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Carter JS, Costa CC, Lewandowski SI, Nelson KH, Goldsmith ST, Scofield MD, Reichel CM. Estrogen receptor beta signaling enhances extinction memory recall for heroin-conditioned cues in a sex- and region-specific manner. Transl Psychiatry 2024; 14:283. [PMID: 38997258 DOI: 10.1038/s41398-024-03001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Return to use, or relapse, is a major challenge in the treatment of opioid use disorder (OUD). Relapse can be precipitated by several factors, including exposure to drug-conditioned cues. Identifying successful treatments to mitigate cue-induced relapse has been challenging, perhaps due to extinction memory recall (EMR) deficits. Previously, inhibition of estradiol (E2) signaling in the basolateral amygdala (BLA) impaired heroin-cue EMR. This effect was recapitulated by antagonism of BLA estrogen receptors (ER) in a sex-specific manner such that blocking ERα in males, but ERβ in females, impaired EMR. However, it is unclear whether increased E2 signaling, in the BLA or systemically, enhances heroin-cue EMR. We hypothesized that ERβ agonism would enhance heroin-cue EMR in a sex- and region-specific manner. To determine the capacity of E2 signaling to improve EMR, we pharmacologically manipulated ERβ across several translationally designed experiments. First, male and female rats acquired heroin or sucrose self-administration. Next, during a cued extinction session, we administered diarylpropionitrile (DPN, an ERβ agonist) and tested anxiety-like behavior on an open field. Subsequently, we assessed EMR in a cue-induced reinstatement test and, finally, measured ERβ expression in several brain regions. Across all experiments, females took more heroin and sucrose than males and had greater responses during heroin-cued extinction. Administration of DPN in the BLA enhanced EMR in females only, driven by ERβ's impacts on memory consolidation. Interestingly, however, systemic DPN administration improved EMR for heroin cues in both sexes across several different tests, but did not impact sucrose-cue EMR. Immunohistochemical analysis of ERβ expression across several different brain regions showed that females only had greater expression of ERβ in the basal nucleus of the BLA. Here, in several preclinical experiments, we demonstrated that ERβ agonism enhances heroin-cue EMR and has potential utility in combatting cue-induced relapse.
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Affiliation(s)
- Jordan S Carter
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Caitlyn C Costa
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Stacia I Lewandowski
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Katharine H Nelson
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Sarah T Goldsmith
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Michael D Scofield
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Carmela M Reichel
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA.
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Amiri S, Keffeler JI, Crain DR, Denney JT, Buchwald D. Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State. Alzheimers Dement 2024; 20:3671-3678. [PMID: 38506275 PMCID: PMC11095416 DOI: 10.1002/alz.13756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Distance to physicians may explain some of the disparities in Alzheimer's disease and related dementia (AD/ADRD) outcomes. METHODS We generated round trip distance between residences of decedents with AD/ADRD and the nearest neurologist and primary care physician in Washington State. RESULTS The overall mean distance to the nearest neurologist and primary care physician was 17 and 4 miles, respectively. Non-Hispanic American Indian and/or Alaska Native and Hispanic decedents would have had to travel 1.12 and 1.07 times farther, respectively, to reach the nearest neurologist compared to non-Hispanic White people. Decedents in micropolitan, small town, and rural areas would have had to travel 2.12 to 4.01 times farther to reach the nearest neurologist and 1.14 to 3.32 times farther to reach the nearest primary care physician than those in metropolitan areas. DISCUSSION These results underscore the critical need to identify strategies to improve access to specialists and primary care physicians to improve AD/ADRD outcomes. HIGHLIGHTS Distance to neurologists and primary care physicians among decedents with AD/ADRD American Indian and/or Alaska Native decedents lived further away from neurologists Hispanic decedents lived further away from neurologists Non-metropolitan decedents lived further away from neurologists and primary care Decrease distance to physicians to improve dementia outcomes.
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Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH)Elson S. Floyd College of Medicine, Washington State UniversitySeattleWashingtonUSA
| | | | | | - Justin T. Denney
- Department of SociologyWashington State UniversityPullmanWashingtonUSA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health (IREACH)Elson S. Floyd College of Medicine, Washington State UniversitySeattleWashingtonUSA
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Tauscher JS, DePue MK, Swank J, Salloum RG. Determinants of preference for telehealth versus in-person treatment for substance use disorders: A discrete choice experiment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208938. [PMID: 36880898 DOI: 10.1016/j.josat.2022.208938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity. METHODS Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making. RESULTS Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use. CONCLUSIONS Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.
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Affiliation(s)
- Justin S Tauscher
- BRiTE Center, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - M Kristina DePue
- Department of Human Development, Family Science, and Counseling, University of Nevada- Reno, Reno, NV, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - Jacqueline Swank
- School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA; Department of Educational, School, and counseling Psychology, College of Education & Human Development, University of Missouri, Columbia, MO, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
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Ford JH, Zehner ME, Schaper H, Saldana L. Adapting the stages of implementation completion to an evidence-based implementation strategy: The development of the NIATx stages of implementation completion. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231200379. [PMID: 37790170 PMCID: PMC10510360 DOI: 10.1177/26334895231200379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Dissemination and implementation frameworks provide the scaffolding to explore the effectiveness of evidence-based practices (EBPs) targeting process of care and organizational outcomes. Few instruments, like the stages of implementation completion (SIC) examine implementation fidelity to EBP adoption and how organizations differ in their approach to implementation. Instruments to measure organizational competency in the utilization of implementation strategies are lacking. Method An iterative process was utilized to adapt the SIC to the NIATx implementation strategies. The new instrument, NIATx-SIC, was applied in a randomized controlled trial involving 53 addiction treatment agencies in Washington state to improve agency co-occurring capacity. NIATx-SIC data were reported by state staff and external facilitators and through participating agency documentation. Proportion and duration scores for each stage and phase of the NIATx-SIC were calculated for each agency. Competency was assessed using the NIATx fidelity tool. Comparisons of proportion, duration, and NIATx activities completed were determined using independent sample t-tests by agency competency level. Results The NIATx-SIC distinguished between agencies achieving competency (n = 23) and those not achieving competency (n = 26). Agencies achieving competency completed a greater proportion of implementation phase activities and had a significantly longer Stage 7 duration. These agencies participated in significantly more individual and group coaching calls, attended more in-person meetings, implemented more change projects, and spent approximately 64 more days, on average, engaging in all NIATx activities. Conclusions Organizational participation in dissemination and implementation research requires a significant investment of staff resources. The inability of an organization to achieve competency when utilizing a set of implementation strategies waste an opportunity to institutionalize knowledge of how to apply implementation strategies to future change efforts. The NIATx-SIC provides evidence that competency is not an attribute of the organization but rather a result of the application of the NIATx implementation strategies to improve agency co-occurring capacity. Trial Registration ClinicalTrials.gov, NCT03007940. Registered January 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03007940.
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Affiliation(s)
- James H. Ford
- School of Pharmacy, Social and Administrative Sciences Division, University of Wisconsin–Madison, Madison, WI, USA
| | - Mark E. Zehner
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
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Bryant J, Horwitz R, Gray RM, Lafferty L, Jops P, Blunden H, Hudson S, Brener L. Improving access to drug and alcohol treatment in NSW Australia: The role of self-determination and peer support. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2050-e2057. [PMID: 34750909 DOI: 10.1111/hsc.13639] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 09/16/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
One of the key issues in the alcohol and other drug (AOD) treatment sector concerns the reported difficulties that clients have in accessing treatment. This paper draws on qualitative interview data collected from clients undergoing treatment (n = 20) and stakeholders (n = 15) of five specialist non-government AOD treatment services in New South Wales, Australia, to offer an in-depth perspective about treatment entry experiences. We identified four key themes of positive treatment entry experiences: the presence of high-quality online information which enabled clients to best match themselves to treatment; flexible and simple intake procedures with skilled and welcoming staff; the presence and quality of social and other resources (such as families, peers and private health insurance) which enabled quicker access; and prior experience in the treatment system which helped clients to gain important knowledge and skills to improve future access. We discuss implications of these findings, including that waiting lists significantly exacerbate inequity, but that this could be ameliorated by providing peer-support to those trying to gain entry, especially clients who do not have family and friends for help during this period. The findings also point to the way that client self-determination is central to all positive treatment entry experiences, and that supporting clients to find 'the right fit' in relation to treatment options improves their experiences.
