GTO-Related Studies

Current Studies

Improving the Implementation of Evidence-based Drug Prevention Programs in Schools 2020–2025

We are now recruiting schools and districts for this study which will begin in schools in fall 2021. Visit the Project ALERT - GTO site for more information.

Sponsor: National Institute on Drug Abuse (NIDA)

PIs: Matthew Chinman, Eric Pedersen

Start Date: 2020

End Date: 2025

U.S. rates of alcohol and drug use among youth remain problematic, and changes in youth use of opioids, marijuana, and e-cigarettes have increased the need for drug use prevention efforts. Unfortunately, evidence-based programs (EBPs) for reducing alcohol and drug use are not widely adopted by schools, and when they are adopted, schools sometimes struggle to implement them successfully. The evidence-based, middle-school drug prevention program Project ALERT coupled with an implementation support program called Getting To Outcomes® (GTO) can address the challenges schools face successfully implementing drug use prevention programs. Project ALERT is a widely implemented middle-school drug abuse prevention program that has been shown to prevent drug use and reduce pro-drug risk factors. It is addresses new drug trends; includes online teacher training, resource manuals, classroom posters, and a teacher help line; and is free for schools. GTO is an implementation support program that includes training, manuals, coaching, and technical assistance that helps organizations build the skills needed to choose, plan, implement, evaluate, and sustain EBPs. This study assesses the effectiveness of the updated Project ALERT curriculum alone and in combination with GTO implementation support. The 3-year randomized controlled trial will include 42 middle schools in multiple states. If successful, the updated Project ALERT—supported by customized GTO tools—would be one of the most effective and easiest EBPs for schools to adopt and use.

Getting To Outcomes® for Integrated Violence Prevention and Resilience in the Military 2018–2021

Sponsor: Air Force, Integrated Resilience Office (A1Z)

PIs: Joie Acosta, Matthew Chinman

Start Date: 2018

End Date: 2020

The objective for this project is to use Getting To Outcomes® to support the Air Force’s initiative to stand up high-quality resilience and integrated violence prevention programming across all its installations. This project will develop tailored implementation support tools and deliver technical assistance to the Air Force to achieve this objective. This project will also recommend ways to improve the Air Force’s prevention readiness. To enable the Air Force to use GTO to support their violence prevention and resilience efforts, RAND staff will first develop GTO guides tailored to the needs of the Air Force. Simultaneously, RAND staff will train key Air Force personnel on how to provide GTO-based TA and representatives from all Air Force installations on how to use the GTO approach in their violence prevention and resilience efforts.

Recent Publications

Training the Department of Defense In Getting to Outcomes to Strengthen Sexual Assault Prevention Programs® 2018–2021

Sponsor: Department of Defense, Sexual Assault Prevention and Response Office (SAPRO)

PIs: Matthew Chinman, Joie Acosta

Start Date: 2018

End Date: 2020

The Department of Defense (DoD) has begun the Applied Prevention Project (APP), an initiative to support Service planning and evaluation of sexual assault prevention programs in operating environments. This RAND National Defense Research Institute (RAND NDRI) project operationalizes this initiative. RAND NDRI will function as the external consultants in teaching 10 different DoD installations in the GTO methodology. RAND NDRI will teach DoD SAPRO and its service stakeholders the key steps and techniques. RAND NDRI will customize the language of GTO to fit the culture of the military and the topic of sexual assault. The objectives of the project are to:

  1. Train select sites on how to use Getting To Outcomes® to plan, implement, and evaluate sexual assault prevention programs, and
  2. Assess the program readiness of each participating site and provide feedback and support to build readiness to conduct sexual assault prevention programs.

Prior Studies

Preparing to Run Effective Prevention (PREP) 2013–2019

Sponsor: National Institute On Alcohol Abuse and Alcoholism (NIAAA)

