QUERI – Quality Enhancement Research Initiative

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Evaluating the Implementation of the VA Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) Program

Seattle, WA


The SCOUTT program includes both VISN- and facility-level teams, such as: VISN mental health lead, VISN Substance Use Disorder (SUD) lead, VISN pain lead, VISN primary care lead, and two clinical champions. These teams help ensure that SCOUTT is implemented within their VA facility.

The increase in opioid prescribing is associated with parallel increases in overdose deaths and opioid use disorders (OUD). To address this problem, VA launched the Stepped-Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program, a model that aims to improve access to OUD treatment and prevent intentional overdose deaths.

The QUERI Evaluating the Implementation of the VA Stepped Care for Opioid Use Disorder Train-the-Trainer Partnered Evaluation Initiative will evaluate the implementation of the SCOUTT program. Specific aims are to:

  • Estimate the monthly number and describe characteristics of patients receiving OUD care at participating sites;
  • Identify trends in the proportion of patients receiving pharmacologic treatment for OUD, acute care utilization, and all-cause mortality in the year before and after SCOUTT's launch – relative to patients in matched comparison clinics;
  • Survey providers and clinic leadership regarding their perspectives on providing OUD treatment, organizational climate, and barriers and facilitators to implementing OUD care; and
  • Assess patient retention in and compliance with SCOUTT.


Using a mixed-methods design and guidance from the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, QUERI investigators will assess the effectiveness of SCOUTT in increasing OUD care and improving outcomes and identify patient, provider and system factors influencing its implementation. They also will assess QUERI’s Facilitation of the Stepped-Care Model and Medication Treatment for Opioid Use Disorder Partnered Evaluation Initiative, which is working to implement a comprehensive plan to train interdisciplinary teams to deliver stepped-care for OUD to Veterans at his/her preferred point-of-care.

Potential Impacts:

The SCOUTT roll-out includes approximately 100 providers from clinics across 18 VA facilities and all VISNs. In year one, implementation clinics will focus on providing stepped-care for OUD in their clinics and training additional providers in one additional clinic at their facility. In year two, implementation teams will train providers in clinics at other facilities within their VISN. Patients receiving care in participating clinics will have access to potentially life-saving OUD care. [See figure one.]

Evaluation procedures

Principal Investigators: Eric Hawkins, PhD, also is part of HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle, WA.

Operational Partners: VA’s Office of Mental Health and Suicide Prevention.