Studying Implementation of Dual Diagnosis Services: A Review

Abstract

Objective: Over the past 15 years, considerable time and energy has been devoted to implementing integrated services for individuals with dual disorders. While the key factors in the successful implementation of such services have been documented, applying them remains a challenge. What are we missing? In this article we attempt to answer this question by examining how implementation studies of integrated services have been carried out. The aim is to identify possible avenues for future implementation research. Methods: We updated a recent literature review of published studies on service implementation. Articles written in English and addressing organization-level factors were included. The reviewed articles were categorized based on two aspects of their methodology: their approach to the implementation process (content- or process-centered) and their objective (descriptive or explanatory). Results: In the 15 studies reviewed, we observed a tendency toward a content-centered approach (n = 9) with a majority having an explanatory objective. Studies that reflected this trend identified the most common determining factors in order to explain the level of implementation achieved within a given period of time. These studies did not examine the sequencing and transformation of the implementation process over time. Such a process-centered approach was used in only six studies. Conclusions: Research exploring the evolutive dynamics of implementation projects should be prioritized to counter the lack of knowledge on the subject. Such studies have the potential to greatly enhance our understanding as well as our capacity to master the implementation of integrated services.

Keywords:

• integrated services
• implementation
• dual diagnosis
• dual disorders
• methods

Notes

1. The implementation model used integrated three elements: educational material (written documents, videos, etc.), access to a specialized consultant's services for 2 years, and feedback to teams every 6 months on their level of fidelity to the intervention model.

2. COSIG projects provide funding for initiatives related to capacity building, e.g., implementing standardized screening and assessment, supporting training, and paying for some services that enhance co-occurring disorders treatment. Funds are also dedicated to infrastructure development at the state level.

3. The Carlson et al. (2012) study could not be included because their sample was made up of implementation experts.