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Affiliation(s)
- Joanne Bryant
- Centre for Social research in Health, UNSW, Sydney, New South Wales, Australia
| | - Robyn Horwitz
- Centre for Social research in Health, UNSW, Sydney, New South Wales, Australia
| | - Rebecca M Gray
- Centre for Social research in Health, UNSW, Sydney, New South Wales, Australia
| | - Lise Lafferty
- Centre for Social research in Health, UNSW, Sydney, New South Wales, Australia
| | - Paula Jops
- Social Policy Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Hazel Blunden
- Social Policy Research Centre, UNSW, Sydney, New South Wales, Australia
| | - Suzie Hudson
- NADA The Network of Alcohol and Other Drugs Agencies NSW, Sydney, New South Wales, Australia
| | - Loren Brener
- Centre for Social research in Health, UNSW, Sydney, New South Wales, Australia
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Ford JH, Rao D, Gilson A, Kaur A, Garneau HC, Saldana L, McGovern MP. Wait No Longer: Reducing Medication Wait-Times for Individuals with Co-Occurring Disorders. J Dual Diagn 2022; 18:101-110. [PMID: 35387577 PMCID: PMC9503325 DOI: 10.1080/15504263.2022.2052225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). Methods: In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort 1, n = 25) or to a Waitlist control (Cohort 2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. Results: The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. Conclusions: NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients "wait no longer" to receive integrated treatment and medications for their COD.
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Affiliation(s)
- James H. Ford
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Deepika Rao
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Aaron Gilson
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Arveen Kaur
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Helene Chokron Garneau
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304
| | | | - Mark P. McGovern
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304
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Mark TL, Seibert J, Dowd WN, Zuckerbraun SM, Popovic JR, Barch DH. Development, Testing, and Dissemination of a Public-Facing Tool to Help Consumers Find Higher-Quality Addiction Treatment. Psychiatr Serv 2022; 73:293-298. [PMID: 34281358 DOI: 10.1176/appi.ps.202000879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors aimed to describe the development and testing of quality measures included in a public-facing addiction treatment facility search engine. METHODS An addiction treatment facility survey was created that queried providers in six U.S. states about whether they offered the services and used the processes identified by federal agencies and nonprofit organizations as signs of higher-quality addiction treatment. Four insurance claims-based quality measures were created to capture the percentage of a provider's patients with opioid use disorder receiving opioid use disorder medications, who filled prescriptions for such medication for at least 180 days, who received follow-up care after treatment for substance use disorder in inpatient or residential settings, or who had a substance use disorder-related hospitalization or emergency department visit. A patient experience-of-care survey captured patients' perceptions of the quality of the addiction treatment. The project was undertaken from November 2018 through July 2020. RESULTS The authors tested the measures by using 1,245 facility surveys, 7,970 patients' experience-of-care surveys, and four claims-based measures submitted by 129, 136, 283, and 408 addiction treatment providers. Statistical testing demonstrated that the quality measures were reliable and valid. The quality measure scores varied among providers, capturing a wide performance range. A public website containing quality measures launched in July 2020 in the six states and has been accessed by thousands of consumers. CONCLUSIONS This study developed valid, reliable, and useful addiction treatment quality measures. Dissemination of these measures may help consumers select among providers and help providers, policy makers, and payers improve quality.
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Affiliation(s)
- Tami L Mark
- RTI International, Rockville, Maryland (Mark), Research Triangle Park, North Carolina (Seibert, Dowd), Chicago (Zuckerbraun), and Waltham, Massachusetts (Popovic, Barch)
| | - Julie Seibert
- RTI International, Rockville, Maryland (Mark), Research Triangle Park, North Carolina (Seibert, Dowd), Chicago (Zuckerbraun), and Waltham, Massachusetts (Popovic, Barch)
| | - William N Dowd
- RTI International, Rockville, Maryland (Mark), Research Triangle Park, North Carolina (Seibert, Dowd), Chicago (Zuckerbraun), and Waltham, Massachusetts (Popovic, Barch)
| | - Sara M Zuckerbraun
- RTI International, Rockville, Maryland (Mark), Research Triangle Park, North Carolina (Seibert, Dowd), Chicago (Zuckerbraun), and Waltham, Massachusetts (Popovic, Barch)
| | - Jennifer R Popovic
- RTI International, Rockville, Maryland (Mark), Research Triangle Park, North Carolina (Seibert, Dowd), Chicago (Zuckerbraun), and Waltham, Massachusetts (Popovic, Barch)
| | - Daniel H Barch
- RTI International, Rockville, Maryland (Mark), Research Triangle Park, North Carolina (Seibert, Dowd), Chicago (Zuckerbraun), and Waltham, Massachusetts (Popovic, Barch)
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 178] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Huebner RA, Hall MT, Walton MT, Smead E, Willauer T, Posze L. The Sobriety Treatment and Recovery Teams program for families with parental substance use: Comparison of child welfare outcomes through 12 months post-intervention. CHILD ABUSE & NEGLECT 2021; 120:105260. [PMID: 34391128 DOI: 10.1016/j.chiabu.2021.105260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/07/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The 2018 Family First Prevention Services Act (FFPSA) shifted child welfare funding to interventions proven effective in preserving families with parental substance use and child welfare involvement. The Sobriety Treatment and Recovery Teams (START) program serves this population with FFPSA aligned goals. OBJECTIVE This study was the first to test the sustained effects of START from the initial CPS report through 12-months post-intervention. PARTICIPANTS AND SETTING Children (n = 784) receiving START services in four sites were compared to 784 children receiving child welfare treatment as usual (TAU). METHODS Using child welfare administrative data, children in START were matched to children in TAU using propensity score matching. Outcomes were tested during the intervention period, and at six- and 12-months post-intervention using comparative statistics and multilevel logistic regression. RESULTS The odds of START children being placed in out-of-home care (OOHC) during the intervention period were half those of children in TAU (20.3% vs. 35.2%, p < .001, OR = 0.47, 95% CI [0.37, 0.59]). When placed in OOHC, START children were more likely to be reunified with their parents (p = .042, OR = 1.44, 95% CI [0.99, 1.62]). At 12-months post-intervention, 68.5% of START and 56.0% of TAU-served children remained free from both OOHC placement and child abuse and neglect (after multilevel clustering adjustment: p < .001, OR = 1.85, 95% CI [1.41, 2.43]). CONCLUSION The primary impact of START was significantly reduced rates of OOHC placement, with results sustained through 12-months post-intervention and after accounting for family clusters and site differences.
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Affiliation(s)
- Ruth A Huebner
- Kentucky Department of Community Based Services, Retired Professor Eastern Kentucky University, United States of America.
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, United States of America.
| | - Mathew T Walton
- Office of Health Data and Analytics, Division of Analytics, Frankfort, KY 40621, United States of America.
| | - Erin Smead
- University of Kentucky College of Social Work, Department for Community Based Services, United States of America.
| | - Tina Willauer
- National START Training and Technical Assistance Program, Children and Family Futures, Inc., Lake Forest, CA 92630, United States of America.
| | - Lynn Posze
- National START Training and Technical Assistance Program, Children and Family Futures, Inc., Lake Forest, CA 92630, United States of America.
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Huebner RA, Willauer T, Hall MT, Smead E, Poole V, Posze L, Hibbeler PG. Comparative outcomes for Black children served by the Sobriety Treatment and Recovery Teams program for families with parental substance abuse and child maltreatment. J Subst Abuse Treat 2021; 131:108563. [PMID: 34256968 DOI: 10.1016/j.jsat.2021.108563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION An urgent need exists for child welfare and substance use disorder (SUD) interventions that safely preserve Black families, engage parents in treatment services, and improve child and parent outcomes. The Title IV-E Prevention Services Clearinghouse rated The Sobriety Treatment and Recovery Teams (START) as a promising practice for families with parental substance use and child maltreatment. This study is the first to test the effects of START on Black families. METHODS This study compared child welfare and parent outcomes for 894 children and their 567 primary parents in three groups: Black children served by START, Black children served in treatment as usual (TAU), and White children served in START. This was a quasi-experimental study using a propensity score matched dataset of START-served children to TAU children. Comparisons included placement in state custody and repeat child abuse or neglect (CA/N) during the intervention period, and at 12 months post-intervention. Generalized linear models accounted for the effects of clustering and unbalanced covariates on outcomes. RESULTS In this study, 51.8% of children were neonates or infants at the CPS report. At 12-months post-intervention, 80.6% of Black children served by START, but only 56.0% of Black children in TAU, remained free of both placement in state custody and CA/N (p < .001, OR = 3.27, 95% CI [2.14, 4.98]); these effects held after controlling for family clusters. Black and White families in START received equal SUD treatment and community-based services. For START-served families, parental use of opioids (p = .005, OR = 3.52, 95% CI [1.46, 8.48]) and mental health issues (p = .002, OR = 1.90, 95% CI [1.27, 2.86]), rather than race, predicted child placement in state custody. Parent mental health issues or opioid use doubled or quadrupled, respectively, the odds of failing to achieve early recovery by case closure. CONCLUSIONS START is a potent intervention, co-implemented with SUD treatment providers, that kept Black children safely with their families through the intervention and 12-months post-intervention periods. Scaling up effective programs, like START, that align with the goals of the Family First Prevention Services Act might reduce racial disparities and improve child welfare and SUD treatment outcomes.
