How do you make it work? A pragmatic framework for the Sustained Uptake of Service Innovations (SUSI).

Background. The provision of integrated care across addiction and mental health services represents best practice, yet the consistent and sustainable delivery of integrated care in routine practice rarely occurs. Our hypothesis is that there is no practical or feasible systems-change approach to guide staff, researchers, or clients through the complex real-world transition that is required for the sustained uptake of integrated care across these diverse clinical settings. Methods. A mixed method, co-design study was iteratively conducted over ten years with the goal of developing a process that is both standardised by the best available evidence and can be tailored to the specific characteristics of different health services. The expertise of people who provide treatment and/or seek treatment from addiction and mental health services was combined with the best available research evidence to develop a framework to drive the uptake of integrated care. Results. The outcome of this collaboration is the framework for the Sustained Uptake of Service Innovation (SUSI), which comprises six core components that are applied in a specified sequence and a range of flexible activities that staff can use to deliver the core components according to their circumstances and preferences. Conclusions. The SUSI is evidence-based and practical, and further testing is currently underway to ensure it is acceptable to people with co-occurring disorders, and feasible to implement in different addiction and mental health services. Examples of the SUSI being used in practice will be discussed, as will the resulting international collaborations and implications.