1
|
Herschell AD, Kolko DJ, Scudder AT, Taber-Thomas SM, Schaffner KF, Hart JA, Mrozowski SJ, Hiegel SA, Iyengar S, Metzger A, Jackson CB. A Statewide Randomized Controlled Trial to Compare Three Models for Implementing Parent Child Interaction Therapy. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:780-796. [PMID: 34928748 DOI: 10.1080/15374416.2021.2001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359) evaluated the effectiveness of three training models to implement a well-established evidence-based treatment, Parent-Child Interaction Therapy (PCIT). METHOD Fifty licensed outpatient clinics, including 100 clinicians, 50 supervisors, and 50 administrators were randomized to one of three training conditions: 1) Learning Collaborative (LC), 2) Cascading Model (CM) or 3) Distance Education (DE). Data to assess training and implementation outcomes were collected at 4 time points coinciding with the training period: baseline, 6- (mid), 12- (post), and 24-months (1-year follow-up). RESULTS Multi-level hierarchical linear growth modeling was used to examine changes over time in training outcomes. Results indicate that clinicians in CM were more likely to complete training, reported high levels of training satisfaction and better learning experiences compared to the other training conditions. However, supervisors in the LC condition reported greater learning experiences, higher levels of knowledge, understanding of treatment, and satisfaction compared to supervisors in other conditions. Although clinicians and supervisors in the DE condition did not outperform their counterparts on any outcomes, their performance was comparable to both LC and CM in terms of PCIT use, supervisor perceived acceptability, feasibility, system support, and clinician satisfaction. CONCLUSIONS Through the use of a randomized controlled design and community implementation, this study contributes to the current understanding of the impact of training design on implementation of PCIT. Results also indicate that although in-person training methods may produce more positive clinician and supervisor outcomes, training is not a one-size-fits-all model, with DE producing comparable results on some variables.
Collapse
Affiliation(s)
- Amy D Herschell
- Community Care Behavioral Health Organization, UPMC Insurance Services Division
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - David J Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ashley T Scudder
- Department of Human Development & Family Studies, Iowa State University
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Making Implementation Last: The Impact of Training Design on the Sustainability of an Evidence-Based Treatment in a Randomized Controlled Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:757-767. [PMID: 33728558 DOI: 10.1007/s10488-021-01126-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over time. The current study examined the sustainability of one evidence-based treatment, Parent-Child Interaction Therapy (PCIT), following a statewide implementation trial testing three training methods: Cascading Model, Learning Collaborative, and Distance Education. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Clinicians and administrators reported on sustainability at 24-months, as measured by the number of clients receiving PCIT and the continued use of the PCIT protocol. Multi-level path analysis was utilized to examine the role of training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months. Clinicians in the Cascading Model reported greater average PCIT caseloads at 24-months, whereas clinicians in the Learning Collaborative reported greater full use of the PCIT protocol at 24-months. Attending consultation calls was associated with delivering PCIT to fewer families. Implications for the sustainable delivery of PCIT beyond the training year as well as for the broader field of implementation science are discussed.
Collapse
|
3
|
Hah JM, Trafton JA, Narasimhan B, Krishnamurthy P, Hilmoe H, Sharifzadeh Y, Huddleston JI, Amanatullah D, Maloney WJ, Goodman S, Carroll I, Mackey SC. Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): A prospective, assessor-blind, randomized controlled pilot trial. EClinicalMedicine 2020; 28:100596. [PMID: 33294812 PMCID: PMC7700897 DOI: 10.1016/j.eclinm.2020.100596] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Postoperative opioid use can lead to chronic use and misuse. Few studies have examined effective approaches to taper postoperative opioid use while maintaining adequate analgesia. METHODS This randomized, assessor-blinded, pilot trial of postoperative motivational interviewing and guided opioid tapering support (MI-Opioid Taper) added to usual care (UC) enrolled patients undergoing total hip or knee arthroplasty at a single U.S. academic medical center. MI-Opioid Taper involved weekly (to seven weeks) and monthly (to one year) phone calls until patient-reported opioid cessation. Opioid tapering involved 25% weekly dose reductions. The primary feasibility outcome was study completion in the group to which participants were randomized. The primary efficacy outcome, time to baseline opioid use, was the first of five consecutive days of return to baseline preoperative dose. Intention-to-treat analysis with Cox proportional hazards regression was adjusted for operation. ClinicalTrials.gov registration: NCT02070003. FINDINGS From November 26, 2014, to April 27, 2018, 209 patients were screened, and 104 patients were assigned to receive MI-Opioid Taper (49 patients) or UC only (55 patients). Study completion after randomization was similar between groups (96.4%, 53 patients receiving UC, 91.8%, 45 patients receiving MI-Opioid Taper). Patients receiving MI-Opioid Taper had a 62% increase in the rate of return to baseline opioid use after surgery (HR 1.62; 95%CI 1.06-2.46; p = 0•03). No trial-related adverse events occurred. INTERPRETATION In patients undergoing total joint arthroplasty, MI-Opioid Taper is feasible and future research is needed to establish the efficacy of MI-Opioid Taper to promote postoperative opioid cessation. FUNDING National Institute on Drug Abuse.
Collapse
Affiliation(s)
- Jennifer M. Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, 1070 Arastradero Rd., Suite 200, Stanford, CA 94304, United States
- Corresponding author.
| | - Jodie A. Trafton
- Psychiatry and Behavioral Sciences, Stanford University, Director, VA Program Evaluation and Resource Center, VHA Office of Mental Health and Suicide Prevention, Menlo Park, CA, United States
| | - Balasubramanian Narasimhan
- Department of Statistics, Department of Biomedical Data Sciences, Stanford University, Stanford CA, United States
| | - Partha Krishnamurthy
- Department of Marketing and Entrepreneurship, C. T. Bauer College of Business, University of Houston, Houston, Texas, United States
| | - Heather Hilmoe
- Stanford Systems Neuroscience and Pain Lab, Stanford University, Stanford, California, United States
| | - Yasamin Sharifzadeh
- Stanford Systems Neuroscience and Pain Lab, Stanford University, Stanford, California, United States
| | - James I. Huddleston
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, United States
| | - Derek Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, United States
| | | | - Stuart Goodman
- Department of Orthopaedic Surgery and (by courtesy) Bioengineering, Department of Orthopaedic Surgery, Stanford University, United States
| | - Ian Carroll
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California, United States
| | - Sean C. Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, United States
| |
Collapse
|
4
|
Carcone AI, Naar S, Clark J, MacDonell K, Zhang L. Provider behaviors that predict motivational statements in adolescents and young adults with HIV: a study of clinical communication using the Motivational Interviewing framework. AIDS Care 2019; 32:1069-1077. [PMID: 31621396 DOI: 10.1080/09540121.2019.1679709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Medical care providers' use of Motivational Interviewing (MI) is linked to improved medication adherence, viral load, and associated behaviors in adolescents and young adults living with HIV. Mastering MI is difficult for busy providers; however, tailoring MI training to the specific MI communication strategies most relevant for HIV treatment context may be a strategy to increase proficiency. The present study aimed to identify communication strategies likely to elicit motivational statements among adolescent-young adult patients living with HIV. Language used by MI-exposed providers during 80 HIV medical clinic visits was transcribed and coded to characterize patient-provider communication within the MI framework. Sequential analysis, an approach to establish empirical support for the order of behavioral events, found patients were more likely to express motivational statements after provider questions phrased to elicit motivation, reflections of motivational statements, and statements emphasizing patients' decision-making autonomy. Patients were more likely to express amotivational statements when providers asked questions phrased to elicit amotivational statements or reflected amotivational language. Training providers to strategically phrase their questions and reflections to elicit change language and to emphasize patients' autonomy may be critical skills for working with adolescents and young adults living with HIV.
