Browsing by Author "McGuire, Alan"

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    Alpha test results for a Housing First eLearning strategy: the value of multiple qualitative methods for intervention design
    (BMC, 2017-10-31) Ahonen, Emily Q.; Watson, Dennis P.; Adams, Erin L.; McGuire, Alan; Health Policy and Management, School of Public Health
    Background Detailed descriptions of implementation strategies are lacking, and there is a corresponding dearth of information regarding methods employed in implementation strategy development. This paper describes methods and findings related to the alpha testing of eLearning modules developed as part of the Housing First Technical Assistance and Training (HFTAT) program’s development. Alpha testing is an approach for improving the quality of a product prior to beta (i.e., real world) testing with potential applications for intervention development. Methods Ten participants in two cities tested the modules. We collected data through (1) a structured log where participants were asked to record their experiences as they worked through the modules; (2) a brief online questionnaire delivered at the end of each module; and (3) focus groups. Results The alpha test provided useful data related to the acceptability and feasibility of eLearning as an implementation strategy, as well as identifying a number of technical issues and bugs. Each of the qualitative methods used provided unique and valuable information. In particular, logs were the most useful for identifying technical issues, and focus groups provided high quality data regarding how the intervention could best be used as an implementation strategy. Conclusions Alpha testing was a valuable step in intervention development, providing us an understanding of issues that would have been more difficult to address at a later stage of the study. As a result, we were able to improve the modules prior to pilot testing of the entire HFTAT. Researchers wishing to alpha test interventions prior to piloting should balance the unique benefits of different data collection approaches with the need to minimize burdens for themselves and participants. Electronic supplementary material The online version of this article (10.1186/s40814-017-0187-y) contains supplementary material, which is available to authorized users.
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    Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in “real-world” research
    (BMC, 2021-02-04) Dir, Allyson L.; Watson, Dennis P.; Zhiss, Matthew; Taylor, Lisa; Bray, Bethany C.; McGuire, Alan; Psychiatry, School of Medicine
    Background: This manuscript provides a research update to the ongoing pragmatic trial of Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment), an emergency department-based peer recovery coaching intervention for linking patients with opioid use disorder to evidence-based treatment. The research team has encountered a number of challenges related to the "real-world" study setting since the trial began. Using an implementation science lens, we sought to identify and describe barriers impacting both the intervention and research protocols of the POINT study, which are often intertwined in pragmatic trials due to the focus on external validity. Method: Qualitative data were collected from 3 peer recovery coaches, 2 peer recovery coach supervisors, and 3 members of the research team. Questions and deductive qualitative analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Results: Nine unique barriers were noted, with 5 of these barriers impacting intervention and research protocol implementation simultaneously. These simultaneous barriers were timing of intervention delivery, ineffective communication with emergency department staff, lack of privacy in the emergency department, the fast-paced emergency department setting, and patient's limited resources. Together, these barriers represent the intervention characteristics, inner setting, and outer setting domains of the CFIR. Conclusion: Results highlight the utility of employing an implementation science framework to assess implementation issues in pragmatic trials and how this approach might be used as a quality assurance mechanism given the considerable overlap that exists between research and intervention protocols in real-world trial settings. Previously undocumented changes to the trial design that have been made as a result of the identified barriers are discussed.