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Affiliation(s)
- Ruth A Huebner
- Former Child Welfare Researcher for Kentucky Department for Community Based Services, Retired Professor from Eastern Kentucky University, United States of America.
| | - Tina Willauer
- National START Training and Technical Assistance Program, Children and Family Futures, Inc., Lake Forest, CA 92630, United States of America.
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, United States of America.
| | - Erin Smead
- University of Kentucky, College of Social Work, Department for Community Based Services, United States of America.
| | - Velva Poole
- Department for Community Based Services, Louisville, KY, United States of America.
| | - Lynn Posze
- National START Training and Technical Assistance Program, Children and Family Futures, Inc., Lake Forest, CA 92630, United States of America.
| | - Paul G Hibbeler
- Kent School of Social Work, University of Louisville, Louisville, KY, United States of America.
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11
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Mendez B, Bozzay M, Verona E. Internalizing and externalizing symptoms and aggression and violence in men and women. Aggress Behav 2021; 47:439-452. [PMID: 33728684 DOI: 10.1002/ab.21962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/09/2021] [Accepted: 03/04/2021] [Indexed: 01/04/2023]
Abstract
Literature linking aggressive behavior across internalizing and externalizing disorders support the co-occurrence of aggression and various mental health diagnoses. However, research has yet to examine relationships between aggression and dimensional psychopathology models that cut across diagnostic boundaries (e.g., internalizing, externalizing composites) and capture shared liability across common disorders. The role of gender has also been largely ignored in prior work, despite evidence that men and women manifest psychopathology differently. The present study examined cross-sectional and longitudinal relationships between psychopathology composites (i.e., Internalizing, Externalizing) and different manifestations of physical aggression (i.e., aggressive traits, general violence, physical intimate partner violence, and self-directed aggression), as well as moderation by gender. Internalizing (INT) and Externalizing (EXT) lifetime symptoms and various physically aggressive behaviors were assessed at baseline and at 6 months and 1 year follow up in a sample of 319 adults with violence and/or substance use histories. Cross-sectional results showed that INT was associated with all forms of aggression, and women showed stronger relationships between INT and both physical intimate partner violence (IPV) and self-directed aggression. EXT was specifically linked to general violence, and a stronger relationship between EXT and self-directed aggression emerged in men compared to women. Longitudinal relationships were mostly small and nonsignificant. Results support the co-occurrence of aggression with distinct forms of psychopathology, as well as gender-dependent relationships, but do not support the predictive validity of symptom composites in aggression risk. Findings implicate the need for aggression interventions tailored within gender.
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Affiliation(s)
- Beatriz Mendez
- Department of Psychology The University of Alabama Tuscaloosa Alabama USA
| | - Melanie Bozzay
- Department of Psychiatry & Human Behavior Brown University Providence Rhode Island USA
| | - Edelyn Verona
- Department of Psychology University of South Florida Tampa Florida USA
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12
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Facilitating rapid access to addiction treatment: a randomized controlled trial. Addict Sci Clin Pract 2021; 16:34. [PMID: 34034821 PMCID: PMC8152083 DOI: 10.1186/s13722-021-00240-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization. Methods Individuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS). Subjects randomized to the Delayed Intervention (DI) group were given contact information for a nearby addiction medicine clinic; those randomized to the Rapid Intervention (RI) group were given an appointment at the clinic within 2 days and were accompanied to their first appointment. Results Of the 174 individuals who were screened, 106 were randomized to either the DI or RI group. The two groups were similar in demographics, housing status, and substance use in the last 30 days. In the 6-month period following randomization, 85% of the RI group attended at least one clinic appointment, compared to only 29% in the DI group (p < 0.0001). The RI group had a mean of 6.39 ED visits per subject in the 12 months after randomization, while the DI group had a mean of 13.02 ED visits per subject in the same 12-month period (p = 0.0469). Other health utilization measures did not differ between the two groups. Conclusion Providing immediate facilitated access to an addiction medicine service resulted in greater initial engagement and reduced emergency department visits at 6 months. Trial registration This trial is registered at the National Institutes of Health (ClinicalTrials.gov) under identifier #NCT01934751. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00240-y.
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13
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Reif S, Stewart MT, Torres ME, Davis MT, Dana BM, Ritter GA. Effectiveness of value-based purchasing for substance use treatment engagement and retention. J Subst Abuse Treat 2021; 122:108217. [PMID: 33509415 PMCID: PMC8380407 DOI: 10.1016/j.jsat.2020.108217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Many people drop out of substance use disorder (SUD) treatment within the first few sessions, which suggests the need for innovative strategies to address this. We examined the effectiveness of incentive-based contracting for Maine's publicly funded outpatient (OP) and intensive outpatient (IOP) SUD treatment, to determine its potential for improving treatment engagement and retention. METHODS Maine's incentive-based contract with federally block grant-funded OP and IOP treatment agencies created a natural experiment, in which we could compare treatment engagement and retention with a group of state-licensed treatment agencies that were not part of the incentive-based contract. We used administrative data for OP (N = 18,375) and IOP (N = 5986) SUD treatment admissions from FY2005-FY2011 to capture trends prior to and after the FY2008 contract implementation date. We performed multivariable difference-in-difference logistic regression models following propensity score matching of clients. RESULTS Two-thirds (66%) of OP admissions engaged in treatment, defined as 4+ treatment sessions, and 85% of IOP admissions satisfied the similar criteria of 4+ treatment days. About 40-45% of OP admissions reached the threshold for retention, defined as 90 days in treatment. IOP treatment completion was attained by 50-58% of admissions. For OP, the incentive and nonincentive groups had no significant differences in percentages with treatment engagement (AOR = 1.28, DID = 5.9%, p = .19), and 90-day retention was significant in the opposite direction of what we hypothesized (AOR = 0.80, DID = -4.6%, p = .0003). For IOP, the incentive group had a significant, but still small, increase in percentage with treatment engagement (AOR = 1.52, DID = 5.5%, p = .003), but the corresponding increase in treatment completion was not similarly significant (AOR = 1.12, DID = 2.7%, p = .53). In all models, individual-level variables were strong predictors of outcomes. CONCLUSION We found little to no impact of the incentive-based contract on the treatment engagement, retention, and completion measures, adding to the body of evidence that shows few or null results for value-based purchasing in SUD treatment programs. The limited success of such efforts is likely to reflect the bandwidth that providers and programs have to focus on new endeavors, the importance of the incentive funding to their bottom line, and forces beyond their immediate control.
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Affiliation(s)
- Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America.
| | - Maureen T Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Maria E Torres
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Margot T Davis
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Beth Mohr Dana
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
| | - Grant A Ritter
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, United States of America
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14
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Ford JH, Gilson A. Influence of participation in a quality improvement collaborative on staff perceptions of organizational sustainability. BMC Health Serv Res 2021; 21:34. [PMID: 33413357 PMCID: PMC7791971 DOI: 10.1186/s12913-020-06026-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sustainability capacity (SC), which is an organization's ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention - the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200). METHODS A mixed linear model repeated measures analysis was applied to matched staff members (n = 908, representing 2329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III). RESULTS For Model I, staff perceptions of total SC increased throughout most of the study (t1,4 = - 6.74, p < .0001; t2,4 = - 3.100, p < .036; t3,4 = - 0.23, p = ns). Model II did not change Model I's overall Time effect, but combined NIATx200 services (t = - 2.23, p = .026), staff job function (t = - 3.27, p = .001), and organizational administrators (t = - 3.50, p = .001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t = - 3.09, p < .002) and being in a free-standing clinic (t = - 2.06, p < .04) on staff perceptions of total SC. CONCLUSION Although staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization's SC significantly differed over time. However, an organization's participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors' influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change. TRIAL REGISTRATION ClinicalTrials.gov , NCT00934141 . Registered July 6, 2009. Retrospectively registered.
