Implementing evidence-based SUD treament within a VA Medical Center

The Veterans Health Administration endeavors to standardize evidence-based mental health and substance use disorder (SUD) treatment for veterans nationwide (Department of Veterans Affairs, 2008), and our facility strives to implement this care efficiently, effectively, and creatively (Francis et al 2011; Shealy & Winn, 2014; Winn et al, 2013).  Recent initiatives within our intensive outpatient program (IOP) include offering contingency management for cocaine dependence and development of a CBT (cognitive-behavioral skills training) track.  Our continuum of care has broadened through integration of outpatient  SUD services into ambulatory care utilizing motivational enhancement and harm reduction approaches, as well as implementation of a lower-intensity evening outpatient program and separate groups for patients receiving buprenorphine/naloxone for opioid dependence.  Outpatient relapse prevention services for chronically-relapsing veterans at risk for homelessness are being enhanced through collaboration with community- based staff.  We have also recently begun offering brief interventions for inpatients with high SUD risk (based on admission AUDIT-C score or reporting of drug use). Issues faced in implementing new program services include managing change (including staff transitions); juggling national and local imperatives to meet multiple objectives; obtaining adequate space, transportation,  and support services; and maintaining the effectiveness of existing services.  Lessons learned include creative use of the performance improvement process, empowering champions, and advocating for needed resources and changes.  Recommendations will be offered related to staff development, organizational alignment, and creating  cross-disciplinary and departmental partnerships.  Effectiveness data related to program implementation will be provided.