This is an exploratory case study to identify barriers, facilitators, and implementation needs during the phases of implementation of a virtual SUD clinic offering low-barrier MOUD across the state of Texas. From January 2022 to September 2023, researchers conducted 10 individual and 11 group periodic reflections with 16 individuals (including clinic leadership, operation staff, and providers) to evaluate implementation activities, clinic processes, and events during the rollout of the virtual clinic. In the preparation phase, participants emphasized the importance of strong leadership, effective workforce and technology infrastructure, staff training, and mission alignment. During implementation, participants highlighted the need for strong interprofessional communication, continuous reflection and evaluation, and medication supply chain management, as well as the challenge of workforce turnover. In the sustainment phase, participants identified a need for diversified funding and intentional growth.
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