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    Evaluation of an emergency department-based opioid overdose survivor intervention: Difference-in-difference analysis of electronic health record data to assess key outcomes
    (Elsevier, 2021) Watson, Dennis P.; Weathers, Tess; McGuire, Alan; Cohen, Alex; Huynh, Philip; Bowes, Clay; O’Donnell, Daniel; Brucker, Krista; Gupta, Sumedha; Social and Behavioral Sciences, School of Public Health
    Background: In recent years, a number of emergency department (ED)-based interventions have been developed to provide supports and/or treatment linkage for people who use opioids. However, there is limited research supporting the effectiveness of the majority of these interventions. Project POINT is an ED-based intervention aimed at providing opioid overdose survivors with naloxone and recovery supports and connecting them to evidence-based medications for opioid use disorder (MOUD). An evaluation of POINT was conducted. Methods: A difference-in-difference analysis of electronic health record data was completed to understand the difference in outcomes for patients admitted to the ED when a POINT staff member was working versus times when they were not. The observation window was January 1, 2012 to July 6, 2019, which included N = 1462 unique individuals, of which 802 were in the POINT arm. Outcomes of focus include MOUD opioid prescriptions dispensed, active non-MOUD opioid prescriptions dispensed, naloxone access, and drug poisonings. Results: The POINT arm had a significant increase in MOUD prescriptions dispensed, non-MOUD prescriptions dispensed, and naloxone access (all p-values < 0.001). There was no significant effect related to subsequent drug poisoning-related hospital admissions. Conclusions: The results support the assertion that POINT is meeting its two primary goals related to increasing naloxone access and connecting patients to MOUD. Generalization of these results is limited; however, the evaluation contributes to a nascent area of research and can serve a foundation for future work.
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    Evaluation of post-discharge engagement for emergency department patients with opioid use history who received telehealth recovery coaching services
    (BMC, 2023-02-11) Watson, Dennis P.; Phalen, Peter; Medcalf, Spencer; Messmer, Sarah; McGuire, Alan; Social and Behavioral Sciences, School of Public Health
    Background: In recent years, emergency departments (EDs) across the nation have implemented peer recovery coach (PRC) services to support patients who use opioids. The majority of such interventions discussed in the literature follow an in-person modality where PRCs engage patients directly at the ED bedside. However, the use of telehealth services in EDs is becoming more popular. These services connect PRCs with ED patients in real-time via secure communications technology, and very little is known about the service- and clinical-based outcomes with which they are associated. The current study sought to assess factors associated with successful post-discharge follow-up of patients with a history of opioid use who received PRC telehealth services while in the ED. Method: Data come from records for 917 patients who engaged with a telehealth PRC one or more times (1208 total engagements) at 1 of 13 EDs within the same health system. A multilevel Poisson regression model was used to assess the degree to which variables predicted successful post-discharge follow-up, defined as the number of times a PRC successfully spoke with the patient each month after ED discharge. Results: At least one follow-up was successfully completed by a PRC for 23% of enrolled patients. Significant predictors of successful follow-up included patient employment at baseline (Incidence Rate Ratio [IRR]: 2.8, CI: 2.05-3.9), living in a rural area (IRR: 1.8, CI: 1.04-3.2), PRC provision of referrals (IRR: 1.7, CI: 1.2-2.2), number of ED encounters in the previous 365 days (IRR: 0.99, CI: 0.98-0.99), and duration of the initial PRC telehealth interaction (IRR: 0.87, CI: 0.85-0.88). Conclusion: Given that relationship development is a key tool in the PRC profession, understanding successful follow-up associated with telehealth engagement has unique importance. The results have potential utility for planning and implementing peer telehealth services in EDs and other locations, which is needed for the development of the PRC profession and the likely expansion of peer telehealth services.
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    Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation
    (BMJ, 2022-05-30) Eliacin, Johanne; Carter, Jessica; Bass, Emily; Flanagan, Mindy; Salyers, Michelle P.; McGuire, Alan; Psychiatry, School of Medicine
    Objectives: To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units. Design: VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data. Setting: 34 VHA inpatient mental health units located in every geographical region of the USA. Participants: 55 treatment team members. Results: Our results identified an overarching theme of 'power-sharing' that describes participants' conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1) No power sharing: patients are excluded from treatment decisions; (2) Limited power sharing: patients are informed of treatment decisions but have limited influence on the decision-making process; and (3) Shared-power: patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy. Conclusions: Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients' self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.
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    A National Survey of Patient Completion of Cognitive Behavioral Therapy for Chronic Pain: The Role of Therapist Characteristics, Attempt Rates, and Modification
    (American Psychological Association, 2021) McGuire, Alan; Matthias, Marianne S.; Kukla, Marina; Henry, Nancy; Carter, Jessica; Flanagan, Mindy; Bair, Matthew J.; Murphy, Jennifer L.; Psychology, School of Science
    The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). Objective: The current study explores therapists' decisions to offer a particular evidence-based psychotherapy (cognitive behavioral therapy for chronic pain; CBT-CP), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. Methods: The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. Results: Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (mean = 48.8%, s.d.=35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t (111) = 4.57, p<.001. Conclusions: Therapists who attempt CBT-CP more frequently may experience better completion rates, perhaps due to practice effects or contextual factors that support both attempts and completion. Future research should examine this relationship using objective measures of attempt rates and completion.
