledge Exchange and Co-Design i) Convene a translation team to drive the implementation of eCliPSE in select LHDs ii) Engage in relationship building and deconstruction of dynamics through open discussion about attitudes, assumptions, and values about research and practice; this engagement will be dependent on the needs of each LHD, but may involve email exchange between investigators and service directions, introductory meetings between investigators and service directors, formal presentations at service-level meetings iii) Assess - use baseline Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assessments to identify gaps and opportunities in service provision for mental health and alcohol/other drug co-morbidity iv) Shape the implementation of eCliPSE with the translation team in line with above assessments Phase 2 - Implementation and Support i) Introduce eCliPSE employing a 'trigger encounter' (example role play encounters) to enhance engagement with eCliPSE ii) Train practitioners in the use of eCliPSE (minimum 4 x 2-hour sessions in each LHD) iii) Provide support by: a) training to enhance practitioner confidence and to understand key terms/processes, b) addressing any concerns or defensiveness, and c) engaging in regular active interaction; support will be individualised based on practitioner’s needs Phase 3 - Sustainability and Organisational Change i) Establish adequate supports and mentoring within the practice setting to achieve effective, sustained implementation of eCliPSE; a champion will be identified to act as an advocate for organisational change ii) Advocate for organisational change to enable and support sustained implementation and avoid top-down translation iii) Assess - use DDCAT/DDCMHT to compare initial audit of service provision