Collapse
Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Research, Florida State University, Tallahassee, Florida, USA
| | - Jamie Clark
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Liying Zhang
- Biostatistics and Epidemiology Research Design Core, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
5
|
Parsons JT, Starks T, Gurung S, Cain D, Marmo J, Naar S. Clinic-Based Delivery of the Young Men's Health Project (YMHP) Targeting HIV Risk Reduction and Substance Use Among Young Men Who Have Sex with Men: Protocol for a Type 2, Hybrid Implementation-Effectiveness Trial. JMIR Res Protoc 2019; 8:e11184. [PMID: 31115346 PMCID: PMC6547767 DOI: 10.2196/11184] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/31/2018] [Accepted: 01/31/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) are disproportionately at risk for HIV and sexually transmitted infections. Adapting and testing the effectiveness of the Young Men's Health Project (YMHP), an efficacious intervention designed to reduce substance use and condomless anal sex (CAS) among YMSM, at clinics in Miami, Detroit, and Philadelphia has the potential to reduce HIV and STI disparities among urban YMSM. OBJECTIVE This study (Adolescent Medicine Trials Network for HIV/AIDS Interventions [ATN] 145 YMHP) aims to adapt YMHP for clinic and remote delivery by existing clinic staff and compare their effectiveness in real-world adolescent HIV clinics. This protocol is part of the ATN Scale It Up program described in a recently published article by Naar et al. METHODS This is a comparative effectiveness hybrid type-2 trial of the YMHP intervention with 2 delivery formats-clinic-based versus remote delivery-offered following HIV counseling and testing. Phase 1 includes conducting focus groups with youth to obtain implementation feedback about the delivery of the YMHP intervention and intervention components to ensure culturally competent, feasible, and scalable implementation. Phase 2 includes recruitment and enrollment of 270 YMSM, aged 15 to 24 years, 90 at each of the 3 sites. Enrollment will be limited to HIV-negative YMSM who report recent substance use and either CAS or a positive STI test result. Participants will be randomized to receive the YMHP intervention either in person or by remote delivery. Both conditions involve completion of the 4 YMHP sessions and the delivery of pre-exposure prophylaxis information and navigation services. A minimum of 2 community health workers (CHWs) will be trained to deliver the intervention sessions at each site. Sessions will be audio-recorded for Motivational Interviewing Treatment Integrity (MITI) fidelity coding, and CHWs and supervisors will be given implementation support throughout the study period. RESULTS Phase 1 focus groups were completed in July 2017 (n=25). Feedback from these focus groups at the 3 sites informed adaptations to the YMHP intervention manual, implementation of the intervention, and recruitment plans for phase 2. Baseline enrollment for phase 2 began in November 2018, and assessments will be at immediate posttest (IP)-, 3-, 6-, 9-, and 12-months after the intervention. Upon collection of both baseline and follow-up data, we will compare the effectiveness and cost-effectiveness of clinic-based versus remote delivery of YMHP in the context of health care access. CONCLUSIONS We are conducting YMHP in 3 cities with high rates of YMSM at risk for HIV and STIs. When adapted for real-world clinics, this study will help substance-using YMSM at risk for HIV and STIs and allow us to examine differences in effectiveness and cost by the method of delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT03488914; https://clinicaltrials.gov/ct2/show/NCT03488914 (Archived by WebCite at http://www.webcitation.org/770WaWWfi). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/11184.
Collapse
Affiliation(s)
- Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Hunter Department of Psychology, Hunter College, City University of New York, New York, NY, United States.,Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States
| | - Tyrel Starks
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Hunter Department of Psychology, Hunter College, City University of New York, New York, NY, United States.,Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States
| | - Sitaji Gurung
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Demetria Cain
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Jonathan Marmo
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Sylvie Naar
- College of Medicine, Florida State University, Tallahassee, FL, United States
| |
Collapse
|
6
|
Lord SE, Seavey KM, Oren SD, Budney AJ, Marsch LA. Digital Presence of a Research Center as a Research Dissemination Platform: Reach and Resources. JMIR Ment Health 2019; 6:e11686. [PMID: 30950800 PMCID: PMC6473206 DOI: 10.2196/11686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based platforms can be powerful tools for research dissemination. By leveraging the advantages of mass media and interpersonal channels of communication, Web-based dissemination platforms may improve awareness about, and subsequent adoption of, evidence-based practices (EBPs). Digital dissemination strategies can augment traditional dissemination models, improving stakeholder access to digestible and actionable information and promoting translation of EBPs. OBJECTIVE This study aimed to describe the reach and content of the Web presence of a National Institute on Drug Abuse Center of Excellence and how it is used to disseminate research related to digital behavioral health approaches. METHODS The Center for Technology and Behavioral Health (CTBH) has a website and regularly updated Facebook and Twitter accounts. The website features include summaries of digital behavioral health approaches and related empirical literature, a blog feed focused on the state of the science and technology concerning digital health care approaches, and a newsletter about Center activities. We extracted website usage metrics from Google Analytics and follower counts from social media accounts for the period from March 1, 2013, to July 17, 2018. RESULTS Since the implementation of analytic tracking, 70,331 users have initiated 96,995 sessions on the CTBH website. The website includes summaries of 86 digital therapeutic programs, encompassing 447 empirical articles. There are 1160 posts in the CTBH blog feed, including 180 summaries of scholarly articles. The Twitter and Facebook accounts have 577 and 1500 followers, respectively. The newsletter has reached a growing subscriber network and has a high open rate relative to industry standards. CONCLUSIONS The CTBH Web presence serves as a model for how to leverage accessible and easily updatable digital platforms as research dissemination channels. Digital dissemination tools can augment traditional dissemination strategies to promote awareness about evidence-based digital therapeutic approaches for behavioral health and health care more broadly.
