The role of staffing stability in the implementation of integrated dual disorders treatment: An exploratory study

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Abstract
Background: Integrated dual disorders treatment (IDDT) is an efficacious treatment for people with a co-occurring serious mental illness (SMI) and substance abuse disorder. Little is known about the ability of routine mental health centers to implement IDDT. Workforce issues may impede agencies' ability to implement IDDT. Aims: To investigate the relationship between staffing stability and implementation of IDDT and to examine strategies undertaken by agencies to overcome staffing barriers during implementation. Methods: This study uses data from an IDDT implementation demonstration project to examine the relationship between staffing challenges and both fidelity to the practice model and penetration rate. Challenges and strategies related to staffing instability are investigated via thematic analyses of qualitative data. Results: The majority of agencies implementing IDDT had staffing challenges, and four out of eleven teams almost completely turned over within 1 year. When this occurred, a drop in penetration or fidelity was often observed. Training infrastructure appeared to be important in the ability of agencies to sustain implementation during times of staffing instability, as was replacing departing staff with more appropriate clinicians. Conclusions: While challenging to overcome, agencies were often able to work through staffing problems to achieve reasonable fidelity in the face of team turnover. Declaration of interest: This research was supported by the West Family Foundation, the Center for Mental Health Services (CMS) at The Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation, the MacArthur Foundation, the Johnson & Johnson Charitable Trust, as well as a predoctoral institutional training grant to the first author from the Agency for Healthcare Research and Quality (AHRQ).