PI: Matt Chinman

Start Date: 2013

End Date: 2018

As an implementation support intervention, Getting To Outcomes (GTO) provides technical assistance, training, and a manual to improve community-based practitioners' capacity to complete tasks associated with implementing an evidence-based program (EBP), which in turn leads to improved implementation fidelity. Improved implementation fidelity of substance use prevention EBPs leads to improved alcohol and marijuana outcomes. In randomized and quasi-experimental studies, GTO has been effective in helping community-based organizations improve their capacity to implement substance use prevention EBPs with quality. Also, GTO has been adopted by the CDC for use in its 5-year initiative to prevent teen pregnancy and by SAMHSA in its underage drinking Town Hall initiative. However, GTO's direct impact on program fidelity and individual youth outcomes has not yet been evaluated. Further, no study to date has evaluated the cost effectiveness of implementation support. The proposed randomized, controlled trial would use the tools developed in previous GTO projects to address these gaps by comparing staff capacity, program fidelity, alcohol and marijuana outcomes, and cost effectiveness across 16 Boys and Girls Club sites implementing a substance use prevention EBP called Project Choice (PC) in the fashion typical of community settings (PC only) compared to 17 Boys and Girls Club sites (BGCs) implementing PC augmented with GTO (PC+GTO). All BGCs are from the Greater Los Angeles area. The specific aims of this project are to:

  • Assess the use of GTO and (b) compare BGC staff capacity between PC+GTO (n=17) and PC only (n=16)
  • Compare PC fidelity between PC+GTO (n=17) and PC only (n=16) groups
  • Compare alcohol and marijuana outcomes of middle-school youth in the PC+GTO (n=510) and PC only (n=480) groups
  • Assess the cost-effectiveness of GTO's impact on staff capacity, fidelity, and alcohol and marijuana outcomes

Building Resilient Regions: Workforce Capacity for Translation, Implementation and Evaluation of Promising PERRC Products 2016-2017

Sponsor: Centers for Disease Control and Prevention (subcontract from University of California Los Angeles)

PI: Joie Acosta

Co-PI: Matthew Chinman

Start Date: 2016

End Date: 2017

The project proposes to use Getting To Outcomes® support and guidance to help multiple public health departments in southern California translate and implement existing evidence-based tools and best practices for improving community emergency preparedness—with a focus on functional needs populations (populations whose members may have additional functional needs before, during, and after a disaster). The goal of the project is to improve the translation and implementation of evidence-based public health approaches or other products from Preparedness and Emergency Response Research Centers (PERRC). To support this goal, we developed a GTO® Guide to Community Emergency Preparedness. This guide applies the structure and guidance of past Getting To Outcomes® manuals to the implementation of evidence-based public health approaches that enhance community emergency preparedness utilizing the relevant PERRC products. The guide is intended to improve the capacity of local health department staff, and other individuals interested in implementing a community emergency preparedness program, to:

  1. translate and implement public health response and preparedness knowledge into practice
  2. improve quality of performance in carrying out key programming tasks (e.g., goal setting, planning, evaluation) of the selected evidence-based public health approaches
  3. improve attitudes toward and organizational support for evidence-based public health among the participating public health and community-based workforce

Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS) 2011–2016

Sponsor: National Institute on Child Health & Human Development (NICHD)

PI: Matt Chinman

Start Date: 2011

End Date: 2016

Large community trials focused on the adoption and implementation of EBPs (evidence based programs) targeting teen sexual health outcomes are needed to assess the type and amount of support that helps community-based organizations to implement these EBPs with fidelity and achieve outcomes similar to those achieved in research. Therefore, the goal for this 5-year study will be to conduct a multi-state, community based trial to assess how a capacity-building intervention called Getting To Outcomes affects three variables of interest: 32 Boys and Girls Clubs' capacity to adopt and implement an EBP (Making Proud Choices or MPC27), the fidelity of their MPC implementation, and the sex outcomes of the middle school youth they serve. The capacity building intervention for program staff called Getting To Outcomes (GTO) provides technical assistance, training, and a manual to improve community-based practitioners' capacity to complete tasks associated with implementing an EBP, which in turn leads to improved implementation fidelity. Improved implementation fidelity of EBPs like Making Proud Choices leads to improved teen sexual health outcomes. The proposed randomized, controlled trial would build on the tools developed in CDC's 5-year Promoting Science Based Approaches to Teen Pregnancy Prevention Project (PSBA-GTO) and other GTO projects to compare staff capacity, program fidelity, and teen sexual health outcomes across 16 Boys and Girls Clubs implementing MPC in the fashion typical of community settings (8 in Atlanta, 8 in Alabama) with 16 Boys and Girls Clubs implementing MPC augmented with GTO (also 8 in Atlanta, 8 in Alabama). The specific aims of this investigator-initiated R01 are to:

  • Assess the (a) utilization of and (b) subsequent effects of GTO on program staff capacity to implement EBPs
  • Assess the degree to which Boys and Girls Clubs using GTO show greater improvements in MPC fidelity than Boys and Girls Clubs that are not using GTO
  • Assess the degree to which middle-school-aged youth enrolled in the Boys and Girls Clubs using GTO show greater improvements in sexual health outcomes than Boys and Girls Clubs that are not using GTO

This study has the potential to document, for the first time, how a capacity-building intervention (GTO) can help community-based organizations implement EBPs and improve teen sexual health outcomes.