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Affiliation(s)
- James H Ford
- University of Wisconsin - Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Aaron Gilson
- University of Wisconsin - Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, USA
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15
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Ford JH, Kaur A, Rao D, Gilson A, Bolt DM, Garneau HC, Saldana L, McGovern MP. Improving Medication Access within Integrated Treatment for Individuals with Co-Occurring Disorders in Substance Use Treatment Agencies. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211033659. [PMID: 34988462 PMCID: PMC8726008 DOI: 10.1177/26334895211033659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The best approach to provide comprehensive care for individuals with co-occurring disorders (CODs) related to substance use and mental health is to address both disorders through an integrated treatment approach. However, only 25% of behavioral health agencies offer integrated care and less than 7% of individuals who need integrated treatment receive it. A project used a cluster-randomized waitlist control group design to evaluate the effectiveness of Network for the Improvement of Addiction Treatment (NIATx) implementation strategies to improve access to addiction and psychotropic medications. METHODS This study represents a secondary analysis of data from the NIATx project. Forty-nine agencies were randomized to Cohort1 (active implementation group, receiving the NIATx strategy [n=25]) or Cohort2 (waitlist control group [n=24]). Data were collected at three time points (Baseline, Year1 and Year2). A two-level (patient within agency) multinomial logistic regression model investigated the effects of implementation strategy condition on one of four medication outcomes: both medication types, only psychotropic medication, only addiction medication, or neither medication type. A per-protocol analysis included time, NIATx fidelity, and agency focus as predictors. RESULTS The intent-to-treat analysis found a statistically significant change in access to addiction versus neither medication, but Cohort1 compared to Cohort2 at Year1 showed no differences. Changes were associated with the experimental intervention and occurred in the transition from Year 1 to Year 2, where greater increases were seen for agencies in Cohort2 versus Cohort1. The per-protocol analysis showed increased access to both medications and addiction medications from pre- to post-intervention for agencies in both cohorts; however, differences in change between high- and low-implementation agencies were not significant. CONCLUSIONS Access to integrated services for people with CODs is a long-standing problem. NIATx implementation strategies had limited effectiveness in improving medication access for individuals with CODs. Implementation strategy adherence is associated with increased medication access.
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Affiliation(s)
- James H Ford
- School of Pharmacy, Social and Administrative Sciences Division, University of
Wisconsin–Madison, USA
| | - Arveen Kaur
- School of Pharmacy, Social and Administrative Sciences Division, University of
Wisconsin–Madison, USA
| | - Deepika Rao
- School of Pharmacy, Social and Administrative Sciences Division, University of
Wisconsin–Madison, USA
| | - Aaron Gilson
- School of Pharmacy, Social and Administrative Sciences Division, University of
Wisconsin–Madison, USA
| | - Daniel M Bolt
- School of Education, Educational Psychology Division, University of
Wisconsin–Madison, USA
| | - Helene Chokron Garneau
- Center for Behavioral Health Services and Implementation Research,
Division of Public Health & Population Sciences, Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, USA
| | | | - Mark P McGovern
- Center for Behavioral Health Services and Implementation Research,
Division of Public Health & Population Sciences, Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, USA
- Division of Primary Care and Population Health, Department of
Medicine, Stanford University School of
Medicine, USA
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16
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Pagano A, Hosakote S, Kapiteni K, Straus ER, Wong J, Guydish JR. Impacts of COVID-19 on residential treatment programs for substance use disorder. J Subst Abuse Treat 2020; 123:108255. [PMID: 33375986 DOI: 10.1016/j.jsat.2020.108255] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/19/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The COVID-19 pandemic may present special challenges for residential substance use disorder (SUD) treatment facilities, which may lack infrastructure and support to implement infection control protocols while maintaining on-site treatment services. However, little is known about how residential SUD treatment programs are impacted by the COVID-19 pandemic. METHODS The research team conducted semi-structured interviews with 17 directors of 20 residential SUD treatment programs across California during the state's shelter-in-place order. The researchers then analyzed qualitative interview data thematically and coded them using ATLAS.ti software. FINDINGS Thematic analyses identified six major themes: program-level impacts, staff impacts, client impacts, use of telehealth, program needs, and positive effects. "Program-level impacts" were decreased revenue from diminished client censuses and insufficient resources to implement infection control measures. "Staff impacts" included layoffs, furloughs, and increased physical and emotional fatigue. "Client impacts" were delayed treatment initiation; receipt of fewer services while in treatment; lower retention; and economic and psychosocial barriers to community re-entry. "Use of telehealth" included technical and interpersonal challenges associated with telehealth visits. "Program needs" were personal protective equipment (PPE), stimulus funding, hazard pay, and consistent public health guidance. "Positive effects" of the pandemic response included increased attention to hygiene and health, telehealth expansion, operational improvements, and official recognition of SUD treatment as an essential health care service. CONCLUSION Study findings highlight COVID-related threats to the survival of residential SUD treatment programs; retention of the SUD treatment workforce; and clients' SUD treatment outcomes. These findings also identify opportunities to improve SUD service delivery and suggest avenues of support for residential SUD treatment facilities during and after the COVID-19 pandemic.
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Affiliation(s)
- Anna Pagano
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America.
| | - Sindhu Hosakote
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Kwinoja Kapiteni
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Elana R Straus
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Jessie Wong
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
| | - Joseph R Guydish
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94118, United States of America
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17
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Assessing public behavioral health services data: a mixed method analysis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:85. [PMID: 33176839 PMCID: PMC7661157 DOI: 10.1186/s13011-020-00328-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
Background Measuring behavioral health treatment accessibility requires timely, comprehensive and accurate data collection. Existing public sources of data have inconsistent metrics, delayed times to publication and do not measure all factors related to accessibility. This study seeks to capture this additional information and determine its importance for informing accessibility and care coordination. Methods The 2018 National Survey for Substance Abuse and Treatment Services (N-SSATS) data were used to identify behavioral health facilities in Indiana and gather baseline information. A telephone survey was administered to facilities with questions parallel to the N-SSATS and additional questions regarding capacity and patient intake. Quantitative analysis includes chi-square tests. A standard qualitative analysis was used for theming answers to open-ended questions. Results About 20% of behavioral health facilities responded to the study survey, and non-response bias was identified by geographic region. Among respondents, statistically significant differences were found in several questions asked in both the study survey and N-SSATS. Data gathered from the additional questions revealed many facilities to have wait times to intake longer than 2 weeks, inconsistency in intake assessment tools used, limited capacity for walk-ins and numerous requirements for engaging in treatment. Conclusion Despite the low response rate to this study survey, results demonstrate that multiple factors not currently captured in public data sources can influence coordination of care. The questions included in this study survey could serve as a framework for routinely gathering these data and can facilitate efforts for successful coordination of care and clinical decision-making.
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18
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Iheanacho T, Bommersbach T, Fuehrlein B, Arnaout B, Dike C. Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians' Confidence and Readiness to Address Substance Use Disorders. Community Ment Health J 2020; 56:1429-1435. [PMID: 32062717 PMCID: PMC7429311 DOI: 10.1007/s10597-020-00586-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
Despite the availability and effectiveness of medication-assisted treatment (MAT) for substance use disorders (SUDs), utilization of these medications remains suboptimal, especially in public sector settings. A key limitation is clinicians' reluctance to include MAT in their routine practice due, in part, to low confidence about managing SUDs and limited awareness of the disease model of addiction. This study evaluates the impact of a 1-day MAT training for community mental health clinicians using a 30-item pre- and post-training questionnaire. Of the 109 clinicians who attended the training, 107 completed the pre- and post-training questionnaires. Factor analysis of the questionnaire identified two domains: readiness to address SUDs among patients (factor 1) and understanding SUDs as diseases (factor 2). Post training, there was a significant change in both factor 1 (p = .00001) and factor 2 (p = .00003), indicating that a brief MAT training can increase clinicians' confidence and readiness to address SUDs and improve their understanding of the disease model of addiction.
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Affiliation(s)
- Theddeus Iheanacho
- Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA.
| | | | - Brian Fuehrlein
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Bachaar Arnaout
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Charles Dike
- Yale University School of Medicine, New Haven, CT, USA
- Connecticut's Department of Mental Health and Addiction Services, Hartford, CT, USA
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19
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Kovach JV, Flores MN. Streamlining admissions to outpatient substance use treatment using lean methods. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1821809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jamison V. Kovach
- Project Management Program, University of Houston, Houston, Texas, USA
| | - Manuel N. Flores
- Project Management Program, University of Houston, Houston, Texas, USA
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20
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Pilarinos A, Barker B, Nosova E, Milloy MJ, Hayashi K, Wood E, Kerr T, DeBeck K. Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada. Addiction 2020; 115:97-106. [PMID: 31379008 PMCID: PMC6933075 DOI: 10.1111/add.14769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/26/2018] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment. DESIGN Data from three linked prospective cohort studies of PWUD were used. McNemar's test and non-linear growth curve modeling were employed to: (a) assess changes in substance use patterns before and after coerced addiction treatment and (b) compare these changes with changes in PWUD who (1) voluntarily accessed and (2) did not access treatment. SETTING Vancouver, Canada. PARTICIPANTS A total of 3196 community-recruited PWUD. MEASUREMENTS The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment. FINDINGS Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar's test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all P > 0.05). In subanalyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician. CONCLUSIONS Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.