Collapse
Affiliation(s)
- Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Katherine M Seavey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sonia D Oren
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
7
|
Boyce CA, Barfield W, Curry J, Shero S, Green Parker M, Cox H, Bustillo J, Price LN. Building the Next Generation of Implementation Science Careers to Advance Health Equity. Ethn Dis 2019; 29:77-82. [PMID: 30906153 DOI: 10.18865/ed.29.s1.77] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rapid advancements in translational research have produced innovative clinical discoveries and evidence-based interventions that are ready for uptake in real-world settings, creating vast opportunities and challenges for implementation science. However, there is an inadequate research workforce to study effective strategies and delivery of implementation to advance the field. Novel career development initiatives will build scholars for the next generation of implementation science to bridge research to practice for diverse populations to advance health equity, specifically with a strategic focus on heart, lung, blood and sleep diseases and conditions. Along with traditional mentoring and curricula, research training includes state-of-the-art approaches using complex methods and multi-disciplinary collaborations between researchers, practice settings, and diverse communities. Implementation science scholars strive not only to decrease the lag time between the discovery of evidence-based interventions and successful implementation but also how to advance health equity and to reduce disparities for underserved populations that suffer disproportionally.
Collapse
Affiliation(s)
- Cheryl Anne Boyce
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Whitney Barfield
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Jennifer Curry
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Susan Shero
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Melissa Green Parker
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Helen Cox
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Jazmin Bustillo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - LeShawndra N Price
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| |
Collapse
|
8
|
McLeod BD, Cox JR, Jensen-Doss A, Herschell A, Ehrenreich-May J, Wood JJ. Proposing a Mechanistic Model of Clinician Training and Consultation. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018; 25:e12260. [PMID: 30713369 PMCID: PMC6353552 DOI: 10.1111/cpsp.12260] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To make evidence-based treatments deliverable, effective, and scalable in community settings, it is critical to develop a workforce that can deliver evidence-based treatments as designed with skill. However, the science and practice of clinician training and consultation lags behind other areas of implementation science. In this paper, we present the Longitudinal Education for Advancing Practice (LEAP) model designed to help span this gap. The LEAP model is a mechanistic model of clinician training and consultation that details how training inputs, training and consultation strategies, and mechanisms of learning influence training outcomes. We first describe the LEAP model and then discuss how key implications of the model can be used to develop effective training and consultation strategies.
Collapse
Affiliation(s)
- Bryce D McLeod
- Virginia Commonwealth University, Department of Psychology
| | - Julia R Cox
- Virginia Commonwealth University, Department of Psychology
| | | | | | | | - Jeffrey J Wood
- Departments of Education and Psychiatry, University of California
| |
Collapse
|
9
|
Miguel AQC, Madruga CS, Simões V, Yamauchi R, da Silva CJ, Abdalla RR, McDonell M, McPherson S, Roll JM, Mari JJ, Laranjeira RR. Crack cocaine users views regarding treatment with contingency management in Brazil. Subst Abuse Treat Prev Policy 2018; 13:7. [PMID: 29433535 PMCID: PMC5809835 DOI: 10.1186/s13011-018-0144-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/30/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Contingency management (CM) has recently shown efficacy in promoting abstinence and retention in treatment among crack cocaine users in Brazil. However, partially because of unawareness and resistance among health care providers, CM has not been widely employed. The objective of this study was to conduct a secondary analysis in order to evaluate how CM participants perceive their treatment experience. METHODS Twenty-seven crack cocaine users, previously assigned to 12 weeks of CM treatment, were assessed with a structured questionnaire designed to assess their personal opinion of, difficulty in understanding, and acceptance of the CM intervention, as well as their opinion regarding its impact on their treatment responses. RESULTS Descriptive analyses showed that 92.6% of the participants found it very easy to understand the CM protocol. All participants reported liking their CM experience quite a bit. For the perceived effects of CM on their treatment response, 81.5% of the participants stated that CM helped them considerably, the mean score for the impact of CM on treatment response (out of a maximum of 10) being 9 (SD = 1.5). When asked if they believed CM could help other people with crack cocaine dependence, 92.6% of the participants stated that CM could help such people a lot and 7.4% stated that it could help them a little. CONCLUSIONS From the perspective of the patients, CM was easily assimilated, easily accepted, and had a direct positive effect on treatment response. These findings provide additional support for the incorporation of CM into substance abuse treatment services in Brazil.
Collapse
Affiliation(s)
- André Q C Miguel
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
- Department of Psychiatry and Medical Psychology of the Federal University of São Paulo- UNIFESP, São Paulo, Brazil.
| | - Clarice S Madruga
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Psychiatry and Medical Psychology of the Federal University of São Paulo- UNIFESP, São Paulo, Brazil
| | - Viviane Simões
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Rodolfo Yamauchi
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Claudio J da Silva
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Renata R Abdalla
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Psychiatry and Medical Psychology of the Federal University of São Paulo- UNIFESP, São Paulo, Brazil
| | - Michael McDonell
- Program of Excellence in Addictions Research, Washington State University, Spokane, USA
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, Spokane, USA
| | - John M Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, USA
| | - Jair J Mari
- Department of Psychiatry and Medical Psychology of the Federal University of São Paulo- UNIFESP, São Paulo, Brazil
| | - Ronaldo R Laranjeira
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department Psychiatry and Medical Psychology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Psychiatry and Medical Psychology of the Federal University of São Paulo- UNIFESP, São Paulo, Brazil
| |
Collapse
|
10
|
Martino S, Paris M, Añez L, Nich C, Canning-Ball M, Hunkele K, Olmstead TA, Carroll KM. The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial. J Subst Abuse Treat 2016; 68:11-23. [PMID: 27431042 DOI: 10.1016/j.jsat.2016.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/22/2016] [Accepted: 04/27/2016] [Indexed: 11/18/2022]
Abstract
The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to supervision-as-usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite hybrid type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices.