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    Patterns of opioid use behaviors among patients seen in the emergency department: Latent class analysis of baseline data from the POINT pragmatic trial
    (Elsevier, 2023) Bray, Bethany C.; Watson, Dennis P.; Salisbury-Afshar, Elizabeth; Taylor, Lisa; McGuire, Alan; Psychology, School of Science
    Introduction: The nation's overdose epidemic has been characterized by increasingly potent opioids resulting in more emergency department (ED) encounters over time. ED-based opioid use interventions are growing in popularity; however, they tend to treat people who use opioids as a homogenous population. The current study sought to understand heterogeneity among people who use opioids who encounter the ED by identifying qualitatively different subgroups among participants in an opioid use intervention clinical trial at baseline and examining associations between subgroup membership and multiple correlates. Methods: Participants were from a larger pragmatic clinical trial of the Planned Outreach, Intervention, Naloxone, and Treatment (POINT) intervention (n = 212; 59.2 % male, 85.3 % Non-Hispanic White, mean age = 36.6 years). The study employed latent class analysis (LCA) using five indicators of opioid use behavior: preference for opioids, preference for stimulants, usually use drugs alone, injection drug use, and opioid-related problem at ED encounter. Correlates of interest included participants' demographics, prescription histories, health care contact histories, and recovery capital (e.g., social support, naloxone knowledge). Results: The study identified three classes: (1) noninjecting opioid preferers, (2) injecting opioid and stimulant preferers, and (3) social nonopioid preferers. We identified limited significant differences in correlates across the classes: differences existed for select demographics, prescription histories, and recovery capital but not for health care contact histories. For example, members of Class 1 were the most likely to be a race/ethnicity other than non-Hispanic White, oldest on average, and most likely to have received a benzodiazepine prescription, whereas members of Class 2 had the highest average barriers to treatment and members of Class 3 were the least likely to have been diagnosed with a major mental health illness and had the lowest average barriers to treatment. Conclusions: LCA identified distinct subgroups among POINT trial participants. Knowledge of such subgroups assists with the development of better-targeted interventions and can help staff to identify the most appropriate treatment and recovery pathways for patients.
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    Preferences of Pregnant and Postpartum Women for Differentiated Service Delivery in Kenya
    (Wolters Kluwer, 2023) Humphrey, John; Wanjama, Esther; Carlucci, James G.; Naanyu, Violet; Were, Edwin; Muli, Lindah; Alera, Marsha; McGuire, Alan; Nyandiko, Winstone; Songok, Julia; Wools-Kaloustian, Kara; Zimet, Gregory; Medicine, School of Medicine
    Background: Differentiated service delivery models are implemented by HIV care programs globally, but models for pregnant and postpartum women living with HIV (PPWH) are lacking. We conducted a discrete choice experiment to determine women's preferences for differentiated service delivery. Setting: Five public health facilities in western Kenya. Methods: PPWH were enrolled from April to December 2022 and asked to choose between pairs of hypothetical clinics that differed across 5 attributes: clinic visit frequency during pregnancy (monthly vs. every 2 months), postpartum visit frequency (monthly vs. only with routine infant immunizations), seeing a mentor mother (each visit vs. as needed), seeing a clinician (each visit vs. as needed), and basic consultation cost (0, 50, or 100 Kenya Shillings [KSh]). We used multinomial logit modeling to determine the relative effects (β) of each attribute on clinic choice. Results: Among 250 PPWH (median age 31 years, 42% pregnant, 58% postpartum, 20% with a gap in care), preferences were for pregnancy visits every 2 months (β = 0.15), postpartum visits with infant immunizations (β = 0.36), seeing a mentor mother and clinician each visit (β = 0.05 and 0.08, respectively), and 0 KSh cost (β = 0.39). Preferences were similar when stratified by age, pregnancy, and retention status. At the same cost, predicted market choice for a clinic model with fewer pregnant/postpartum visits was 75% versus 25% for the standard of care (ie, monthly visits during pregnancy/postpartum). Conclusion: PPWH prefer fewer clinic visits than currently provided within the standard of care in Kenya, supporting the need for implementation of differentiated service delivery for this population.
