Implementation barriers and fidelity in implementing evidence-based addiction treatment: A national study

Purpose: Prior work by these authors has identified that clinical staff who reported higher levels of barriers in implementing an evidence-based practice (EBP) also report higher levels of modifications in implementing EBPs. This study explores for 311 addiction treatment staff, the ten most commonly implemented evidence-based practices (EBPs), EBP fidelity, and specific barriers associated with the implementation of the ten EBPs.

Methods: This mixed methods study used open-ended qualitative data to identify the type of barriers staff experienced and level of modifications made to EBPs. A 10-point ordinal variable measured levels of modification. For each EBP, the mean modification score (MMS) and the most commonly identified barriers are presented.

Results: Data analyses identified that staff reported different levels of modifying EBPs, by type of EBP. Specifically, the EBPs reported to have been the most modified were the Peer to Peer Recovery Model and Motivational Enhancement Therapy (MMS score > 4). The two EBPs rated as having been changed the least were MI and Case Management (MMS <3). The EBP modification scores for staff implementing MI (n = 72) were higher when staff experienced barriers related to clients and to the logistics of implementation, compared to their counterparts.

Discussion: Barriers to EBP implementation are clearly associated with fidelity. As this and prior papers by the authors suggest, staff who experience different types and levels of barriers make changes to the EBP responding to these barriers. Funders of EBP implementation need to provide ongoing technical assistance to reduce barriers to EBP implementation.