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Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, B.C., Canada V6T 1Z4
| | - Brittany Barker
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- First Nations Health Authority, 100 Park Royal S, West Vancouver, B.C., Canada, V7T 1A2
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Room 11300, Blusson Hall, Burnaby, B.C., Canada, V5A 1S6
| | - Evan Wood
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- School of Public Policy, Simon Fraser University, 3277-515 West Hastings Street, Vancouver, B.C., Canada, V6B 5K3
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Abstract
OBJECTIVES The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increased demand for treatment, however, is not being met by a corresponding increase in access to or availability of treatment. This report focuses specifically on the treatment referral process, which we have identified as 1 of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (ie, referral source) and individuals who work in substance use disorder facilities (ie, referral recipient). METHODS Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n = 59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures. RESULTS Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then proposed several solutions to address specific barriers. CONCLUSIONS Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.
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22
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Assefa MT, Ford JH, Osborne E, McIlvaine A, King A, Campbell K, Jo B, McGovern MP. Implementing integrated services in routine behavioral health care: primary outcomes from a cluster randomized controlled trial. BMC Health Serv Res 2019; 19:749. [PMID: 31651302 PMCID: PMC6814122 DOI: 10.1186/s12913-019-4624-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders. METHODS This study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not? RESULTS From baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen's d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen's d = 0.91) and Continuity of Care (p = 0.026, Cohen's d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen's d = 0.51) were found. CONCLUSIONS Overall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders. TRAIL REGISTRATION ClinicalTrials.gov, NCT03007940 . Retrospectively registered January 2017.
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Affiliation(s)
- Mehret T. Assefa
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304 USA
| | - James H. Ford
- School of Pharmacy – Social and Administrative Sciences Division, University of Wisconsin – Madison, Madison, WI 53705 USA
| | - Eric Osborne
- Office of Behavioral Health and Managed Care, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA 98504 USA
| | - Amy McIlvaine
- School of Pharmacy – Social and Administrative Sciences Division, University of Wisconsin – Madison, Madison, WI 53705 USA
| | - Ahney King
- Office of Behavioral Health and Managed Care, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA 98504 USA
| | - Kevin Campbell
- Washington State Health Care Authority, Olympia, WA 98501 USA
| | - Booil Jo
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304 USA
| | - Mark P. McGovern
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304 USA
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Sander K, Wilson H, Kelly J, Bligh A. Examination of a group entry model into alcohol and other drug (AOD) treatment: Improvements in attendance, retention, and clinical capacity. Subst Abus 2019; 41:19-23. [PMID: 31287785 DOI: 10.1080/08897077.2019.1635064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Nonattendance in alcohol and other drug (AOD) treatment has been a persistent issue for service provision. The study reports on the outcomes of implementing a group intervention, titled Getting Ready for Change (GRFC), as the default entry pathway into an AOD counseling service that aimed to improve initial attendance and retention through reduced wait days and improved clinical capacity. Methods: Clients of the service (N = 274) were offered either an individual appointment (baseline) between September 2015 and February 2016 or a group-based appointment (intervention) between September 2016 and February 2017. The samples were compared in terms of demographics, principal drug of concern, wait days to initial and follow-up appointments, and attendance. Results: The implementation of GRFC reduced wait days to initial appointment from 15 to 5 days and improved initial attendance rates by 24%. Wait days to follow-up were reduced from 10 to 8, retention rates improved by 24%. Further, there was an increased service capacity to meet community demand. Conclusions: A group entry model into AOD treatment is a novel intervention, is easy to implement, improves attendance and retention in treatment, reduces wait days, and enhances clinical capacity.
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Affiliation(s)
- Kim Sander
- Metro North Mental Health Alcohol and Drug Service, Metro North Hospital and Health Service, Brisbane, Queensland
| | - Hollie Wilson
- Metro North Mental Health Alcohol and Drug Service, Metro North Hospital and Health Service, Brisbane, Queensland
| | - John Kelly
- Metro North Mental Health Alcohol and Drug Service, Metro North Hospital and Health Service, Brisbane, Queensland
| | - Anthony Bligh
- Metro North Mental Health Service, Metro North Hospital and Health Service, Herston, Australia
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Pankow J, Willett J, Yang Y, Swan H, Dembo R, Burdon WM, Patterson Y, Pearson FS, Belenko S, Frisman LK. Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities. J Behav Health Serv Res 2019; 45:187-203. [PMID: 28439790 DOI: 10.1007/s11414-017-9551-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.
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Affiliation(s)
- Jennifer Pankow
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX, 76129, USA.
| | - Jennifer Willett
- University of Connecticut School of Social Work, West Hartford, CT, USA.,School of Social Work, University of Nevada, Reno, Reno, NV, USA
| | - Yang Yang
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX, 76129, USA.,Department of Psychology, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Holly Swan
- Center for Drug and Health Studies, University of Delaware, Newark, DE, USA.,Abt Associates, Inc., Cambridge, MA, USA
| | | | - William M Burdon
- Integrated Substance Abuse Programs, University of California at Los Angeles, Los Angeles, CA, USA.,Independent Research Consultant and Business Owner, Toluca Lake, CA, USA
| | - Yvonne Patterson
- Eastern Connecticut State University, Willimantic, CT, USA.,Central Connecticut State University, New Britain, CT, USA
| | - Frank S Pearson
- National Development and Research Institutes, Inc., New York, NY, USA
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Linda K Frisman
- University of Connecticut School of Social Work, West Hartford, CT, USA
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Russell BS, Hutchison M, Fusco A. Emotion Regulation Outcomes and Preliminary Feasibility Evidence From a Mindfulness Intervention for Adolescent Substance Use. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2019. [DOI: 10.1080/1067828x.2018.1561577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Ritter A, Mellor R, Chalmers J, Sunderland M, Lancaster K. Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand. J Stud Alcohol Drugs Suppl 2019; Sup 18:22-30. [PMID: 30681945 PMCID: PMC6377022 DOI: 10.15288/jsads.2019.s18.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 02/07/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners. METHOD A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date. RESULTS Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available. CONCLUSIONS Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Richard Mellor
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Matthew Sunderland
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Kari Lancaster
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
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Ford JH, Stumbo SP, Robinson JM. Assessing long-term sustainment of clinic participation in NIATx200: Results and a new methodological approach. J Subst Abuse Treat 2018; 92:51-63. [PMID: 30032945 DOI: 10.1016/j.jsat.2018.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sustainability frameworks differentiate between sustainability capacity and sustainment of organizational change. Multiple studies have examined sustainability capacity. Methodological approaches to assess long-term sustainment have not been explored. This study addresses this gap by describing the development of a long-term sustainment methodology and evaluating its application utilizing data from substance abuse clinics participating in a quality improvement collaborative. METHODS The study involved clinics (n = 121) in three states (MI, NY and WA) participating in the 2007-2009 NIATx200 quality improvement (QI) intervention. It extended the primary analysis to focus on clinics' long-term sustainment of wait time, retention and admission improvements. Long-term sustainment was defined as two years post end of the active implementation period (Calendar Years 2010 and 2011). The analysis defined case exclusion criteria and spline "knot" time intervals; allowed for Cp statistic use to address clinic data volatility; established the structure of sustainment plots and explored differences between NIATx implementation strategies. RESULTS Example spline and sustain plots highlight the application of the long-term sustainment methodology for NIATx200 clinics. In clinics with available longitudinal outcome data, 40.8% (n = 31 of 76 clinics) sustained improvements in wait time, 26.7% (n = 20 of 75 clinics) in retention, and 28.1% (n = 32 of 114 clinics) for admissions. Clinic assignment to a NIATx200 implementation strategy did not significantly influence a clinics' long-term sustainment except for lower wait time changes in the interest circle interventions. Thirty clinics (24.8%) sustained improvements for two outcomes and six clinics (5.0%) did so for all three outcomes. The clinics that sustained multiple outcome improvements were assigned to the interest circle (n = 12), learning session (n = 10), combination (n = 8), and coaching (n = 6) implementation strategies. Guidance for applying the long-term sustainment methodology in other quality improvement settings is described. CONCLUSIONS Research about sustainability capacity and sustainment of change has become increasingly important in dissemination and implementation research. Assessment of long-term sustainment in a multi-organizational quality improvement collaborative (QIC) is needed to identify when program drift and intervention decay occurs. If "cut-points" indicate when effects diminish, specific sustainability modules could be developed and introduced within the structure of a QIC to improve organizational long-term sustainment. Coaches and change teams could be trained to focus on organizational change sustainment and strengthen the likelihood of institutionalization. ClinicalTrials.gov Identifier: NCT00934141 Registered July 6, 2009. Retrospectively registered.