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    Proceedings of the 8th Annual Conference on the Science of Dissemination and Implementation
    (BioMed Central, 2016-08-01) Chambers, David; Simpson, Lisa; Hill-Briggs, Felicia; Neta, Gila; Vinson, Cynthia; Beidas, Rinad; Marcus, Steven; Aarons, Gregory; Hoagwood, Kimberly; Schoenwald, Sonja; Evans, Arthur; Hurford, Matthew; Rubin, Ronnie; Hadley, Trevor; Barg, Frances; Walsh, Lucia; Adams, Danielle; Mandell, David; Martin, Lindsey; Mignogna, Joseph; Mott, Juliette; Hundt, Natalie; Kauth, Michael; Kunik, Mark; Naik, Aanand; Cully, Jeffrey; McGuire, Alan; White, Dominique; Bartholomew, Tom; McGrew, John H.; Luther, Lauren; Rollins, Angie; Salyers, Michelle P.; Cooper, Brittany; Funaiole, Angie; Richards, Julie; Lee, Amy; Lapham, Gwen; Caldeiro, Ryan; Lozano, Paula; Gildred, Tory; Achtmeyer, Carol; Ludman, Evette; Addis, Megan; Marx, Larry; Bradley, Katharine; VanDeinse, Tonya; Wilson, Amy Blank; Stacey, Burgin; Powell, Byron; Bunger, Alicia; Cuddeback, Gary; Barnett, Miya; Stadnick, Nicole; Brookman-Frazee, Lauren; Lau, Anna; Dorsey, Shannon; Pullmann, Michael; Mitchell, Shannon; Schwartz, Robert; Kirk, Arethusa; Dusek, Kristi; Oros, Marla; Hosler, Colleen; Gryczynski, Jan; Barbosa, Carolina; Dunlap, Laura; Lounsbury, David; O'Grady, Kevin; Brown, Barry; Damschroder, Laura; Waltz, Thomas; Powell, Byron; Ritchie, Mona; Waltz, Thomas; Atkins, David; Imel, Zac E.; Xiao, Bo; Can, Doğan; Georiou, Panayiotis; Narayanan, Shrikanth; Berkel, Cady; Gallo, Carlos; Sandler, Irwin; Brown, C. Hendricks; Wolcik, Sharlene; Mauricio, Anne Marie; Gallo, Carlos; Mehrota, Sanjay; Chandurkar, Dharmendra; Bora, Siddhartha; Das, Arup; Tripathi, Anand; Saggurti, Nirajan; Raj, Anita; Hughes, Eric; Jacobs, Brian; Kirkendall, Eric; Loeb, Danielle; Trinkley, Katy; Yang, Michael; Sprowell, Andrew; Nease, Donald; Lyon, Aaron; Lewis, Cara; Boyd, Meredith; Melvin, Abigail; Nicodimos, Semret; Liu, Freda; Jungbluth, Nathanial; Lyon, Aaron; Landis-Lewis, Zach; Sales, Anne; Baloh, Jure; Ward, Marcia; Zhu, Xi; Bennett, Ian; Unutzer, Jurgen; Mao, Johnny; Proctor, Enola; Vredevoogd, Mindy; Chan, Ya-Fen; Williams, Nathaniel; Green, Phillip; Bernstein, Steven; Rosner, June-Marie; DeWitt, Michelle; Tetrault, Jeanette; Dziura, James; Hsiao, Allen; Sussman, Scott; O'Connor, Patrick; Toll, Benjamin; Jones, Michael; Gassaway, Julie; Tobin, Jonathan; Zatzick, Douglas; Bradbury, Angela R.; Patrick-Miller, Linda; Egleston, Brian; Olopade, Olufunmilayo I.; Hall, Michael J.; Daly, Mary B.; Fleisher, Linda; Grana, Generosa; Ganschow, Pamela; Fetzer, Dominique; Brandt, Amanda; Farengo-Clark, Dana; Forman, Andrea; Gaber, Rikki S.; Gulden, Cassandra; Horte, Janice; Long, Jessica; Chambers, Rachelle Lorenz; Lucas, Terra; Madaan, Shreshtha; Mattie, Kristin; McKenna, Danielle; Montgomery, Susan; Nielsen, Sarah; Powers, Jacquelyn; Rainey, Kim; Rybak, Christina; Savage, Michelle; Seelaus, Christina; Stoll, Jessica; Stopfer, Jill; Yao, Shirley; Domchek, Susan; Hahn, Erin; Munoz-Plaza, Corrine; Wang, Jianjin; Delgadillo, Jazmine