Collapse
Affiliation(s)
- Steve Martino
- VA Connecticut Healthcare System, Psychology Service, 950 Campbell Avenue, West Haven, CT, 06516, USA; Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Manuel Paris
- Yale University School of Medicine, The Hispanic Clinic, 25 Park Street, New Haven, CT, 06511, USA.
| | - Luis Añez
- Yale University School of Medicine, The Hispanic Clinic, 25 Park Street, New Haven, CT, 06511, USA.
| | - Charla Nich
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Monica Canning-Ball
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Karen Hunkele
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Todd A Olmstead
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX, 78713, USA; Seton/UT Clinical Research Institute, 1400 North IH 35, Austin, TX, 78701, USA.
| | - Kathleen M Carroll
- Yale University School of Medicine, Department of Psychiatry, Division of Substance Abuse, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| |
Collapse
|
11
|
Herschell AD, Kolko DJ, Scudder AT, Taber-Thomas S, Schaffner KF, Hiegel SA, Iyengar S, Chaffin M, Mrozowski S. Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment. Implement Sci 2015; 10:133. [PMID: 26416029 PMCID: PMC4586014 DOI: 10.1186/s13012-015-0324-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/10/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes. METHODS/DESIGN This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment). DISCUSSION This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective. TRIAL REGISTRATION ClinicalTrials.gov: NCT02543359.
Collapse
Affiliation(s)
- Amy D Herschell
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - David J Kolko
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley T Scudder
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | - Satish Iyengar
- University of Pittsburgh Department of Statistics, Pittsburgh, PA, USA
| | - Mark Chaffin
- Georgia State University School of Public Health, Atlanta, GA, USA
| | - Stanley Mrozowski
- Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg, PA, USA
| |
Collapse
|
12
|
Horigian VE, Marín-Navarrete RA, Verdeja RE, Alonso E, Perez MA, Fernández-Mondragón J, Berlanga C, Medina-Mora ME, Szapocznik J. Technology transfer for the implementation of a clinical trials network on drug abuse and mental health treatment in Mexico. Rev Panam Salud Publica 2015; 38:233-42. [PMID: 26758002 PMCID: PMC6896211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 04/16/2015] [Indexed: 06/05/2023] Open
Abstract
Low- and middle-income countries (LMIC) lack the research infrastructure and capacity to conduct rigorous substance abuse and mental health effectiveness clinical trials to guide clinical practice. A partnership between the Florida Node Alliance of the United States National Drug Abuse Treatment Clinical Trials Network and the National Institute of Psychiatry in Mexico was established in 2011 to improve substance abuse practice in Mexico. The purpose of this partnership was to develop a Mexican national clinical trials network of substance abuse researchers and providers capable of implementing effectiveness randomized clinical trials in community-based settings. A technology transfer model was implemented and ran from 2011-2013. The Florida Node Alliance shared the "know how" for the development of the research infrastructure to implement randomized clinical trials in community programs through core and specific training modules, role-specific coaching, pairings, modeling, monitoring, and feedback. The technology transfer process was bi-directional in nature in that it was informed by feedback on feasibility and cultural appropriateness for the context in which practices were implemented. The Institute, in turn, led the effort to create the national network of researchers and practitioners in Mexico and the implementation of the first trial. A collaborative model of technology transfer was useful in creating a Mexican researcher-provider network that is capable of changing national practice in substance abuse research and treatment. Key considerations for transnational technology transfer are presented.
Collapse
Affiliation(s)
- Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | | | - Rosa E Verdeja
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | - Elizabeth Alonso
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | - María A Perez
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| | | | - Carlos Berlanga
- Instituto Nacional de Psiquiatría Ramón de La Fuente, Mexico City, Mexico
| | | | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, United States of America,
| |
Collapse
|
13
|
Rieckmann T, Abraham A, Zwick J, Rasplica C, McCarty D. A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation. Health Serv Res 2015; 50:1125-45. [PMID: 25532616 PMCID: PMC4545350 DOI: 10.1111/1475-6773.12273] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). DATA SOURCES/STUDY SETTING Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009. STUDY DESIGN/DATA COLLECTION The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. PRINCIPAL FINDINGS Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. CONCLUSIONS Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.
Collapse
Affiliation(s)
- Traci Rieckmann
- Address correspondence to Traci Rieckmann, Ph.D., Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., CSB 669, Portland, OR 97239; e-mail:
| | - Amanda Abraham
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Janet Zwick
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Caitlin Rasplica
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Dennis McCarty
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| |
Collapse
|
14
|
Gainforth HL, Latimer-Cheung AE, Davis C, Casemore S, Martin Ginis KA. Testing the feasibility of training peers with a spinal cord injury to learn and implement brief action planning to promote physical activity to people with spinal cord injury. J Spinal Cord Med 2015; 38:515-25. [PMID: 25429692 PMCID: PMC4612207 DOI: 10.1179/2045772314y.0000000239] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The present study tested the feasibility of training peers with spinal cord injury (SCI) to learn brief action planning (BAP), an application of motivational interviewing principles, to promote physical activity to mentees with SCI. METHOD Thirteen peers with SCI attended a half-day BAP workshop. Using a one-arm, pre-, post-test design, feasibility to learn BAP was assessed in terms of peers' (1) BAP and motivational interviewing spirit competence; (2) training satisfaction; and (3) motivations to use BAP as assessed by measures of the theory of planned behavior constructs. Measures were taken at baseline, immediately post-training, and 1 month follow up. RESULTS Following the training, participants' BAP and motivational interviewing competence significantly increased (P's < 0.05, d's > 2.27). Training satisfaction was very positive with all means falling above the scale midpoint. Participants' perceived behavioral control to use BAP increased from baseline to post (P < 0.05, d = 0.91) but was not maintained at follow up (P > 0.05). CONCLUSION Training peers with a SCI to learn to use BAP is feasible. PRACTICAL IMPLICATIONS BAP is a tool that can be feasibly learned by peers to promote physical activity to their mentees.
Collapse
Affiliation(s)
- Heather L. Gainforth
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Amy E. Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada,Correspondence to: Amy Latimer-Cheung, School of Kinesiology and Health Studies, Queens University, SKHS Building, 28 Division Street, Kingston, ON K7L 3N6, Canada.
| | - Connie Davis
- Centre for Collaboration, Motivation and Innovation, Hope, BC, Canada
| | | | | |
Collapse
|
15
|
Hartzler B. Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: preliminary psychometrics. J Subst Abuse Treat 2015; 55:52-7. [PMID: 25770870 DOI: 10.1016/j.jsat.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 11/15/2022]
Abstract
A paper/pencil instrument, adapted from Miller and colleagues' (1991) Helpful Responses Questionnaire (HRQ), was developed to assess clinician skill with core communicative aspects involved in delivering contingency management (CM). The instrument presents a single vignette consisting of six points of client dialogue to which respondents write 'what they would say next.' In the context of an implementation/effectiveness hybrid trial, 19 staff clinicians at an opiate treatment program completed serial training outcome assessments before, following, and three months after CM training. Assessments included this adaptation of the HRQ, a multiple-choice CM knowledge test, and a recorded standardized patient encounter scored for CM skillfulness. Study results reveal promising psychometric properties for the instrument, including strong scoring reliability, internal consistency, concurrent and predictive validity, test-retest reliability and sensitivity to training effects. These preliminary findings suggest the instrument is a viable, practical method to assess clinician skill in communicative aspects of CM delivery.
