Model and approach for assessing implementation context and fidelity in the HEALing Communities Study

Hannah K. Knudsen, Mari Lynn Drainoni, Louisa Gilbert, Timothy R. Huerta, Carrie B. Oser, Alison M. Aldrich, Aimee N.C. Campbell, Erika L. Crable, Bryan R. Garner, La Shawn M. Glasgow, Dawn Goddard-Eckrich, Katherine R. Marks, Ann Scheck McAlearney, Emmanuel A. Oga, Ariel L. Scalise, Daniel M. Walker

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: In response to the U.S. opioid epidemic, the HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) is a multisite, wait-listed, community-level cluster-randomized trial that aims to test the novel Communities That HEAL (CTH) intervention, in 67 communities. CTH will expand an integrated set of evidence-based practices (EBPs) across health care, behavioral health, justice, and other community-based settings to reduce opioid overdose deaths. We present the rationale for and adaptation of the RE-AIM/PRISM framework and methodological approach used to capture the CTH implementation context and to evaluate implementation fidelity. Methods: HCS measures key domains of the internal and external CTH implementation context with repeated annual surveys and qualitative interviews with community coalition members and key stakeholders. Core constructs of fidelity include dosage, adherence, quality, and program differentiation—the adaptation of the CTH intervention to fit each community's needs. Fidelity measures include a monthly CTH checklist, collation of artifacts produced during CTH activities, coalition and workgroup attendance, and coalition meeting minutes. Training and technical assistance delivered by the research sites to the communities are tracked monthly. Discussion: To help attenuate the nation's opioid epidemic, the adoption of EBPs must be increased in communities. The HCS represents one of the largest and most complex implementation research experiments yet conducted. Our systematic examination of implementation context and fidelity will significantly advance understanding of how to best evaluate community-level implementation of EBPs and assess relations among implementation context, fidelity, and intervention impact.

Original languageEnglish
Article number108330
JournalDrug and Alcohol Dependence
StatePublished - Dec 1 2020

Bibliographical note

Funding Information:
This research is supported by the National Institutes of Healththrough the NIH HEAL Initiative under award numbers UM1DA049406 (Kentucky), UM1DA049417 (Ohio), UM1DA049412 (Massachusetts), UM1DA049415 (New York), and UM1DA049394 (RTI). Survey data collection through REDCap was also supported by the Boston University Clinical & Translational Science Institute(National Center for Advancing Translational Sciences, NCATS Grant UL1TR001430), The Ohio State University Center for Clinical and Translational Science(NCATS Grant UL1TR002733), and the University of Kentucky Center for Clinical and Translational Science(NCATS Grant UL1TR001998). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or its NIH HEAL Initiative.

Funding Information:
As research sites partner with community coalitions and local organizations to support the implementation of the ORCCA, training and technical assistance (TTA) is provided to support expansion of EBPs in communities. The Training and Technical Assistance Tracking (TTAT) form measures, at the community level, TTA directly provided or coordinated by research sites outside of the context of HCS-designated coalition meetings and subcommittee meetings. Although much of the TTA is focused on the ORCCA, TTA may also focus on stigma, community engagement, data visualization, and other topics related to the CTH intervention. Some aspects of TTA, such as buprenorphine waiver training, may be time-limited. Other forms of TTA, such as building data capacity to use dashboards or redesigning workflows to support EBP implementation, may entail multiple ongoing contacts. Only TTA that is funded or partially funded using HCS grant funding is included in the TTAT form.

Publisher Copyright:
© 2020 Elsevier B.V.


  • Community-Level Implementation
  • Fidelity
  • HEALing Communities Study
  • Helping to End Addiction Long-term
  • Implementation Context
  • Implementation Strategy
  • Opioid Use Disorder
  • Overdose
  • PRISM Framework
  • RE-AIM framework

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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