Garcia; Mittman, Brian; Gould, Michael; Liang, Shuting (Lily); Kegler, Michelle C.; Cotter, Megan; Philips, Emily; Hermstad, April; Morton, Rentonia; Beasley, Derrick; Martinez, Jeremy; Riehman, Kara; Gustafson, David; Marsch, Lisa; Mares, Louise; Quanbeck, Andrew; McTavish, Fiona; McDowell, Helene; Brown, Randall; Thomas, Chantelle; Glass, Joseph; Isham, Joseph; Shah, Dhavan; Liebschutz, Jane; Lasser, Karen; Watkins, Katherine; Ober, Allison; Hunter, Sarah; Lamp, Karen; Ewing, Brett; Iwelunmor, Juliet; Gyamfi, Joyce; Blackstone, Sarah; Quakyi, Nana Kofi; Plange-Rhule, Jacob; Ogedegbe, Gbenga; Kumar, Pritika; Devanter, Nancy Van; Nguyen, Nam; Nguyen, Linh; Nguyen, Trang; Phuong, Nguyet; Shelley, Donna; Rudge, Sian; Langlois, Etienne; Tricco, Andrea; Ball, Sherry; Lambert-Kerzner, Anne; Sulc, Christine; Simmons, Carol; Shell-Boyd, Jeneen; Oestreich, Taryn; O'Connor, Ashley; Neely, Emily; McCreight, Marina; Labebue, Amy; DiFiore, Doreen; Brostow, Diana; Ho, P. Michael; Aron, David; Harvey, Jillian; McHugh, Megan; Scanon, Dennis; Lee, Rebecca; Soltero, Erica; Parker, Nathan; McNeill, Lorna; Ledoux, Tracey; McIsaac, Jessie-Lee; MacLeod, Kate; Ata, Nicole; Jarvis, Sherry; Kirk, Sara; Purtle, Jonathan; Dodson, Elizabeth; Brownson, Ross; Mittman, Brian; Curran, Geoffrey; Pyne, Jeffrey; Aarons, Gregory; Ehrhart, Mark; Torres, Elisa; Miech, Edward; Stevens, Kathleen; Hamilton, Alison; Cohen, Deborah; Padgett, Deborah; Morshed, Alexandra; Patel, Rupa; Prusaczyk, Beth; Aron, David C.; Gupta, Divya; Ball, Sherry; Hand, Rosa; Abram, Jenica; Wolfram, Taylor; Hastings, Molly; Moreland-Russell, Sarah; Tabek, Rachel; Ramsey, Alex; Baumann, Ana; Kryzer, Emily; Montgomery, Katherine; Lewis, Ericka; Padek, Margaret; Brownson, Ross; Mamaril, Cezar Brian; Mays, Glen; Branham, Keith; Timsina, Lava; Mays, Glen; Hogg, Rachel; Fagan, Abigail; Shapiro, Valerie; Brown, Eric; Haggerty, Kevin; Hawkins, David; Oesterle, Sabrina; Hawkins, David; Catalano, Richard; McKay, Virginia; Dolcini, M. Margaret; Hoffer, Lee; Moin, Tannaz; Li, Jinnan; Duru, O. Kenrik; Ettner, Susan; Turk, Norman; Chan, Charles; Keckhafer, Abigail; Luchs, Robert; Ho, Sam; Mangione, Carol; Selby, Peter; Zawertailo, Laurie; Minian, Nadia; Balliunas, Dolly; Dragonetti, Rosa; Hussain, Sarwar; Lecce, Julia; Chinman, Matthew; Acosta, Joie; Ebener, Patricia; Malone, Patrick S.; Slaughter, Mary; Freedman, Darcy; Flocke, Susan; Lee, Eunlye; Matlack, Kristen; Trapl, Erika; Ohri-Vachaspati, Punam; Taggart, Morgan; Borawski, Elaine; Parrish, Amanda; Harris, Jeffrey; Kohn, Marlana; Hammerback, Kristen; McMilan, Becca; Hannon, Peggy; Swindle, Taren; Curran, Geoffrey; Whiteside-Mansell, Leanne; Ward, Wendy; Holt, Cheryl; Santos, Sheri Lou; Tagai, Erin; Scheirer, Mary Ann; Carter, Roxanne; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie; Wang, Min Qi; Masica, Andrew; Ogola, Gerald; Berryman, Candice; Richter, Kathleen; Shelton, Rachel; Jandorf, Lina; Erwin, Deborah; Truong, Khoa; Javier, Joyce