Collapse
Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| |
Collapse
|
16
|
Knudsen HK, Roman PM. Innovation attributes and adoption decisions: perspectives from leaders of a national sample of addiction treatment organizations. J Subst Abuse Treat 2015; 49:1-7. [PMID: 25218918 PMCID: PMC4277913 DOI: 10.1016/j.jsat.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/30/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Abstract
Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year ("recent adoption"), (2) plans to adopt an innovation in the upcoming year ("planned adoption"), or (3) no actual or planned adoption ("non-adoption"). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n=93) or planned adoption (n=62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program's treatment philosophy (mean=4.47, SD=1.03), improvement in the program's reputation with referral sources (mean=4.00, SD=1.33), reputational improvement with clients and their families (mean=3.98, SD=1.31), and reductions in treatment dropout (mean=3.75, SD=1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may enhance efforts to increase subsequent adoption.
Collapse
Affiliation(s)
- Hannah K Knudsen
- University of Kentucky, Department of Behavioral Science, 141 Medical Behavioral Science Building, Lexington, KY 40536-0086.
| | - Paul M Roman
- University of Georgia, Owens Institute for Behavioral Research and Department of Sociology, 106 Barrow Hall, Athens, GA, 30602-2401.
| |
Collapse
|
17
|
Knudsen HK, Roman PM. The transition to medication adoption in publicly funded substance use disorder treatment programs: organizational structure, culture, and resources. J Stud Alcohol Drugs 2014; 75:476-85. [PMID: 24766760 DOI: 10.15288/jsad.2014.75.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. METHOD Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. RESULTS Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. CONCLUSIONS Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Paul M Roman
- Owens Institute for Behavioral Research and Department of Sociology, University of Georgia, Athens, Georgia
| |
Collapse
|
18
|
Carroll KM. Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice. Ann N Y Acad Sci 2014; 1327:94-111. [PMID: 25204847 PMCID: PMC4206586 DOI: 10.1111/nyas.12501] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the treatment of addictions, the gap between the availability of evidence-based therapies and their limited implementation in practice has not yet been bridged. Two empirically validated behavioral therapies, contingency management (CM) and cognitive behavioral therapy (CBT), exemplify this challenge. Both have a relatively strong level of empirical support but each has weak and uneven adoption in clinical practice. This review highlights examples of how barriers to their implementation in practice have been addressed systematically, using the Stage Model of Behavioral Therapies Development as an organizing framework. For CM, barriers such as cost and ideology have been addressed through the development of lower-cost and other adaptations to make it more community friendly. For CBT, barriers such as relative complexity, lack of trained providers, and need for supervision have been addressed via conversion to standardized computer-assisted versions that can serve as clinician extenders. Although these and other modifications have rendered both interventions more disseminable, diffusion of innovation remains a complex, often unpredictable process. The existing specialty addiction-treatment system may require significant reforms to fully implement CBT and CM, particularly greater focus on definable treatment goals and performance-based outcomes.
Collapse
Affiliation(s)
- Kathleen M Carroll
- Division of Substance Abuse, Yale University School of Medicine, West Haven, Connecticut
| |
Collapse
|
19
|
Development of an Instrument to Characterize Methodological and Collaborative Factors that May Influence Community-Based Clinician Post-Trial Adoption of Clinical Research Interventions. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
20
|
Winstanley EL, Brigham GS, Babcock D, Winhusen T. Improving treatment for opioid dependence: a perspective from the Ohio Valley node of the NIDA Clinical Trials Network. Prog Community Health Partnersh 2014; 8:99-107. [PMID: 24859107 DOI: 10.1353/cpr.2014.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PROBLEM Rates of adoption of evidenced-based practices, including the use of medications, to treat opioid dependence are low and severely limit secondary prevention efforts to curtail the prescription drug epidemic. PURPOSE The goal of this article was to describe how involvement in a research clinical trials network (CTN) facilitated the adoption of medications to treat opioid dependence at two community-based treatment programs (CTPs) affiliated with the Ohio Valley Node (OVN) of the National Institute on Drug Abuse's (NIDA) CTN. KEY POINTS Participation in a CTN may facilitate adoption by providing the infrastructure for trialability and observability, but the most critical function may be the knowledge translation that occurs through the individual-level professional relationships that develop. CONCLUSION Community-based treatment providers' involvement in research networks may increase the rate of evidence-based practice (EBP) adoption and improve outcomes for patients with opioid dependence.
Collapse
|
21
|
Rieckmann TR, Abraham AJ, Kovas AE, McFarland BH, Roman PM. Impact of research network participation on the adoption of buprenorphine for substance abuse treatment. Addict Behav 2014; 39:889-96. [PMID: 24594902 DOI: 10.1016/j.addbeh.2014.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 01/18/2014] [Accepted: 01/29/2014] [Indexed: 11/24/2022]
Abstract
There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.
Collapse
|
22
|
Menear M, Briand C. Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1-review of major initiatives and implementation strategies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:178-86. [PMID: 25007110 PMCID: PMC4079135 DOI: 10.1177/070674371405900402] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 10/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review. METHOD Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted. RESULTS Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described. CONCLUSION Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.
Collapse
Affiliation(s)
- Matthew Menear
- Student, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec
| | - Catherine Briand
- Associate Professor, School of Rehabilitation, University of Montreal, Montreal, Quebec; Researcher, Centre d'études sur la réadaptation, le rétablissement et l'insertion sociale (CÉRRIS), Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| |
Collapse
|
23
|
Briand C, Menear M. Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 2-review of critical implementation issues. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:187-95. [PMID: 25007111 PMCID: PMC4079132 DOI: 10.1177/070674371405900403] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 10/01/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In North America and internationally, efforts have been made to reduce the gaps between knowledge of psychosocial evidence-based practices (EBPs) and the delivery of such services in routine mental health practice. Part 2 of this review identifies key issues for stakeholders to consider when implementing comprehensive psychosocial EBPs for people with severe mental illness (SMI). METHOD A rapid review of the literature was conducted. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, and psychosocial practices and implementation. The Consolidated Framework for Implementation Research (CFIR) was used to structure findings according to key domains and constructs known to influence the implementation process. RESULTS The CFIR allowed us to identify 17 issues reflecting more than 30 constructs of the framework that were viewed as influential to the process of implementing evidence-based psychosocial interventions for people with SMI. Issues arising at different levels of influence (intervention, individual, organizational, and system) and at all phases of the implementation process (planning, engagement, execution, and evaluation) were found to play important roles in implementation. CONCLUSION The issues identified in this review should be taken into consideration by stakeholders when engaging in efforts to promote uptake of new psychosocial EBPs and to widen the range of effective psychosocial services available in routine mental health care.