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Affiliation(s)
- James H Ford
- Social and Administrative Sciences Division, University of Wisconsin - School of Pharmacy, United States of America.
| | - Scott P Stumbo
- Center for Health Research, Kaiser Permanente Northwest, United States of America
| | - James M Robinson
- Center for Health Systems Research and Analysis, University of Wisconsin - Madison, United States of America
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Ford JH, Osborne EL, Assefa MT, McIlvaine AM, King AM, Campbell K, McGovern MP. Using NIATx strategies to implement integrated services in routine care: a study protocol. BMC Health Serv Res 2018; 18:431. [PMID: 29884164 PMCID: PMC5994046 DOI: 10.1186/s12913-018-3241-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/27/2018] [Indexed: 01/06/2023] Open
Abstract
Background Access to integrated services for individuals with co-occurring substance use and mental health disorders is a long-standing public health issue. Receiving integrated treatment services are both more effective and preferred by patients and families versus parallel or fragmented care. National policy statements and expert consensus guidelines underscore the benefits of integrated treatment. Despite decades of awareness, adequate treatment for individuals with co-occurring substance use and mental health disorders occurs infrequently. The underlying disease burden associated with alcohol, illicit and prescription drug problems, as well as mental health disorders, such as depression, posttraumatic stress disorder and schizophrenia, is substantial. Methods This cluster randomized controlled trial (RCT) is designed to determine if the multi-component Network for the Improvement of Addiction Treatment (NIATx) strategies are effective in implementing integrated services for persons with co-occurring substance use and mental health disorders. In this study, 50 behavioral health programs in Washington State will be recruited and then randomized into one of two intervention arms: 1) NIATx implementation strategies, including coaching and learning sessions over a 12-month intervention period to implement changes targeting integrated treatment services; or 2) wait-list control. Primary outcome measures include: 1) fidelity - a standardized organizational assessment of integrated services (Dual Diagnosis in Addiction Treatment [DDCAT] Index); and 2) penetration - proportion of patients screened and diagnosed with co-occurring disorders, proportion of eligible patients receiving substance use and mental health services, and psychotropic or substance use disorder medications. Barriers and facilitators, as determinants of implementation outcomes, will be assessed using the Consolidated Framework for Implementation Research (CFIR) Index. Fidelity to and participation in NIATx strategies will be assessed utilizing the NIATx Fidelity Scale and Stages of Implementation Completion (SIC). Discussion This study addresses an issue of substantial public health significance: the gap in access to an evidence-based practice for integrated treatment for individuals with co-occurring mental health and substance use disorders. The study utilizes rigorous and reproducible quantitative approaches to measuring implementation determinants and strategies, and may address a longstanding gap in the quality of care for persons with co-occurring disorders. Trial registration ClinicalTrials.gov NCT03007940. Registered 02 January 2017 – Retrospectively Registered Electronic supplementary material The online version of this article (10.1186/s12913-018-3241-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James H Ford
- School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, 777 University Ave, Madison, WI, 53705, USA.
| | - Eric L Osborne
- Office of Behavioral Health and Managed Care, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA, 98504, USA
| | - Mehret T Assefa
- Center for Behavioral Health Services and Implementation Research, Division of Public Health & Population Sciences, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, 94304, USA
| | - Amy M McIlvaine
- School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, 777 University Ave, Madison, WI, 53705, USA
| | - Ahney M King
- Office of Behavioral Health and Prevention, Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services, Olympia, WA, 98504, USA
| | - Kevin Campbell
- Washington State Health Care Authority, Olympia, WA, 98501, USA
| | - Mark P McGovern
- Division of Public Mental Health & Population Sciences, Department of Psychiatry & Behavioral Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1520 Page Mill Road MC5265, Palo Alto, CA, 94304, USA
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Do benefits restrictions limit Medicaid acceptance in addiction treatment? Results from a national study. J Subst Abuse Treat 2018; 87:50-55. [PMID: 29471926 DOI: 10.1016/j.jsat.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the relationship of restrictions on Medicaid benefits for addiction treatment to Medicaid acceptance among addiction treatment programs. DATA SOURCES We collected primary data from the 2013-2014 wave of the National Drug Abuse Treatment System Survey. STUDY DESIGN We created two measures of benefits restrictiveness. In the first, we calculated the number of addiction treatment services covered by each state Medicaid program. In the second, we calculated the total number of utilization controls imposed on each service. Using a mixed-effects logistic regression model, we estimated the relationship between state Medicaid benefit restrictiveness for addiction treatment and adjusted odds of Medicaid acceptance among addiction treatment programs. DATA COLLECTION Study data come from a nationally-representative sample of 695 addiction treatment programs (85.5% response rate), representatives from Medicaid programs in forty-seven states and the District of Columbia (response rate 92%), and data collected by the American Society for Addiction Medicine. PRINCIPAL FINDINGS Addiction treatment programs in states with more restrictive Medicaid benefits for addiction treatment had lower odds of accepting Medicaid enrollees (AOR = 0.65; CI = 0.43, 0.97). The predicted probability of Medicaid acceptance was 35.4% in highly restrictive states, 48.3% in moderately restrictive states, and 61.2% in the least restrictive states. CONCLUSIONS Addiction treatment programs are more likely to accept Medicaid in states with less restrictive benefits for addiction treatment. Program ownership and technological infrastructure also play an important role in increasing Medicaid acceptance.
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Bringing Healthy Aging to Scale: A Randomized Trial of a Quality Improvement Intervention to Increase Adoption of Evidence-Based Health Promotion Programs by Community Partners. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23:e17-e24. [DOI: 10.1097/phh.0000000000000503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Spithoff S, Turner S, Gomes T, Martins D, Singh S. First-line medications for alcohol use disorders among public drug plan beneficiaries in Ontario. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e277-e283. [PMID: 28500210 PMCID: PMC5429069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine use of first-line alcohol use disorder (AUD) medications (naltrexone and acamprosate) among public drug plan beneficiaries in the year following an AUD diagnosis. DESIGN Retrospective population-based cohort study. SETTING Ontario. PARTICIPANTS Individuals eligible for public drug plan benefits who had an AUD diagnosis at a hospital visit between April 1, 2011, and March 31, 2012. MAIN OUTCOME MEASURES Number of AUD medications dispensed to public drug plan beneficiaries who had a recent hospital visit with an AUD diagnosis, and number of prescriptions dispensed per person. RESULTS A total of 10 394 Ontarians between 18 and 65 years of age were identified who had a hospital visit with an AUD diagnosis and were eligible for public drug plan benefits. The rate of AUD medications dispensed in the subsequent year was 3.56 per 1000 population (95% CI 2.51 to 4.91; n = 37). This rate did not differ significantly by sex (P = .83). CONCLUSION Very few public drug plan beneficiaries are dispensed first-line AUD medications in the year following an AUD diagnosis.
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Affiliation(s)
- Sheryl Spithoff
- Family physician and addiction physician at Women's College Hospital in Toronto, Ont, and a lecturer at the University of Toronto.
| | - Suzanne Turner
- Family physician and addiction physician at St Michael's Hospital in Toronto, Ont, and Assistant Professor at the University of Toronto
| | - Tara Gomes
- Scientist at the Institute for Clinical Evaluative Sciences and in the Li Ka Shing Knowledge Institute at St Michael's Hospital, and is Assistant Professor at the University of Toronto
| | - Diana Martins
- Epidemiologist, the Institute for Clinical Evaluative Sciences
| | - Samantha Singh
- Research project manager, the Institute for Clinical Evaluative Sciences
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Stratifying delays for assessment by type of substance to improve the probability of attendance in outpatient services. Drug Alcohol Depend 2016; 166:187-93. [PMID: 27465970 DOI: 10.1016/j.drugalcdep.2016.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/23/2016] [Accepted: 07/12/2016] [Indexed: 11/21/2022]
Abstract
AIMS 1) To confirm the association between delay for assessment (DFA) and probability of first-time attendance in outpatient substance use disorder (SUD) treatment. 2) To evaluate whether this association varies by the type of primary substance for which the assessment was requested. 3) To assess the possibility of estimating differential DFAs to conform to equal probabilities of attendance across various types of primary substance. METHODS A prospective observational cohort of consecutive patients (N=1015) who requested a first-time assessment appointment at a publicly funded outpatient SUD treatment center in France between January 2014 and December 2015 was conducted. Logistic regression analyses were performed to evaluate associations between DFA (after log-transformation) and attendance and to provide estimates of attendance probability over time by the type of primary substance. FINDINGS After adjusting for gender, age and referral status, the attendance rate was observed to decrease significantly with longer DFA (OR=0.54; 95%CI: 0.44-0.66). The strength of this association differed across types of primary substance (p for heterogeneity <0.0001), with the strongest association being found for opioids (adjusted OR=0.21; 95%CI: 0.10-0.45). DFA was also associated with attendance for alcohol (OR=0.51; 95%CI: 0.37-0.71) and cannabis (OR=0.60; 95%CI: 0.37-0.96), but not for tobacco (OR=0.95; 95%CI: 0.60-1.50). Differential DFAs reflecting equal probabilities of attendance across types of substance could be estimated. CONCLUSION Our study suggests that the approach of stratifying DFAs by the type of primary substance could be helpful to improve the probability of first-time attendance in outpatient SUD treatment services.
