Openness to Adopting Evidence-Based Practice in Public Substance use Treatment in South Africa Using Task Shifting: Caseload Size Matters

Abstract

As pressure to scale up implementation of EBPs in South African substance use treatment services intensifies, additional efforts are needed to understand barriers to adopt EBPs in this setting. Supporting staff adoption of EBPs in resource-limited settings may require additional resources to limit staff caseloads in the context of task shifting.

A Mixed-Methods Evaluation of the Implementation of a Performance Measurement System for South Africa’s Substance Use Treatment Services

“…We found relatively high levels of SQM system penetration across participating treatment agencies, providing the first evidence that it is feasible to implement a performance measurement system for SUD treatment services in a resource-limited setting in which the workforce is less skilled and more burdened than in high-income settings (Magidson et al, 2017; Pasche et al, 2015). As in high-income countries (Herbeck et al, 2010), agencies varied in the extent of SQM system implementation.…”

“…We developed a system tailored to the South African treatment system because of contextual and resource differences between South Africa and high-income settings. Compared with the United States, South Africa has considerably fewer health and SUD providers and facilities per 100,000 patient population (Connell et al, 2007; Pasche et al, 2015), providers have higher caseloads and less administrative support (Magidson et al, 2017), and there are no administrative databases that can be used for SUD treatment monitoring (Myers et al, 2014b). The SQM system is comparable to performance measurement systems used within high-income settings in that it assesses the effectiveness of, efficiency of, access to, person-centeredness of, and quality of treatment (Garnick et al, 2012; Institute of Medicine, 2005).…”

“…In high-income settings, the extent to which SUD providers implement performance measurement systems varies considerably (Herbeck et al, 2010; Kilbourne et al, 2010). This raises questions about the feasibility of implementing such a system in a less-resourced setting in which providers already have heavy administrative burdens (Magidson et al., 2017). To improve the extent of system implementation, a broad range of potential facilitators to implementation must be identified and enhanced.…”

Service deserts and service oases: Utilizing geographic information systems to evaluate service availability for individuals with autism spectrum disorder

“…Our data speak specifically of one domain of supply- side determinants of ASD services; namely, availability. Given that research suggests a negative relationship between caseload size and the use of EBPs (Becker-Haimes et al, 2017; Magidson et al, 2018), fidelity of implementation (Bertram et al, 2011), and family centered practice (Wright et al, 2010), we might expect that the higher ratio of available ASD service providers to individuals with ASD served in rural and low SES urban communities could negatively impact the appropriateness and quality of the services that are delivered. This may be particularly true among rural communities, whose providers have less access to training in EBPs (Dotson et al, 2014).…”

Implementation challenges to patient safety in Guatemala: a mixed methods evaluation

“…The EBPAS survey has been validated in a number of high-income and middle-income settings, and has been translated and validated in several non-English languages, including Spanish. [17][18][19] To qualitatively assess staff views towards implementation, we used semistructured interviews (SSIs). 20 We conducted SSIs using a 15-question interview tool with questions aligned with CFIR domains as described previously (online supplemental file 2).…”