Examining the Feasibility of Integrating Measurement Based Care into Group Therapy for Alcohol and Other Drug use using the 'Collect Share Act' Framework.

Measurement Based Care Services allocated to the intervention arm will add measurement based care (outcome monitoring and feedback per the 'Collect Share Act' framework) to their routine delivery of community based group therapy sessions. This will involve the routine administration of outcome measures (‘collect’), and then using this data to a) provide clients with progress feedback (‘share’) and b) inform treatment planning (‘act’). Group Therapy Sessions Measurement based care will be integrated into the delivery of the following community-based group therapy programs. ‘Our Recovery Journey’ is a ten-session manualised group therapy program delivered across two modules. Module one groups are run in a weekly, rolling, open format with eligible participants welcome to join at any point in the cycle. This module comprises four 1.5hr groups and is designed to encourage people to reflect on their use of alcohol and other substances, help them to set goals and develop a personalized recovery plan. Following completion of Module One, participants are eligible for Module Two, which comprises six 2hr groups delivered weekly in a closed format. Module two focuses more on skills development to sustain recovery and prevent relapse. A six-session relapse prevention program is also available for people with previous experience of treatment who require additional support. People do not need to have completed modules one or two to attend. This program is delivered in an open format across weekly 2-hr groups, with people welcome to join at any point. The relapse prevention program is designed to support participants to reflect on their recovery journey, with a particular focus on early signs of lapse/ relapse to inform the development of a relapse prevention plan and emergency plan for crisis situations. Groups are available face-to-face and online. Group size is dependent on participant attendance. All groups are run by a trained facilitator, with one co-facilitator where possible (i.e. dependent on resourcing). Outcome monitoring (Collect) Following participants first scheduled group therapy session, they will receive weekly invitations (over 12-weeks) to complete a brief questionnaire (‘check-in’) in the 24-hour window before their weekly group session is scheduled to be delivered. Invitations will be sent automatically each week via text message or email (based on client preference) using routine practice software (RediCASE, Smartsheet or Microsoft Forms). Up to two reminders will be sent each week. It is expected that the check-in questionnaire will take approximately five minutes to complete. Feedback (Share & Act) Aligned with recommendations by the International Consortium for Health Outcome Measurement, outcome monitoring and feedback will be multi-dimensional. the monitoring tool from the work of Hallgren et al. which reflects domains identified by clinician as clinically useful. This includes alcohol and substance use, craving, mental health, confidence in avoiding alcohol or substance use, therapeutic alliance and client goals. Feedback from the above weekly ‘check-in’ questionnaire will be integrated into the routine delivery of ‘Our Recovery Journey’ and ‘Relapse Prevention’ outpatient group therapy sessions (over 12-weeks). Feedback will comprise written statements to encourage self-reflection/ build motivation (e.g. Keep setting and working towards realistic plans - notice the wins and allow yourself to learn from the challenges. What good things (no matter how small) have you noticed?); summaries of the domains/ items that show evidence of improvement/ staying the same/ deteriorating; participant scores and how they compare to severity ranges/ response categories and graphs depicting progress over time. The generation of feedback will be largely automated using formulas embedded into Microsoft Forms, and supported by the research team as needed. Written feedback will be disseminated to participants (via email or hardcopy) in time for their next group (ideally within the 24-hours before the scheduled group). At the beginning of every group, clinicians will be asked to spend 5-10 minutes discussing the feedback with clients and to adapt their treatment protocol as needed. The steps include: 1. Invite participants to discuss outcome feedback at the start of every group session 2. Ask participants if the results match their own perception of progress, and prompt as needed 2a. Encourage participants to identify signs of progress (and what might be contributing) 2b. Encourage participants to identify signs of deterioration (and what might be contributing) 3. Use the discussion to develop a plan to consolidate change and address obstacles 4. Use the feedback to see if the plan is working, or needs to be adapted 5. Prioritise discussing not-on-track clients in individual sessions/ supervision Providers The intervention will be delivered by experienced community drug and alcohol workers already employed by the service. Up to 20 clinicians will be involved in delivering the intervention (dependent on who is responsible for delivering the included group therapy sessions) Training Clinicians will be trained in study procedures and the interpretation and discussion of feedback in two half-day workshops held within 2-weeks prior to implementation of the intervention. To maximise learning training will comprise a combination of best practice methods for training healthcare professionals including education, modelling, role-play, self-reflection and feedback from both peers and trainers. The workshop will be co-facilitated by the research team and a ‘champion’ identified by the service. To promote scalability, the training materials will rely heavily on free, publicly available materials. As a one-off workshop is insufficient to promote sustained change in clinician behaviour, ongoing support will be provided in the form of regular coaching (fortnightly for one month, monthly thereafter) to identify and troubleshoot implementation problems. The agenda of these sessions will be driven by the participating clinicians with a focus on shared learning by discussing successes, problem solving challenges and addressing questions. Fidelity Adherence to feedback practices will be assessed weekly via clinician self-report. Findings will be fed back to the service and discussed during supervision/ coaching sessions to promote adherence.