PAC 799B Module 3 Carrying Out the Project Example

Packing the Bag: What It Took to Switch a Jail to Opt-Out Naloxone Kits

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 799B: Addiction Studies Capstone

Instructor Name

Month Day, Year

Packing the Bag: What It Took to Switch a Jail to Opt-Out Naloxone Kits

Pine Hollow, the fictional Georgia jail at the center of Avery's capstone, switched to packing naloxone kits by default as soon as a new month opened after the approvals came through. This report covers the first four months of the change: how it was launched, whether it was delivered as planned, what went wrong and what helped. It also reports progress on interviews.

Launch

In the two weeks before the switch, Avery and the head nurse met with the property room staff, who would pack kits, and with the release desk officers. The procedure was simple: when a person flagged at booking as eligible was scheduled for release, property staff placed a naloxone kit in the bag with their belongings. At the desk, the nurse used the new script, pointing out the kit and inviting the person to hand it back if unwanted, and logged the outcome. The county health department supplied an extra month's stock of kits.

Why Delivery Had to Be Measured

Johnson and Goldstein (2003) explained the power of defaults partly by the effort they remove: under an opt-out, doing nothing produces the outcome. But that only holds if the default is actually in place. A kit that was never packed is not a default; it is simply absent. Proctor et al. (2011) distinguished implementation outcomes, such as fidelity, meaning delivery that matches the design, and penetration, meaning how far into the eligible group a practice actually reaches, from outcomes for clients. For this project, the key implementation measure was the share of eligible releases whose bag actually contained a kit.

Fidelity by Month

Deviations Log

Three deviations were recorded. In the first month, people released directly from court, whose property is collected later, did not have kits packed because property staff learned of their release too late; from week three, the court liaison sent the release list to the property room each afternoon. In the second month, a delayed shipment from the health department left the jail without kits for three days, affecting four eligible releases, which were logged as kit not packed. And in the first week, one officer told a person at the desk that the kit "was for addicts," prompting the person to leave it; the head nurse spoke with the officer, and the release desk script was posted at the counter.

Barriers and Facilitators

Damschroder et al. (2009) pulled together earlier implementation theories into one framework with five domains. One concerns the intervention itself; two concern its surroundings, outside the organization and inside it; one concerns the people carrying it out; and one concerns the steps by which it is put in place.

What Was Learned About the Default

The implementation itself taught something about how defaults work in practice. A default is not a single decision but a chain of small tasks: someone must know a person is eligible, someone must know when they will leave and someone must pack the kit in time. Each gap in the first month sat at a handoff between staff groups. Once the handoffs were fixed, delivery became routine.

Progress on Interviews

Interviews with released people reached the target of ten: six released under the opt-in offer, of whom four had declined a kit, and four released under opt-out, of whom one had removed the kit at the desk. Both nurses were interviewed before the switch and again in the fourth month. Recruitment through the peer recovery organization worked well; two people who agreed to interviews could not be reached on the scheduled day and were replaced.

Cost and Staff Time

The change cost little beyond the kits, which the county health department supplied without charge. Packing a kit added under a minute to the property room's work for each eligible release, and the revised script at the desk took about as long as the old offer. The largest time cost fell in the first month, when Avery, the head nurse and the court liaison met three times to fix the court release gap. Proctor and colleagues list implementation cost among the outcomes worth recording, and for a jail deciding whether to keep the change, these figures may matter as much as the uptake results.

What Staff Said About the Change

In informal conversations recorded in Avery's field notes, property staff said the packing step was easy once the checklist was in place. Release officers were mixed: some welcomed not having to stand through a discussion of naloxone at the desk, while one said the kits "encourage" drug use, a view the head nurse addressed with the health department's information sheet. The nurses said the new script was quicker and that fewer people seemed embarrassed. These comments are not formal data, but they help explain the fidelity figures and will be set beside the nurse interviews.

Effect on Interpretation

Two implementation facts will shape the analysis. First, because about one eligible release in ten lacked a packed kit in the first two months, uptake in those months reflects incomplete delivery; the analysis will report uptake both among all eligible releases and among those whose kit was packed. Second, the early stigmatizing remark, though corrected quickly, may have affected a few first-week releases. Both will be reported in Chapter 4.

Conclusion

The opt-out offer was launched as planned and reached full delivery by the fourth month, after a checklist and a daily release list closed the gaps for court releases. Proctor and colleagues' fidelity and penetration measures show how complete the default was, Damschroder and colleagues' domains show where the barriers lay and Johnson and Goldstein's account explains why delivery matters for a default to work. Interviews reached their targets.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339. https://doi.org/10.1126/science.1091721

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7