R.; Coffey, Dean; Schrager, Sheree; Palinkas, Lawrence; Miranda, Jeanne; Johnson, Veda; Hutcherson, Valerie; Ellis, Ruth; Kharmats, Anna; Marshall-King, Sandra; LaPradd, Monica; Fonseca-Becker, Fannie; Kepka, Deanna; Bodson, Julia; Warner, Echo; Fowler, Brynn; Shenkman, Elizabeth; Hogan, William; Odedina, Folakami; Leon, Jessica De; Hooper, Monica; Carrasquillo, Olveen; Reams, Renee; Hurt, Myra; Smit, Steven; Szapocznik, Jose; Nelson, David; Mandal, Prabir; Teufel, James; Department of Psychology, School of Science
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    Replication of an emergency department-based recovery coaching intervention and pilot testing of pragmatic trial protocols within the context of Indiana's Opioid State Targeted Response plan
    (Elsevier, 2019) Watson, Dennis P.; Brucker, Krista; McGuire, Alan; Snow-Hill, Nyssa L.; Xu, Huiping; Cohen, Alex; Campbell, Mark; Robison, Lisa; Sightes, Emily; Buhner, Rebecca; O'Donnell, Daniel; Kline, Jeffrey A.; Psychology, School of Science
    Solving the opioid crisis requires immediate, innovative, and sustainable solutions. A number of promising strategies are being carried out by U.S. states and territories as part of their Opioid State Targeted Response (STR) plans funded through the 21st Century Cures Act, and they provide an opportunity for researchers to assess effectiveness of these interventions using pragmatic approaches. This paper describes a pilot study of Project Planned Outreach, Intervention, Naloxone, and Treatment (POINT), the intervention that served as the basis for Indiana's STR-funded, emergency department (ED)-based peer specialist expansion that was conducted in preparation for a larger, multisite pragmatic trial. Through the pilot, we identified, documented, and corrected for challenges encountered while implementing planned study protocols. Per the project's funding mechanism, the ability to move to the larger trial was determined by the achievement of 3 milestones: (1) successful replication of the intervention; (2) demonstrated ability to obtain the necessary sample size; and (3) observe a higher level of engagement in medication for addiction treatment in the POINT group compared to standard care. Overall implementation of the study protocols was successful, with only minor refinements to proposed procedures being required in light of challenges with (1) data access, (2) recruitment, and (3) identification of the expansion hospitals. All three milestones were reached. Challenges in implementing protocols and reaching milestones resulted in refinements that improved the study design overall. The subsequent trial will add to the limited but growing evidence on ED-based peer supports. Capitalizing on STR efforts to study an already scaling and promising intervention is likely to lead to faster and more sustainable results with greater generalizability than traditional, efficacy-focused clinical research.