Introduction
co-occurring disorders, multiple disorders, OUD
DISORDER, MULTIPLE DISORDERS, DISORDERS
Co-occurring mental health and substance use disorders are prevalent, have serious consequences, and remain undertreated—especially with evidence-based practices (EBP).Primary care is an opportune setting to deliver treatments for co-occurring substance and mental health disorders because individuals with substance use disorders, including OUD, tend to access primary care more frequently than specialty substance use settings.Various factors within any organizational setting may influence the implementation of interventions to treat those with co-occurring disorders. In primary care, unique challenges may surface in part because both substance use and mental health disorders tend to be underidentified and undertreated in primary care settings. For example, patient characteristics, such as having multiple disorders that may interact, might pose a challenge to primary care providers or the organization (health system) itself may not be adequately equipped to treat individuals with co-occurring disorders. Broadly, factors like the organizational culture of a clinic may impact the extent to which new practices are adopted by providers. Similarly, an intervention may show positive outcomes however lack of leadership support may complicate the extent to which practices are sustained even if financial resources are stable. For example, previous research on co-occurring substance use disorder treatment has documented contextual barriers including the importance of administrative leadership; challenges related to staff turnover, training and supervision; and financial considerations like potential reductions in billing or process changes to financial services.Understanding the range of contextual factors, or determinants, of sites adopting an EBP can be critical to the success of its implementation.For these reasons, it is vital to understand the landscape of each organization prior to implementing an intervention and treat it as part of the implementation planning process. Identifying potential barriers and facilitators to implementation may reveal areas that are in need of additional support or that should be tracked over time.The current study describes results of a survey administered in three healthcare systems during the pre-implementation phase designed to assess contextual factors that may influence implementation of the CLARO intervention. Guided by the well-established CFIR