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Kaelber K, Seifert LS, Nguyen ATH, McWhirter K. Anxiety on the internet: Describing person, provider, and organization online posts. THE JOURNAL OF GENERAL PSYCHOLOGY 2024:1-26. [PMID: 38801396 DOI: 10.1080/00221309.2024.2349765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/27/2024] [Indexed: 05/29/2024]
Abstract
Anxiety is a pervasive phenomenon in contemporary society. With increased internet use in recent years, more people in the general population are seeking and providing help and participating in community online. The goal of our study was to evaluate the content of internet narratives among those who post about anxiety and determine what stakeholder groups are saying online. We used the bifurcated method; it is a multi-method (qualitative) approach with inductive, thematic analyses, and with quantification of content-related words via a computer program that crawls websites and counts the occurrences of specified terms (for cross-checking purposes). Themes of posts and webpages about anxiety were: using/reporting treatment strategies (83.3% saturation), providing help (77.8% saturation), telling personal stories (72.2% saturation), seeking help (61.1% saturation), and illustrating interpersonal impact (50% saturation). We argue that anxiety stakeholders may take part in health co-inquiry online (i.e., cooperating with others) in many of the same ways that they might collaborate in person. We recommend that clinicians query their clients about use of the internet in ways related to their anxiety (e.g., seeking information/treatment strategies, offering help to others, telling their personal stories, etc.) so that they might help them process what they experience online.
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North MN, Dopp AR, Silovsky JF, Gilbert M, Ringel JS. Perspectives on Financing Strategies for Evidence-Based Treatment Implementation in Youth Mental Health Systems. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2023; 26:115-190. [PMID: 37772508 PMCID: PMC10947519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/11/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Evidence-based treatments (EBTs) are critical to effectively address mental health problems among children and adolescents, but costly for mental health service agencies to implement and sustain. Financing strategies help agencies overcome cost-related barriers by obtaining financial resources to support EBT implementation and/or sustainment. AIMS We sought to (i) understand how youth mental health system decision-makers involved with EBT implementation and sustainment view key features (e.g., relevance, feasibility) that inform financing strategy selection and (ii) compare service agency, funding agency, and intermediary representative perspectives. METHOD Two surveys were disseminated to 48 representatives across U.S. youth mental health service agencies, funding agencies, and intermediaries who were participating in a larger study of financing strategies. Quantitative and qualitative data were gathered on 23 financing strategies through quantitative ratings and open-ended responses. Data were analyzed using descriptive statistics and rapid content analysis. RESULTS The financing strategies rated as most relevant include braided funding streams, contracts for EBTs, credentialing/rostering providers, fee-for-service reimbursement (regular and increased), and grant funding. All other strategies were unfamiliar to 1/3 to 1/2 of participants. The six strategies were rated between somewhat and quite available, feasible, and effective for EBT sustainment. For sustaining different EBT components (e.g., delivery, materials), the mix of financing strategies was rated as somewhat adequate. Qualitative analysis revealed challenges with strategies being non-recurring or unavailable in representatives' regions. Ratings were largely similar across participant roles, though funding agency representatives were the most familiar with financing strategies. DISCUSSION Despite the breadth of innovative financing strategies, expert representatives within the youth mental health services ecosystem had limited knowledge of most options. Experts relied on strategies that were familiar but often did not adequately support EBT implementation or sustainment. These findings underscore more fundamental issues with under-resourced mental health systems in the U.S.; financing strategies can help agencies navigate EBT use but must be accompanied by larger-scale system reforms. Limitations include difficulties generalizing results due to using a small sample familiar with EBTs, high agreement as a potential function of snowball recruiting, and limited responses to the open-ended survey questions. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Although EBTs have been found to effectively address mental health problems in children and adolescents, available strategies for financing their implementation and sustainment in mental health systems are insufficient. This constraint prevents many children and adolescents from receiving high-quality services. IMPLICATIONS FOR HEALTH POLICIES Financing strategies alone cannot solve systematic issues that prevent youth mental health service agencies from providing EBTs. Policy changes may be required, such as increased financial investment from the U.S. government into mental health services to support basic infrastructure (e.g., facility operations, measuring outcomes). IMPLICATIONS FOR FURTHER RESEARCH Future work should examine expert perspectives on EBT financing strategies in different contexts (e.g., substance use services), gathering targeted feedback on financing strategies that are less well known, and exploring topics such as strategic planning, funding stability, and collaborative decision-making as they relate to EBT implementation and sustainment.
