Recruitment procedures and survey administration
A total of 541 staff at the 13 clinics were sent emails asking for their voluntary survey participation. Inclusion criteria included all staff members including clinicians and other clinic staff members who were likely to interact with patients that may qualify for CLARO. Exclusion criteria were staff who worked in dental, facilities, or other areas in which interaction with potential CLARO patients would be unlikely. The healthcare system leaders most directly involved with the CLARO research team also did not take the survey because of their close involvement with the CLARO RCT; in some cases, they were asked to provide input on the survey prior to launch (e.g., to test the length of time the survey would take). Types of staff that took the survey included medical providers (including physicians, physician assistants, and nurses), behavioral health providers, and other non-clinician staff (including medical assistants and key administrators). This approach allowed for obtaining a relatively comprehensive view of each clinic.For the three healthcare systems, CLARO RCT start dates (meaning the date when patient enrollment into CLARO was scheduled to begin) ranged from November 2020 to February 2021. The pre-implementation survey was administered to clinic staff members in the 3–4 weeks prior to the date on which RCT enrollment began at each clinic. Because of restrictions related to COVID, no in-person activities in the clinics were possible, and so all facets of survey administration were conducted virtually.In each system, a clinic champion or administrator sent an email to all staff the week prior to survey launch to let staff know they may receive a legitimate (i.e., not spam) survey invitation email connected to CLARO. These emails also included language that mirrored the IRB-approved survey language to emphasize the voluntary nature of the survey. Survey respondents received an email with a unique URL for the survey from the RAND Survey Research Group. Any respondents who had not yet completed the survey received a weekly email reminder while the survey remained open.