Collapse
Affiliation(s)
- Catherine Briand
- Associate Professor, School of Rehabilitation, University of Montreal, Montreal, Quebec; Researcher, Centre d’études sur la réadaptation, le rétablissement et l’insertion sociale (CÉRRIS), Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| | - Matthew Menear
- Student, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec
| |
Collapse
|
24
|
Valdiserri R, Khalsa J, Dan C, Holmberg S, Zibbell J, Holtzman D, Lubran R, Compton W. Confronting the emerging epidemic of HCV infection among young injection drug users. Am J Public Health 2014; 104:816-21. [PMID: 24625174 DOI: 10.2105/ajph.2013.301812] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus infection is a significant public health problem in the United States and an important cause of morbidity and mortality. Recent reports document HCV infection increases among young injection drug users in several US regions, associated with America's prescription opioid abuse epidemic. Incident HCV infection increases among young injectors who have recently transitioned from oral opioid abuse present an important public health challenge requiring a comprehensive, community-based response. We summarize recommendations from a 2013 Office of HIV/AIDS and Infectious Disease Policy convening of experts in epidemiology, behavioral science, drug prevention and treatment, and other research; community service providers; and federal, state, and local government representatives. Their observations highlight gaps in our surveillance, program, and research portfolios and advocate a syndemic approach to this emerging public health problem.
Collapse
Affiliation(s)
- Ronald Valdiserri
- Ronald Valdiserri and Corinna Dan are with the Office of HIV/AIDS and Infectious Disease Policy, US Department of Health and Human Services, Washington, DC. Jag Khalsa and Wilson Compton are with the National Institute on Drug Abuse, Bethesda, MD. Robert Lubran is with the Substance Abuse and Mental Health Services Administration, Rockville, MD. Scott Holmberg, Jon Zibbell, and Deborah Holtzman are with the Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Hartzler B, Rabun C. Training addiction professionals in empirically supported treatments: perspectives from the treatment community. Subst Abus 2014; 35:30-6. [PMID: 24588290 PMCID: PMC3947611 DOI: 10.1080/08897077.2013.789816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Large-scale dissemination efforts seek to expand opportunities for the addiction treatment community to receive training in empirically supported treatments (ESTs). Prospective consumers of such training are valuable sources of input about content of interest, preferences for how training events are structured, and obstacles that deter receipt of training. METHODS In this mixed-method study, data were collected in 64 semistructured individual interviews with personnel during site visits to 16 community opioid treatment programs (OTPs). At each OTP, interviews were completed with the executive director, a clinical supervisor, and 2 direct-service clinicians. Topical interests were analyzed qualitatively in a cultural domain analysis. Likert ratings of training event preferences were analyzed via generalized linear mixed models (GLMMs), and unstructured interviewee comments were analyzed via narrative analysis. Obstacles to training receipt were analyzed qualitatively with both content coding and narrative analysis. RESULTS Based on topics of reported interest, cultural domain analysis suggests as ESTs of note: Multidimensional Family Therapy, Motivational Enhancement Therapy, Relapse Prevention Therapy, "Seeking Safety," and broad addiction-focused pharmacotherapy. Regarding training event preferences, GLMMs and narrative analysis revealed clear preferences for time-distributed trainings and use of participatory activities (e.g., trainer demonstrations, role plays, small group exercises). Content coding identified cost as the primary obstacle to receipt of EST trainings, followed by lack of time, logistical challenges, and disinterest, and narrative analysis elaborated on contextual issues underlying these obstacles. CONCLUSIONS As primary consumers of EST technologies, the treatment community has valuable input to offer. Dissemination efforts may be enhanced by greater consideration of their preferences for training content and event structure, as well as practical obstacles that challenge their receipt of training.
Collapse
Affiliation(s)
- Bryan Hartzler
- a Alcohol and Drug Abuse Institute , University of Washington , Seattle , Washington , USA
| | | |
Collapse
|
26
|
Hartzler B, Jackson TR, Jones BE, Beadnell B, Calsyn DA. Disseminating contingency management: impacts of staff training and implementation at an opiate treatment program. J Subst Abuse Treat 2013; 46:429-38. [PMID: 24462242 DOI: 10.1016/j.jsat.2013.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 12/15/2022]
Abstract
Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study's collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.
Collapse
Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105.
| | - T Ron Jackson
- School of Social Work, University of Washington, Seattle, WA 98105; Evergreen Treatment Services, Seattle, WA 98134
| | - Brinn E Jones
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105
| | - Blair Beadnell
- School of Social Work, University of Washington, Seattle, WA 98105
| | - Donald A Calsyn
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA 98105; Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98105
| |
Collapse
|
27
|
The relationship between Clinical Trial Network protocol involvement and quality of substance use disorder treatment. J Subst Abuse Treat 2013; 46:232-7. [PMID: 24080073 DOI: 10.1016/j.jsat.2013.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 11/21/2022]
Abstract
The National Institute on Drug Abuse's Clinical Trials Network (CTN) is a practice-based research network that partners academic researchers with community based substance use disorder (SUD) treatment programs designed primarily to conduct effectiveness trials of promising interventions. A secondary goal of the CTN is to widely disseminate results of these trials and thus improve the quality of SUD treatment in the US. Drawing on data from 156 CTN programs, this study examines the association between involvement in CTN protocols and overall treatment quality measured by a comprehensive index of 35 treatment services. Negative binomial regression models show that treatment programs participating in a greater number of CTN protocols had significantly higher levels of treatment quality, an association that held after controlling for key organizational characteristics. These findings contribute to the growing body of research on the role of practice-based research networks in promoting health care quality.