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Affiliation(s)
| | - Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA,
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Magura S, Lee MJ, Abu-Obaid RN, Landsverk J, DeCamp W, Rolls-Reutz J, Green B, Ingoglia C, Hollen V, Flagg A. State Department and Provider Agency Utilization of Evidence-Based Program Registries in Behavioral Healthcare and Child Welfare. Eval Health Prof 2022; 45:397-410. [PMID: 35446692 DOI: 10.1177/01632787221085754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Evidence-based program registries (EBPRs) are web-based compilations of behavioral healthcare programs/interventions that rely on research-based criteria to rate program efficacy or effectiveness for support of programmatic decision-making. The objective was to determine the extent to which behavioral health decision-makers access EBPRs and to understand whether and exactly how they use the information obtained from EPBRs. Single State Authorities (SSAs) and service provider agencies in the areas of behavioral health and child welfare were recruited nationally. Senior staff (n = 375) responsible for the selection and implementation of programs and/or policies were interviewed by telephone concerning their visits (if any) to 28 relevant EBPRs, the types of information they were seeking, whether they found it, and how they may have used that information to effect changes in their organizations. At least one EBPR was visited by 80% of the respondents, with a median of three different registers being visited. Most visitors (55%) found all the information they were seeking; those who did not desired more guidance or tools for individual program implementation or were unable to locate the program or practice that they were seeking. Most visitors (65%) related using the information obtained to make changes in their organizations, in particular to select, start or change a program, or to support the adoption or improvement of evidence-based clinical practices. EBPRs were shown to be important resources for dissemination of research-based program effectiveness data, leading to increased use of evidence-based practices in the field, but the study also identified needs for greater awareness of EBPRs generally and for more attention to implementation of specific recommended programs and practices.
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Affiliation(s)
- Stephen Magura
- Evaluation Center, 4175Western Michigan University, Kalamazoo, MI, USA
| | - Miranda J Lee
- Evaluation Center, 4175Western Michigan University, Kalamazoo, MI, USA
| | | | | | - Whitney DeCamp
- Department of Sociology, Western Michigan University, Kalamazoo, MI, USA
| | | | - Brandn Green
- 420926Development Services Group Inc, Bethesda, MD, USA
| | - Charles Ingoglia
- 51641National Council for Behavioral Health, Washington, DC, USA
| | - Vera Hollen
- National Association of State Mental Health Program Directors Research Institute, Falls Church, VA, USA
| | - Anne Flagg
- 50379American Public Human Services Association, Arlington, VA, USA
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Reif S, Brolin M, Beyene TM, D’Agostino N, Stewart MT, Horgan CM. Payment and Financing for Substance Use Screening and Brief Intervention for Adolescents and Adults in Health, School, and Community Settings. J Adolesc Health 2022; 71:S73-S82. [PMID: 36122974 PMCID: PMC9945348 DOI: 10.1016/j.jadohealth.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 10/14/2022]
Abstract
Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address unhealthy substance use. With SBI services expanding beyond healthcare settings (e.g., schools, community organizations) and reaching younger populations, sustainability efforts must consider payment and financing. This narrative review incorporated rapid scoping review methods and a search of the gray literature to determine payment and financing approaches for SBI with adolescents and to describe related barriers and facilitators for its sustainability. We sought information relevant to adolescents and settings in which they receive SBI, but also reviewed sources with an adult focus. Few peer-reviewed articles met inclusion criteria, and those mostly highlighted healthcare settings. School-based settings were better described in the gray literature; little was found about community settings. SBI is mostly paid through grant funding and public and commercial insurance; school-based settings use a range of approaches including grants, public insurance, and other public funding. We call upon researchers and providers to describe the payment and financing of SBI, to inform how the uptake of SBI may be practicable and sustainable. The increasing activation and use of insurance billing codes, and the expansion of SBI beyond healthcare, is encouraging to address unhealthy substance use by adolescents.
