Table 2 Themes related to the design of the implementation strategy with definitions and illustrative quotes

Didactic training

• Training format

Leader: “Usually our training would probably go through a staff meeting ‘cause that’s the best way to get all of us in the same spot ‘cause it’s a designated time off.”

Staff: “It would probably be best if we all had one training for the entire site. That way, we’re all getting the same exact information. Oftentimes, with a site as small as us, we end up having multiple—we might all go to the same training but on multiple different days throughout the whole year just because we can’t afford to send everybody all at once.”

• Training content

Leader: “maybe if there is any type of existing program that works really well, having someone like that, the leader of that come over here and talk to us about it”

Staff: “Maybe examples…what contingency management is in a way where medical and clinical staff can understand it and where they can both implement it. Potential examples of what maybe financial and non-financial incentives that we could use and maybe some different statistics on how effective it is. Then, maybe, lastly, ways where we could get the funding for the actual incentives.”

• Learning tools

Leader: “Many of the people I supervise are very visual, so if there’s anything they could read. Examples, like case studies, they learn a lot by them, and really good, concrete ways to implement it, like a how-to guide…”

Staff: “…I think a workshop for this would be more beneficial in kind of providing examples and maybe like a role play stuff. I think that would be helpful. We don't too much of that.”

Performance feedback

• Feedback source

Staff: “I think it would be appropriate to have done during our regular scheduled supervision hours that we have with our supervisors cuz they know us in the sense that they know how our delivery is, the type of provider we are, what our strengths and weaknesses both are…”

Staff: “Honestly, if the patients are the ones that we’re doing it for, to have an evaluation on their end would probably make the most sense to me, because they’re the ones that we’re supposed to be trying to affect. In my mind, that feels like the best option.”

• Feedback delivery

Leader: “Interestingly, I’ve noticed that our patients are more [receptive] to having a person sit in on a session than have it audio recorded.”

Staff: “I, personally, wouldn’t have any issues having my supervisor use that [session recordings] as a way to give me feedback. I would think that if it was okay with a patient that a supervisor would observe the session…You can see, for yourself, the effectiveness of what’s happening as opposed to just literally hearing it on tape...”

External facilitation

• Facilitation format

Leader: “…Maybe, some sort of website or online support would be helpful…I think having somebody I could email and say , ‘Hey, I gotta question for ya,’ or ‘What would you do in this situation?’ or something like that would help.”

Staff: “Email is this and email is that. It's great…when we come together as people and we're face-to-face, it's a little different...I might feel comfortable saying things or I might get a facial expression from you—oh okay, I guess I'm doing something wrong or doing something great, and have the support. I just think that in person is the best way.”

• Facilitation duration and frequency

Leader: “perhaps a monthly check-in or office-specific staff meeting and then possibly quarterly in-services agency wide…”

Staff: “…even a file on the computer we could pull up in case we have questions, or even an outside source that we could call, so something like you…If you have questions, call this number.”