Collapse
|
28
|
Carroll KM. Treatment integrity and dissemination: Rethinking fidelity via the stage model. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2013. [DOI: 10.1111/cpsp.12025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Hartzler B, Lash SJ, Roll JM. Contingency management in substance abuse treatment: a structured review of the evidence for its transportability. Drug Alcohol Depend 2012; 122:1-10. [PMID: 22153943 PMCID: PMC3307900 DOI: 10.1016/j.drugalcdep.2011.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
AIMS Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. METHODS PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. RESULTS Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic's technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics-like economic policies and inter-agency networking or competition-are salient, often unrecognized influences. CONCLUSIONS As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science.
Collapse
Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Seattle, WA 98105, USA.
| | | | | |
Collapse
|
30
|
Curran GM, Sullivan G, Mendel P, Craske MG, Sherbourne CD, Stein MB, McDaniel A, Roy-Byrne P. Implementation of the CALM intervention for anxiety disorders: a qualitative study. Implement Sci 2012; 7:1-11. [PMID: 22404963 PMCID: PMC3319426 DOI: 10.1186/1748-5908-7-14] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? METHODS Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. RESULTS Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. CONCLUSIONS The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.
Collapse
Affiliation(s)
- Geoffrey M Curran
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
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.
Collapse
|
32
|
Korte JE, Rosa CL, Wakim PG, Perl HI. Addiction treatment trials: how gender, race/ethnicity, and age relate to ongoing participation and retention in clinical trials. Subst Abuse Rehabil 2011; 2:205-18. [PMID: 24474858 PMCID: PMC3846502 DOI: 10.2147/sar.s23796] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Historically, racial and ethnic minority populations have been underrepresented in clinical research, and the recruitment and retention of women and ethnic minorities in clinical trials has been a significant challenge for investigators. The National Drug Abuse Treatment Clinical Trials Network (CTN) conducts clinical trials in real-life settings and regularly monitors a number of variables critical to clinical trial implementation, including the retention and demographics of participants. Purpose The examination of gender, race/ethnicity, and age group differences with respect to retention characteristics in CTN trials. Methods Reports for 24 completed trials that recruited over 11,000 participants were reviewed, and associations of gender, race/ethnicity, and age group characteristics were examined along with the rate of treatment exposure, the proportion of follow-up assessments obtained, and the availability of primary outcome measure(s). Results Analysis of the CTN data did not indicate statistical differences in retention across gender or race/ethnicity groups; however, retention rates increased for older participants. Conclusion These results are based on a large sample of patients with substance use disorders recruited from a treatment-seeking population. The findings demonstrate that younger participants are less likely than older adults to be retained in clinical trials.
Collapse
Affiliation(s)
- Jeffrey E Korte
- Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA
| | - Carmen L Rosa
- Center for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Paul G Wakim
- Center for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Harold I Perl
- Center for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA
| |
Collapse
|
33
|
Roosa M, Scripa JS, Zastowny TR, Ford JH. Using a NIATx based local learning collaborative for performance improvement. EVALUATION AND PROGRAM PLANNING 2011; 34:390-398. [PMID: 21371751 PMCID: PMC3424268 DOI: 10.1016/j.evalprogplan.2011.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.
Collapse
Affiliation(s)
- Mathew Roosa
- Onondaga County Department of Mental Health, John H. Mulroy Civic Center, 10th Floor, 421 Montgomery St, Syracuse, NY 13202, United States
| | - Joseph S. Scripa
- Onondaga County Department of Mental Health, John H. Mulroy Civic Center, 10th Floor, 421 Montgomery St, Syracuse, NY 13202, United States
| | | | - James H. Ford
- University of Wisconsin – Madison, 1513 University Avenue, Madison, WI 53705, United States
| |
Collapse
|
34
|
Oliva EM, Maisel NC, Gordon AJ, Harris AHS. Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Curr Psychiatry Rep 2011; 13:374-81. [PMID: 21773951 PMCID: PMC4403628 DOI: 10.1007/s11920-011-0222-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Substance use disorders are highly prevalent, debilitating conditions for which effective pharmacotherapies exist with a broad evidence base, yet pharmacotherapy for the treatment of addiction disorders is underutilized. The goals of this review are to describe the barriers that may contribute to poor adoption and utilization of pharmacotherapy for alcohol and opioid dependence at the system, provider, and patient level and to discuss ways to overcome those barriers. Multifaceted efforts directed at all three levels may be needed to speed pharmacotherapy adoption. More research is needed to help us better understand barriers from patients' perspectives. Strategies to promote adoption of pharmacotherapy for addiction disorders should be modified to fit the needs of the practice, system, and individual patients. Pharmacotherapy is a valuable tool in the clinical armamentarium of addiction treatment; thus, overcoming barriers to implementation may improve clinical and social outcomes.
Collapse
Affiliation(s)
- Elizabeth M. Oliva
- Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (Mailcode 152 MPD), Menlo Park, CA 94025, USA
| | - Natalya C. Maisel
- Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (Mailcode 152 MPD), Menlo Park, CA 94025, USA
| | - Adam J. Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive (Mailcode 151-C-H), Pittsburgh, PA 15206, USA. Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. Center for Research on Health Care, University of Pittsburgh, Pittsburgh, USA
| | - Alex H. S. Harris
- Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (Mailcode 152 MPD), Menlo Park, CA 94025, USA
| |
Collapse
|
35
|
Simpson DD, Joe GW, Dansereau DF, Flynn PM. Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University. Addiction 2011; 106:1733-40. [PMID: 20840168 PMCID: PMC3003748 DOI: 10.1111/j.1360-0443.2010.03121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices.
Collapse
Affiliation(s)
- D Dwayne Simpson
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.
| | | | | | | |
Collapse
|
36
|
Carroll KM, Ball SA, Jackson R, Martino S, Petry NM, Stitzer ML, Wells EA, Weiss RD. Ten take home lessons from the first 10 years of the CTN and 10 recommendations for the future. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:275-82. [PMID: 21854269 PMCID: PMC3232679 DOI: 10.3109/00952990.2011.596978] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The first 10 years of the National Institute on Drug Abuse's Clinical Trials Network (CTN) yielded a wealth of data on the effectiveness of a number of behavioral, pharmacological, and combined approaches in community-based settings. METHODS We summarize some of the methodological contributions and lessons learned from the behavioral trials conducted during its first ten years, including the capacity and enormous potential of this national research infrastructure. RESULTS The CTN made contributions to the methodology of effectiveness research; new insights from secondary analyses; the extent to which approaches with strong evidence bases, such as contingency management, extend their effectiveness to real world clinical settings; new data on 'standard treatment' as actually practiced in community programs, the extent to which retention remains a major issue in the field; important data on the safety of specific behavioral therapies for addiction; and heightened the importance of continued sustained attention to bridging the gap between treatment and research. CONCLUSIONS Areas of focus for the CTN's future include defining common outcome measures to be used in treatment outcome studies for illicit drugs; incorporating performance indicators and measures of clinical significance; conducting comparative outcome studies; contributing to the understanding of effective treatments of comorbidity; reaching underserved populations; building implementation science; understanding long-term outcomes of current treatments and sustaining treatment effects; and conducting future trials more efficiently.
