Building implementation infrastructure to address emerging drug trends: qualitative results from Rapid Adaptation to Prevent Drug use (RAPD) pilot study

With a growing emphasis on strengthening prevention infrastructure to improve youth mental, emotional, and behavioral health, sustainable approaches are needed to rapidly address drug trends early in the process. Although Tier 1 interventions like the Michigan Model for Health TM provide a valuable universal prevention foundation, their impact can be diminished by implementation challenges and evolving needs. This study assessed the feasibility of an implementation blueprint intended to build prevention infrastructure by leveraging and adapting the existing MMH implementation support and delivery system, promoting a responsive and sustainable model. We collaborated with four school health coordinators and recruited eight middle school health teachers from four Michigan counties during the 2023–2024 school year. We randomized schools into two groups: the Rapid Adaptation to Prevent Drug use (RAPD) implementation blueprint and standard MMH implementation. We interviewed teachers pre-, interim-, and post-deployment, and health coordinators (the RAPD blueprint facilitators) post-deployment. We explored the feasibility, acceptability, and appropriateness of the RAPD blueprint and analyzed the qualitative data using rapid qualitative and inductive-deductive thematic analysis. Our findings reinforce that the RAPD blueprint process emphasizes decision-making informed by data and capacity considerations, and support for developing needed partnerships that contributed to perceptions of appropriateness. We also found that collaboration, resource access, and the guiding nature of the process were critical to RAPD acceptability. Competing demands, strategic implementation climate, and logistical challenges influenced feasibility. The flexibility of RAPD, however, enabled participants to respond and adapt to these challenges. The flexibility of the blueprint process, using core implementation strategy functions with options for tailoring to each setting, enabled teachers to make implementation decisions that fit the needs and resources of their contexts, while deepening the connection to support professionals (i.e. health coordinators) that can aid in building needed foundational capacity for prevention. This suggests that a hands-on, flexible roadmap to build essential capacity for emerging drug issues within comprehensive health curriculum delivery may be beneficial for schools to respond quickly and effectively. Further research is needed to test the implementation and sustainment of the blueprint on a larger scale. Clinicaltrials.gov, ID NCT05806840. Date registered: March 2, 2023