Table 4 Summary of adaptations made using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) enriched, expanded Framework for Reporting Adaptations and Modifications (FRAME)
Initiator of adaptation | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Adaptation constructs | Research staff | Veteran | Clinician | Clinician & Veteran | Clinician & Research staff | Veteran & Research staff | Clinician, Research staff & Veteran | Total | ||||||||
Which of the following was the primary type of change(s) involved? | ||||||||||||||||
Adding a component | 27 | 13 | 27 | 7 | 3 | 1 | 0 | 78 | ||||||||
Extending a component | 4 | 6 | 17 | 3 | 1 | 0 | 1 | 32 | ||||||||
Tailoring to individuals | 2 | 9 | 7 | 3 | 0 | 0 | 0 | 21 | ||||||||
Substituting for a component | 5 | 5 | 8 | 1 | 0 | 0 | 0 | 19 | ||||||||
Otherwise changing the intervention | 0 | 1 | 6 | 1 | 1 | 0 | 0 | 9 | ||||||||
Changing the order of components | 0 | 2 | 1 | 0 | 0 | 0 | 1 | 4 | ||||||||
Other change | 0 | 2 | 1 | 1 | 0 | 0 | 0 | 4 | ||||||||
Loosening the structure or protocol | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 2 | ||||||||
Removing a component | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||||||||
Condensing a component | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
Integrating with other programs we are doing | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
Repeating a component | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
What was changed- component of CDST | ||||||||||||||||
Service delivery manual | 16 | 7 | 20 | 1 | 0 | 0 | 0 | 44 | ||||||||
Psychoeducation | 2 | 3 | 5 | 3 | 1 | 0 | 0 | 14 | ||||||||
Worksheets | 0 | 3 | 4 | 3 | 2 | 0 | 1 | 13 | ||||||||
Examples | 2 | 0 | 7 | 4 | 0 | 0 | 0 | 13 | ||||||||
Protocol | 13 | 0 | 0 | 0 | 0 | 0 | 0 | 13 | ||||||||
At-home practice | 3 | 1 | 6 | 0 | 0 | 0 | 1 | 11 | ||||||||
Managing conflict and disagreements | 1 | 8 | 2 | 0 | 0 | 0 | 0 | 11 | ||||||||
Other component | 2 | 0 | 6 | 2 | 0 | 0 | 0 | 10 | ||||||||
Assertiveness skills (including ASAP) | 0 | 1 | 8 | 0 | 0 | 0 | 0 | 9 | ||||||||
Treatment teams | 0 | 2 | 3 | 0 | 0 | 0 | 0 | 5 | ||||||||
Clinician instructions | 0 | 3 | 1 | 0 | 1 | 0 | 0 | 5 | ||||||||
Goal identification and planning skills (including NOW) | 0 | 1 | 3 | 0 | 0 | 0 | 0 | 4 | ||||||||
Problem solving skills (including SCALIE) | 0 | 1 | 3 | 0 | 0 | 0 | 0 | 4 | ||||||||
CDST basics card | 0 | 1 | 0 | 3 | 0 | 0 | 0 | 4 | ||||||||
Coping skills | 0 | 2 | 0 | 1 | 0 | 0 | 0 | 3 | ||||||||
Role-plays and other in-session practice | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 2 | ||||||||
Advocacy | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 2 | ||||||||
Practice group | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 2 | ||||||||
Active engagement of participants | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 2 | ||||||||
Empowerment | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | ||||||||
Discussion | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | ||||||||
Coping skill card | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | ||||||||
Other active engagement of participants | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
What was the basis for the adaptation | ||||||||||||||||
Based on our knowledge or experience of working with patients ("knowing the Veterans we serve, I know we'll need to consider XX") | 15 | 5 | 36 | 10 | 2 | 1 | 1 | 70 | ||||||||
Based on patient knowledge or experiences ("Based on my past experiences, I know I would struggle with this because…") | 3 | 29 | 10 | 12 | 2 | 0 | 2 | 58 | ||||||||
Based on a framework (for example collaborative decision-making [CDM] principles) | 17 | 5 | 16 | 4 | 2 | 1 | 0 | 45 | ||||||||
Other | 0 | 1 | 10 | 0 | 0 | 0 | 0 | 11 | ||||||||
Based on our vision or values (VA's vision, interviewee's values, etc.- ex: "VA promotes Veteran centered care…" or "I don't think homework is important…") | 4 | 1 | 3 | 1 | 0 | 0 | 0 | 9 | ||||||||
Based on pragmatic/practical considerations (for example “this is the only way it would work” "our patient flow requires…") | 8 | 1 | 0 | 0 | 0 | 0 | 0 | 9 | ||||||||
Based on QI data, summary information or results (during implementation, identifying patterns in delivery indicating need for changes to improve attendance or at home practice completion) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
Based on financial incentives/payment | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
Why was the change made | ||||||||||||||||
To enhance the impact or success of the intervention for all or important subgroups (effectiveness) | 28 | 34 | 48 | 14 | 3 | 1 | 1 | 129 | ||||||||
To make the intervention delivered more consistently; to better fit the PRRC, clinician needs, patient flow or EHR; for practical reasons (implementation) | 3 | 0 | 15 | 0 | 1 | 0 | 1 | 20 | ||||||||
Other- describe | 4 | 0 | 1 | 0 | 0 | 0 | 0 | 5 | ||||||||
To increase the number or type of patients contacted (reach) | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | ||||||||
To make it possible to involve more teams, team members or staff (adoption) | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 2 | ||||||||
To institutionalize or sustain the intervention (maintenance) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
To respond to external pressures or policy | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
To save money or other resources (implementation) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
Was this adaptation specifically to address population-specific needs? | ||||||||||||||||
No | 35 | 27 | 54 | 11 | 3 | 1 | 1 | 132 | ||||||||
Veteran/military | 2 | 4 | 7 | 2 | 1 | 0 | 1 | 17 | ||||||||
Serious mental illness | 2 | 7 | 5 | 2 | 0 | 0 | 1 | 17 | ||||||||
Other population | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 2 | ||||||||