MISSION-Vet HUD-VASH Implementation Study 2012–2015

Sponsor: Department of Veterans Affairs, Office of Research & Development

PI: David Smelson

Co-PI: Matthew Chinman

Start Date: 2012

End Date: 2016

This project tests an implementation platform—Getting To Outcomes® (GTO)—designed to assist in the delivery of an evidence-based intervention for Veterans with co-occurring mental health and substance use disorders (MISSION-Vet) in the HUD-VASH program. This project will be a cluster randomized controlled trial that compares implementation of MISSION-Vet augmented by GTO® to MISSION-Vet Implemented as Usual (IU) at three of the largest HUD-VASH programs in the country: VA Central Western Massachusetts Healthcare System (Northampton, MA), VA Capitol Health Care Network (Washington, D.C.), and VA Eastern Colorado Health Care System (Denver, CO). This project will randomly assign 150 HUD-VASH case managers and 1106 Veterans on their caseloads who have received HUD-VASH vouchers and case management services into these two groups on a 1-year rolling admission basis determined by when the Veteran receives a housing voucher. The control group will receive MISSION-Vet in addition to HUD-VASH case management services and the intervention group will receive the same as the control, however the HUD-VASH case manager will have access to GTO® implementation support. To compare case managers implementing MISSION-Vet augmented with GTO® to HUD-VASH case managers using IU strategies on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, & Maintenance (RE-AIM) model.

Building System Capacity Through Continuous Quality Improvement 2012–2015

Sponsor: National Institute on Drug Abuse (NIDA)

PI: Sarah Hunter

Start Date: 2012

End Date: 2015

Over the past two decades, quality improvement activities have helped improve health care delivery, with prominent calls for its widespread use from such reports as Crossing the Quality Chasm released by the Institute of Medicine in 2001. While this approach has been utilized in more traditional health care settings, such as hospitals and primary care clinics, the uptake of CQI efforts in community-based settings, where the majority of substance use services is delivered, has lagged behind these other health care settings. To address this lag and improve the quality of substance abuse treatment delivery, this project will pilot test a CQI intervention based upon an expansion of the original Getting To Outcome's resources on CQI developed in collaboration with community based substance abuse treatment providers. The project is designed to significantly advance NIDA's understanding of the capacity needed to put CQI into routine and sustained use in treatment delivery settings, which will lay the groundwork for subsequent implementation projects to disseminate these business practices more broadly. The specific aims of this project are to:

  1. Conduct a randomized pilot study to assess the extent to which the CQI intervention leads to process and outcome improvements;
  2. Investigate the feasibility of CQI implementation by
    1. measuring the process and extent of CQI implementation;
    2. estimating the resources required to conduct CQI; and
    3. exploring CQI sustainability.

Evaluation and Support Services for the New Mexico Federal Home Visiting Development Project 2012–2014

Sponsor: State of New Mexico, Children, Youth and Families Department and Health Services and Services Administration (HRSA)

PIs: M. Rebecca Kilburn and Sarah Hunter

Start Date: 2012

End Date: 2014

This project will provide support to utilize Getting To Outcomes (GTO) to build capacity and improve home visiting program implementation in New Mexico. RAND will conduct both a process and an outcome evaluation utilizing both qualitative and quantitative analysis to evaluate and support a federally-funded home visiting development project in New Mexico communities. The project will also develop for dissemination a Getting To Outcomes manual specific to home visiting services. The purpose of this evaluation is to assess whether the innovation proposed here increases a community's capacity to implement a continuum of home visiting services and whether successful implementation is associated with better outcomes for children and their families

VA HOMES (Homeless Outcomes: a Model for Evaluation and Success) 2009–2012

Sponsor: VA National Center for Homelessness among Veterans

PI: Matt Chinman

Start Date: 2009

End Date: 2012

Homeless veterans are a vulnerable population, with high mortality and morbidity rates. Evidence-based practices for homelessness have been challenging to implement. This study engaged staff members from three VA homeless programs to improve their quality using Getting-To-Outcomes (GTO), a model and intervention of trainings and technical assistance that builds practitioner capacity to plan, implement, and self-evaluate evidence-based practices. Primarily used in community-based, non-VA settings, this study piloted GTO in VA by creating a GTO project within each homeless program and one across all three. The feasibility and acceptability of GTO in VA is examined using the results of the projects, time spent on GTO, and data from focus groups and interviews.