Collapse
Affiliation(s)
- Kathleen M Carroll
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Research to practice in addiction treatment: key terms and a field-driven model of technology transfer. J Subst Abuse Treat 2011; 41:169-78. [PMID: 21466943 DOI: 10.1016/j.jsat.2011.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 02/10/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
The transfer of new technologies (e.g., evidence-based practices) into substance abuse treatment organizations often occurs long after they have been developed and shown to be effective. Transfer is slowed, in part, due to a lack of clear understanding about all that is needed to achieve full implementation of these technologies. Such misunderstanding is exacerbated by inconsistent terminology and overlapping models of an innovation, including its development and validation, dissemination to the public, and implementation or use in the field. For this reason, a workgroup of the Addiction Technology Transfer Center (ATTC) Network developed a field-driven conceptual model of the innovation process that more precisely defines relevant terms and concepts and integrates them into a comprehensive taxonomy. The proposed definitions and conceptual framework will allow for improved understanding and consensus regarding the distinct meaning and conceptual relationships between dimensions of the technology transfer process and accelerate the use of evidence-based practices.
Collapse
|
38
|
Martino S, Canning-Ball M, Carroll KM, Rounsaville BJ. A criterion-based stepwise approach for training counselors in motivational interviewing. J Subst Abuse Treat 2011; 40:357-65. [PMID: 21316183 DOI: 10.1016/j.jsat.2010.12.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/06/2010] [Accepted: 12/23/2010] [Indexed: 11/28/2022]
Abstract
This pilot study evaluated a criterion-based stepwise approach for training counselors in motivational interviewing (MI). Three sequential steps of training in MI were provided to 26 counselors who worked within the U.S. State of Connecticut Veterans Administration addiction treatment programs: a distance learning Web course (Step 1), a skill-building workshop (Step 2), and a competency-based individual supervision (Step 3). Counselors first participated in the course and then only received the next step of training if they failed to meet an independently rated criterion level of adequate MI performance. The results showed that counselors who showed inadequate MI performance immediately after taking the Web course and who subsequently participated in a workshop or supervision improved their adherence to fundamental MI strategies over time, whereas those who performed MI adequately following the Web course continued to demonstrate similar levels of fundamental and advanced MI adherence and competence over a 24-week period without additional training. The pilot study's findings, although preliminary, suggest that different counselors likely require different types and amounts of training to perform a behavioral treatment well.
Collapse
Affiliation(s)
- Steve Martino
- Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
| | | | | | | |
Collapse
|
39
|
Martino S, Ball SA, Nich C, Canning-Ball M, Rounsaville BJ, Carroll KM. Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction 2011; 106:428-41. [PMID: 20925684 PMCID: PMC3017235 DOI: 10.1111/j.1360-0443.2010.03135.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The effectiveness of expert-led (EX) and train-the-trainer (TT) strategies was compared to a self-study approach (SS) for teaching clinicians motivational interviewing (MI). DESIGN Twelve community treatment programs were assigned randomly to the three conditions. EX and TT conditions used skill-building workshops and three monthly supervision sessions guided by treatment integrity ratings, performance feedback and coaching techniques. Trainers in TT were first trained and certified in MI and then prepared carefully to deliver the workshops and supervise MI at their programs. Clinicians in SS only received the training materials. SETTING Licensed out-patient and residential addiction and mental health treatment programs in the US state of Connecticut were involved in the study. PARTICIPANTS Ninety-two clinicians who provided addiction treatment within these programs and had limited experience with MI participated in the study. MEASUREMENTS Primary outcomes were the clinicians' MI adherence and competence and the percentage of clinicians meeting clinical trial standards of MI performance. Assessments occurred at baseline, post-workshop, post-supervision and at 12-week follow-up. FINDINGS The study found EX and TT, in comparison to SS, improved clinicians' adherence and competence significantly, with higher percentages of clinicians reaching clinical trial standards of MI performance and few differences between EX and TT. CONCLUSIONS This study supports the combined use of workshops and supervision to teach community program clinicians MI and suggests the train-the-trainer approach may be a feasible and effective strategy for disseminating empirically supported treatments.
Collapse
Affiliation(s)
- Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
In the late-1980s and early-1990s, much attention in America was focused on cocaine abuse. In particular, the effects of prenatal cocaine use on mothers and infants were in the news spotlight. Risks of adverse effects prompted funding for novel treatment programs. More recently, media attention has shifted elsewhere, and specialized treatment resources have grown scarce. This redirection of funding is unfortunate, as social stigma and fear of legal consequences continue to encourage cocaine-abusing pregnant women to hide drug use and avoid prenatal care. The purpose of this article is to summarize the most prominent adverse maternal and fetal/infant effects associated with prenatal cocaine use; review treatment options, focusing on comprehensive care programs of the 1990s as well as recent research on evidence-based practices and their applicability to pregnant women; and highlight the population of prenatal cocaine-abusing women uninterested in treatment, with a focus on promising strategies to promote drug abstinence and other positive health behaviors.
Collapse
|
41
|
Rieckmann T, Kovas AE, Rutkowski BA. Adoption of medications in substance abuse treatment: priorities and strategies of single state authorities. J Psychoactive Drugs 2010; Suppl 6:227-38. [PMID: 21138199 PMCID: PMC3640346 DOI: 10.1080/02791072.2010.10400546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Research has confirmed the effectiveness of medications, when used in conjunction with ongoing counseling, to treat substance abuse disorders. This article describes a national, mixed-methods research project designed to investigate single state authorities' (SSAs) perceptions of adoption of evidence-based practices in substance abuse treatment. Results are focused specifically on medication-assisted treatment, one of five evidence-based practices defined by the National Quality Forum. Medication-assisted treatment (MAT) is an important and effective part of comprehensive care options available to clients who are chronically ill with alcohol and other drug disorders. Despite mounting clinical evidence and increased availability, overall rates of implementation and sustained adoption of medications to treat addiction remain limited. The results illustrate that the SSA representatives who fund public treatment programs believe MAT is a priority and worthy of system-wide implementation. Current strategies utilized by SSAs to support the adoption of MAT are detailed, as are barriers to adoption and implementation.
Collapse
Affiliation(s)
- Traci Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
| | | | | |
Collapse
|