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Fitzsimons H, Tuten M, Borsuk C, Lookatch S, Hanks L. Clinician-delivered contingency management increases engagement and attendance in drug and alcohol treatment. Drug Alcohol Depend 2015; 152:62-7. [PMID: 25982007 DOI: 10.1016/j.drugalcdep.2015.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/22/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined the impact of a low-cost contingency management (CM) delivered by program clinicians on treatment attendance and utilization for patients enrolled in outpatient psychosocial substance abuse treatment. METHODS The study used a pre-posttest design to compare substance abuse patients who received Reinforcement-Based Treatment (RBT) plus low cost CM (n=130; RBT+CM) to patients who received RBT only (n=132, RBT). RBT+CM participants received a $10 incentive for returning to treatment the day following intake assessment (day one), and a $15 incentive for attending treatment on day five following admission. RBT clients received standard care intervention without the addition of the CM procedures. Groups were compared on proportion of participants who returned to treatment on day one, mean days of treatment attendance, individual sessions attended, and treatment utilization during the first week and the first month following treatment admission. RESULTS Both the RBT+CM and RBT group participants returned to the clinic on day one at high rates (95% versus 89%, respectively). However, the RBT group participants were more likely to attend the intake assessment only (i.e., never return to treatment) compared to the RBT+CM participants. Additionally, the RBT+CM participants attended significantly more treatment days, attended more individual counseling sessions, and had higher rates of overall treatment utilization compared to the RBT participants during the one week and one month following treatment admission. CONCLUSIONS Findings support the feasibility and effectiveness of a CM intervention delivered by clinicians for increasing treatment attendance and utilization in a community substance abuse program.
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Affiliation(s)
- Heather Fitzsimons
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Michelle Tuten
- University of Maryland School of Social Work, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
| | - Courtney Borsuk
- University of Texas at San Antonio College of Education and Human Development, Department of Counseling, San Antonio, TX, USA
| | - Samantha Lookatch
- University of Tennessee, Department of Psychology, Knoxville, TN, USA
| | - Lisa Hanks
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
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Slaunwhite AK, Macdonald S. Alcohol, Isolation, and Access to Treatment: Family Physician Experiences of Alcohol Consumption and Access to Health Care in Rural British Columbia. J Rural Health 2015; 31:335-45. [PMID: 25953523 DOI: 10.1111/jrh.12117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this project was to study the experiences of physicians who treat persons with alcohol-attributed diseases in rural areas of British Columbia, Canada. METHOD A cross-sectional survey was distributed to primary health care physicians that had a family practice in a designated rural community using the Rural Coordination Centre of British Columbia's community isolation rating system. Data were collected through a mail and online survey sent to primary health care physicians. Purposeful sampling was used to select participants that had a primary health care practice in a designated rural community. RESULTS Surveys were returned by 22% of potential participants (N = 67) that had an average of 15.8 years in family practice. The majority of participants (95.4%) reported that alcohol had a negative impact on population health, and physicians expressed particular concern for alcohol consumption in relation to mental health (85.1%) and physical illness (82.1%). Most participants had referred patients out of the community for treatment; however, 76.4% reported difficulty with referrals, including long wait-lists, limited services, and issues related to transportation and leaving the community for substance use treatment. CONCLUSION Rural physicians showed an awareness and concern for alcohol consumption in their community, but they also reported difficulties referring patients for substance use treatment. Additional study is required to understand how to improve the continuity of care provided to persons with alcohol-related issues in rural British Columbia.
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Affiliation(s)
- Amanda K Slaunwhite
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada.,Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada
| | - Scott Macdonald
- Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada.,School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Gilburt H, Drummond C, Sinclair J. Navigating the Alcohol Treatment Pathway: A Qualitative Study from the Service Users' Perspective. Alcohol Alcohol 2015; 50:444-50. [PMID: 25825267 PMCID: PMC4474003 DOI: 10.1093/alcalc/agv027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/05/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Provision of effective treatment for dependent drinkers has been identified as a priority in England yet evidence suggests that access is problematic and there are low levels of retention. This qualitative study explores how the alcohol treatment system is experienced by service users, identifying barriers and facilitators that influence treatment outcomes. METHODS A total of 20 semi-structured face-to-face interviews were conducted with patients from community alcohol treatment services in three London boroughs in 2012. Interviews were undertaken one year after initially entering treatment. A thematic analysis was conducted, with the results further abstracted to relate them to specific aspects of the treatment journey. RESULTS Patients journeys were characterized by a perceived lack of control leading to help-seeking, with treatment outcomes influenced by an individuals' self-efficacy and the capabilities and skills of staff in actively engaging and supporting patients on the journey. A focus of services on the detoxification process and fragmented care pathways impacted negatively on engagement. CONCLUSIONS Current alcohol care pathways require significant levels of motivation and self-efficacy to navigate that few patients possess. Pathways need to better reflect the capacity and capabilities of patients to be successful in supporting recovery.
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Affiliation(s)
- Helen Gilburt
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AB, UK
| | - Colin Drummond
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AB, UK
| | - Julia Sinclair
- University Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Walsh EI, Brinker JK. Delay between recruitment and participation impacts on preinclusion attrition. Q J Exp Psychol (Hove) 2015; 68:635-40. [PMID: 25608178 DOI: 10.1080/17470218.2015.1008019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite being a common aspect of psychological research, the impact of delay between recruitment and active participation on dropout rates has received little research attention. This is probably due to the intuitive sense that longer delays will increase the dropout rate. Preinclusion attrition diminishes sample sizes and may threaten data representativeness. One hundred and two university undergraduates were recruited to participate in a short, one-off study via Short Message Service (SMS). Upon receipt of an SMS indicating consent to participate, the researchers delayed sending the study questions for one day, one week, one month, or two months. Delay was significantly associated with response rate with an 80% response rate in the one-day delay condition, 56% at one week, and 42% at one month. No responses were received in the two-month delay condition. This research confirms that the delay between recruitment and active participation impacts on preinclusion attrition when conducting research via SMS.
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Affiliation(s)
- Erin I Walsh
- a Research School of Psychology , The Australian National University , Canberra , ACT , Australia
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Huebner RA, Posze L, Willauer TM, Hall MT. Sobriety Treatment and Recovery Teams: Implementation Fidelity and Related Outcomes. Subst Use Misuse 2015; 50:1341-50. [PMID: 26441320 DOI: 10.3109/10826084.2015.1013131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although integrated programs between child welfare and substance abuse treatment are recommended for families with co-occurring child maltreatment and substance use disorders, implementing integrated service delivery strategies with fidelity is a challenging process. OBJECTIVE This study of the first five years of the Sobriety Treatment and Recovery Team (START) program examines implementation fidelity using a model proposed by Carroll et al. (2007). The study describes the process of strengthening moderators of implementation fidelity, trends in adherence to START service delivery standards, and trends in parent and child outcomes. METHODS Qualitative and quantitative measures were used to prospectively study three START sites serving 341 families with 550 parents and 717 children. RESULTS To achieve implementation fidelity to service delivery standards required a pre-service year and two full years of operation, persistent leadership, and facilitative actions that challenged the existing paradigm. Over four years of service delivery, the time from the child protective services report to completion of five drug treatment sessions was reduced by an average of 75 days. This trend was associated with an increase in parent retention, parental sobriety, and parent retention of child custody. Conclusions/Importance: Understanding the implementation processes necessary to establish complex integrated programs may support realistic allocation of resources. Although implementation fidelity is a moderator of program outcome, complex inter-agency interventions may benefit from innovative measures of fidelity that promote improvement without extensive cost and data collection burden. The implementation framework applied in this study was useful in examining implementation processes, fidelity, and related outcomes.
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Affiliation(s)
| | - Lynn Posze
- c Division of Behavioral Health, Kentucky Cabinet for Health and Family Services , Frankfort , Kentucky , USA
| | - Tina M Willauer
- a Department for Community-Based Services, Kentucky Cabinet for Health and Family Services , Frankfort , Kentucky , USA
| | - Martin T Hall
- d Kent School of Social Work, University of Louisville , Louisville , Kentucky , USA
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Lawental M. Effectiveness of Rapid Intake into Methadone Treatment: A Natural Experiment in Israel. Eur Addict Res 2015; 21:211-6. [PMID: 25895442 DOI: 10.1159/000375491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 01/24/2015] [Indexed: 11/19/2022]
Abstract
The effect of intake procedures on treatment entry and retention was examined in a natural experiment, in which a methadone maintenance clinic in Israel admitted 127 clients by employing a rapid intake procedure (maximum of 3 days before the initiation of treatment was offered). Using information gathered from patient files, these clients were retrospectively compared to a control group (n = 121) who underwent the clinic's regular intake procedure (between 3 weeks and 3 months). Outcome measures included entry into treatment and subsequent retention in treatment (at 3, 6 and 12 months). Results show that 81% of clients from the rapid intake group entered treatment compared to only 57% from the regular intake group. Treatment retention was similar for both groups. In addition, Jewish clients were more likely to enter treatment via the rapid intake procedure than clients from other religions, and women were retained in treatment longer than men, regardless of the type of intake procedure. Results of this single-site study lend support to the effectiveness of rapid intake procedures as a way to engage clients in treatment and carry significant implications for improving access into treatment.