Enhancing Prevention Capacity with Developmental Assets® and Getting To Outcomes® 2008–2013

Sponsor: National Institute on Drug Abuse

PI: Matt Chinman

Start Date: 2008

End Date: 2013

Alcohol and other drug use among youth is a significant health problem facing US communities. Building a community's prevention capacity, through greater collaboration between scientists and practitioners, with a focus on positive youth development, is a method that could improve the quality of prevention and outcomes. Over a five-year period, this project will assess the combination of Getting To Outcomes and Developmental Assets to foster such an approach: The models are complimentary: GTO enhances local capacity for discrete prevention tasks (e.g., evaluation) while Developmental Assets, created by the Search Institute, supports community mobilization and collaboration to promote positive youth development. Combining the content, tools, and resources of these two SAMHSA "Best Practice" prevention planning processes has the potential to improve the quality of prevention programming and accountability more than either would do alone. The project involves 12 community-based prevention coalitions in Maine. To date, the project has developed an implementation support infrastructure and found an empirical link between individual prevention capacity and program performance.

Getting To Outcomes® and Underage Drinking 2008–2012

Sponsor: Centers for Disease Control and Prevention

PI: Matt Chinman

Start Date: 2008

End Date: 2012

Underage drinking is a significant problem in the United States: Alcohol is the primary contributor to the leading causes of death among adolescents. Successful community-wide strategies to prevent underage drinking depend on the involvement and education of adolescents, parents, law enforcement officials, merchants, and other stakeholders. This three-year randomized controlled study is testing the efficacy and effectiveness of Getting To Outcomes for Underage Drinking. This toolkit is structured according to SAMHSA's Strategic Prevention Framework and incorporates the Getting To Outcomes model of empowerment evaluation, results-based accountability, and continuous quality improvement. The study is being conducted in partnership with six community-based prevention coalitions in South Carolina.

Building Community Capacity to Conduct Effective Violence Prevention 2005–2008

Sponsor: Centers for Disease Control and Prevention

PI: Matt Chinman

Start Date: 2005

End Date: 2008

This project developed and piloted a continuous quality improvement process adapted for community-based violence prevention programs. The process was found to be feasible, acceptable, and helpful to the community-based prevention and treatment providers.

Web-Based IT Solution for Outcome Based Prevention 2005–2007

Sponsor: National Institute on Alcohol Abuse and Alcoholism

PI: Matt Chinman

Start Date: 2005

End Date: 2007

RAND served as a consultant to Kit Solutions, a knowledge-based information technology company to develop an online version of the Getting To Outcomes model called iGTO. We had combined goals of (a) evaluating the impact of iGTO on the programs' prevention performance over a year's time (defined by how well the programs were rated to perform key prevention activities such as needs assessment, planning and evaluation) and (b) documenting the use of the iGTO system among coalitions conducting substance abuse programs in two state prevention systems (Missouri and Tennessee), including the extent to which iGTO was diffused into the operations of these programs. iGTO was evaluated in the state drug prevention systems of Tennessee (using an RCT design) and in Missouri (using a quasi-experimental design). In Tennessee, 54 drug prevention programs were randomly assigned to receive either the iGTO intervention or standard practice. In Missouri, 36 programs that received iGTO were compared with 9 similar programs that did not. At one year, analyses found that iGTO programs in both states improved their performance compared with non-iGTO programs. In terms of iGTO diffusion, monitoring data show that overall, iGTO was diffused by most of the iGTO-assigned coalitions. Users' experience with and perceptions of the iGTO system were mixed.

Participatory Research of an Empowerment Evaluation System 2002–2005

Sponsor: Centers for Disease Control and Prevention

PI: Matt Chinman

Start Date: 2002

End Date: 2005

This project compared substance abuse providers and programs receiving the Getting To Outcomes intervention (comprising written tools, training, and onsite technical assistance) to similar providers and programs that were not. In a small number of programs, it was found that the GTO process helped individual program staff improve their capacity (knowledge, attitudes, skills) and their performance of prevention (how well programs were rated performing various prevention tasks) more than the comparison programs did. Improvements were related to the level of staff participation in GTO activities. The provision of training and technical assistance was found to be key predictors to using the GTO intervention.

The trademarks "Getting To Outcomes" and "GTO" are jointly owned by the RAND Corporation and the University of South Carolina.