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Greenfield SF, Crisafulli MA, Kaufman JS, Freid CM, Bailey GL, Connery HS, Rapoza M, Rodolico J. Implementing substance abuse group therapy clinical trials in real-world settings: challenges and strategies for participant recruitment and therapist training in the Women's Recovery Group Study. Am J Addict 2014; 23:197-204. [PMID: 24724875 DOI: 10.1111/j.1521-0391.2014.12099.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/29/2013] [Accepted: 04/28/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Open-enrollment group therapy research is challenged by the participant recruitment necessary to ensure continuous group enrollment. We present successful strategies to overcome the following barriers during the Women's Recovery Group (WRG) two-site clinical trial (N = 158): maintenance of sample size and balanced gender randomization during continuous enrollment, maintenance of group attendance, and training and retention of therapists over the 24-month continuous group enrollment. METHODS To increase recruitment, we targeted referral sources yielding the highest enrollment conversion at each site. Group sessions were consistently held regardless of group size. Therapists were trained in two teams allowing for coverage and uninterrupted treatment over 24 months. RESULTS At both sites recruitment and enrollment increased with each successive quarter. Sample size and end date targets were met without disruptions in treatment. Group therapists reported high satisfaction with their training and treatment experiences. DISCUSSION AND CONCLUSIONS These strategies supported targeted enrollment and study duration, stability of open-enrollment group therapy frame, and therapist retention and satisfaction. SCIENTIFIC SIGNIFICANCE Applying these strategies can aid in providing evidence-based group therapy in both clinical and research settings.
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Affiliation(s)
- Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Loveland D, Driscoll H. Examining attrition rates at one specialty addiction treatment provider in the United States: a case study using a retrospective chart review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:41. [PMID: 25255797 PMCID: PMC4189207 DOI: 10.1186/1747-597x-9-41] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 09/18/2014] [Indexed: 11/18/2022]
Abstract
Background Engaging individuals who have a substance use disorder (SUD) in treatment continues to be a challenge for the specialty addiction treatment field. Research has consistently revealed high rates of missed appointments at each step of the enrollment process: 1. between calling for services and assessment, 2. between assessment and enrollment, and 3. between enrollment and completion of treatment. Extensive research has examined each step of the process; however, there is limited research examining the overall attrition rate across all steps. Methods A single case study of a specialty addiction treatment agency was used to examine the attrition rates across the first three steps of the enrollment process. Attrition rates were tracked between August 1, 2011 and July 31, 2012. The cohort included 1822 unique individuals who made an initial request for addiction treatment services. Monthly retrospective reviews of medical records, phone logs, and billing data were used to calculate attrition rates. Attrition rates reported in the literature were collected and compared to the rates found at the target agency. Results Median time between request for treatment and assessment was 6 days (mean 7.5) and between assessment and treatment enrollment was 8 days (mean 12.5). An overall attrition rate of 80% was observed, including 45% between call and assessment, 32% between assessment and treatment enrollment (another 17% could not be determined), and 37% left or were removed from treatment before 30 days. Women were less likely to complete 30 days of treatment compared to men. No other demographics were related to attrition rates. Discussion One out of every five people who requested treatment completed a minimum of 30 days of a treatment. The attrition rate was high, yet similar to rates noted in the literature. Limitations of the single case study are noted. Conclusion Attrition rates in the U.S. are high with approximately 75% to 80% of treatment seekers disengaging at one of the multiple stages of the enrollment and treatment process. Significant changes in the system are needed to improve engagement rates.
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Affiliation(s)
- David Loveland
- Human Service Center, 600 Fayette Street, Peoria, IL 61603, USA.
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Valencia JG, Méndez Villanueva MP. [Factors Associated With the Temporary Abandonment of Treatment for Disorders Due to Substance Abuse in an Institution in Medellin, Colombia]. REVISTA COLOMBIANA DE PSIQUIATRIA 2014; 43:7-17. [PMID: 26573251 DOI: 10.1016/s0034-7450(14)70037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/21/2014] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the frequency and factors associated withtreatment drop-out in patients from a Substance User Treatment Center in Medellín, Colombia. METHODS A case-control study was conducted, with patients with an early treatment dropout as cases, and patients who completed the treatment as controls. Demographic data, substance use pattern, concomitant diseases, and the decision to initiate treatment were compared between cases and controls. RESULTS The frequency of early drop-out was 59%, but a high proportion of this drop-out (47.5%) occurred in the transition period between the program stages. The variables associated with drop-out were: psychotic disorder (OR=0.32; 95% CI, 0.11-0.91), bipolar disorder (OR=0.31; 95% CI, 0.12-0.77), heroin as the principal substance compared to alcohol (OR=6.68; 95% CI, 1.52-29.4), decision to initiate the treatment by the family compared to personal decision (OR=3.02; 95% CI, 1.28-7.17), and previous treatments (OR=1.87; 95% CI, 1.02-3.44). CONCLUSIONS The drop-out frequency is similar to those reported in other studies. Associated factors were found, which could be considered in order to plan strategies to improve the program results.
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Affiliation(s)
- Jenny García Valencia
- Médica, Especialista en Psiquiatría, Magíster en Epidemiología, Doctora en Epidemiología; Coordinadora de Investigación, Samein S.A.S; Profesora asociada, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia.
| | - María Paulina Méndez Villanueva
- Médica, Especialista en Psiquiatría; Coordinadora, Centro de Atención de Drogodependencias de Samein S.A.S., Medellín, Antioquia, Colombia
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Des Jarlais DC, McCarty D, Vega WA, Bramson H. HIV infection among people who inject drugs: the challenge of racial/ethnic disparities. AMERICAN PSYCHOLOGIST 2013; 68:274-85. [PMID: 23688094 PMCID: PMC3710402 DOI: 10.1037/a0032745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs.
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Affiliation(s)
- Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10038, USA.
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Pecoraro A, Horton T, Ewen E, Becher J, Wright PA, Silverman B, McGraw P, Woody GE. Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment. Addict Sci Clin Pract 2012. [PMID: 23185969 PMCID: PMC3507657 DOI: 10.1186/1940-0640-7-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients. Methods Program-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable). Results Between September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% ($68,422) decrease in inpatient medical admissions; a 13% ($3,308) decrease in emergency department visits; a 32% ($18,119) decrease in BH/SA inpatient admissions, and a 32% ($963) increase in outpatient BH/SA admissions, for an overall decrease of $88,886. Conclusions These findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.
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Affiliation(s)
- Anna Pecoraro
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jahn-Eimermacher A, Ingel K, Schneider A. Sample size in cluster-randomized trials with time to event as the primary endpoint. Stat Med 2012; 32:739-51. [PMID: 22865817 DOI: 10.1002/sim.5548] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/07/2022]
Abstract
In cluster-randomized trials, groups of individuals (clusters) are randomized to the treatments or interventions to be compared. In many of those trials, the primary objective is to compare the time for an event to occur between randomized groups, and the shared frailty model well fits clustered time-to-event data. Members of the same cluster tend to be more similar than members of different clusters, causing correlations. As correlations affect the power of a trial to detect intervention effects, the clustered design has to be considered in planning the sample size. In this publication, we derive a sample size formula for clustered time-to-event data with constant marginal baseline hazards and correlation within clusters induced by a shared frailty term. The sample size formula is easy to apply and can be interpreted as an extension of the widely used Schoenfeld's formula, accounting for the clustered design of the trial. Simulations confirm the validity of the formula and its use also for non-constant marginal baseline hazards. Findings are illustrated on a cluster-randomized trial investigating methods of disseminating quality improvement to addiction treatment centers in the USA.
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Affiliation(s)
- Antje Jahn-Eimermacher
- Institute of Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg-University, Langenbeckstr.1, 55131 Mainz, Germany.
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Gustafson DH. Essential Ingredients for Successful Redesign of Addiction Treatment. THE BRIDGE 2012; 2:v2i2_article01. [PMID: 25243237 PMCID: PMC4167070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Since the passage of healthcare reform, there have been many discussions about how the mental health and substance use disorder (MH/SUD) system will need to change. Of the many components involved in a system redesign, the identification of essential ingredients is crucial to its success. In an effort to determine what essential ingredients the new MH/SUD system requires to optimally meet the needs of its customers, we convened a group of 16 multi-industrial experts who analyzed data collected from a string of 7 focus groups and 15 interviews with people dealing with or working in the SUD field. This paper summarizes the 11 essential ingredients our group identified.
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