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Affiliation(s)
- Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Mary Brolin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Tiginesh M. Beyene
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Nicole D’Agostino
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Maureen T. Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Constance M. Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Maranda MJ, Lee-Easton MJ, Magura S. Variations in Definitions of Evidence-Based Interventions for Behavioral Health in Eight Selected U.S. States. EVALUATION REVIEW 2022; 46:363-390. [PMID: 35544762 DOI: 10.1177/0193841x221100356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND U.S. state legislatures fill a vital role in supporting the use of evidence-based interventions (EBIs) through statutes and regulations (mandates). OBJECTIVE The study determined the terms used by selected states to describe EBIs and how those terms are defined in mandates. RESEARCH METHODS The mandates of eight purposely selected states were accessed and coded using the Westlaw Legal Research Database. RESULTS Considerable variation was found in the terms used by states to describe EBIs. Although "evidence-based" was the most frequently utilized term (60% of mandates), an additional 29 alternative terms appeared with varying frequencies. Most terms were simply mentioned, with no further definition or elaboration. When terms were further defined or elaborated, the majority were defined using numerous and different types of external sources or references. Three approaches were found in the mandates defining EBIs: "single definition," "hierarchies of evidence levels," and "best available evidence"; the states differed considerably in the approaches used in their mandates. CONCLUSIONS The variations in EBI-related terminology across states and within states, coupled with a lack of elaboration on the meaning of important terms and the predominant use of external rather than internal guidelines, may be a source of confusion for behavioral health provider agencies that seek direction about what constitutes an EBI. Prior studies indicate that many agencies may lack staff with the technical ability to adequately evaluate what constitutes an EBI. Thus, lack of clear guidance from official state government mandates may impede the implementation of EBIs within states.
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Lee MJ, Maranda MJ, Magura S, Greenman G. References to Evidence-based Program Registry (EBPR) websites for behavioral health in U.S. state government statutes and regulations. JOURNAL OF APPLIED SOCIAL SCIENCE 2022; 16:442-458. [PMID: 35873708 PMCID: PMC9306327 DOI: 10.1177/19367244221078278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND AIM U.S. state governments have the responsibility to regulate and license behavioral healthcare interventions, such as for addiction and mental illness, with increasing emphasis on implementing evidence-based programs (EBPs). A serious obstacle to this is lack of clarity or agreement about what constitutes "evidence-based." The study's purpose was to determine the extent to which and in what contexts web-based Evidence-based Program Registries (EBPRs) are referenced in state government statutes and regulations ("mandates") concerning behavioral healthcare. Examples are: What Works Clearinghouse; National Register of Evidence-based Programs and Practices; Cochrane Database of Systematic Reviews. METHODS The study employed the Westlaw Legal Research Database to search for 30 known EBPR websites relevant to behavioral healthcare within the statutes and regulations of all 50 states. RESULTS There was low prevalence of EBPR references in state statutes and regulations pertaining to behavioral healthcare; 20 states had a total of 33 mandates that referenced an EBPR. These mandates usually do not rely on an EBPR as the sole acceptable source for classifying a program or practice as "evidence-based." Instead, EBPRs were named in conjunction with internal state or external sources of information about putative program effectiveness, which may be less valid than EBPRs, to determine what is "evidence-based." CONCLUSION Greater awareness of scientifically - based EBPRs and greater understanding of their advantages need to be fostered among state legislators and regulators charged with making policy to increase or improve the use of evidence-based programs and practices in behavioral healthcare in the U.S.
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Affiliation(s)
- Miranda J. Lee
- The Evaluation Center at Western Michigan University, Kalamazoo, MI
| | | | - Stephen Magura
- The Evaluation Center at Western Michigan University, Kalamazoo, MI
| | - Gregory Greenman
- The Evaluation Center at Western Michigan University, Kalamazoo, MI
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Dopp AR, Hunter SB, Godley MD, Pham C, Han B, Smart R, Cantor J, Kilmer B, Hindmarch G, González I, Passetti LL, Wright KL, Aarons GA, Purtle J. Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study. Implement Sci Commun 2022; 3:51. [PMID: 35562836 PMCID: PMC9099033 DOI: 10.1186/s43058-022-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. METHOD We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types' outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. DISCUSSION The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health-while advancing implementation science through the use of novel methods to study financing strategies and sustainment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Isabelle González
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Gregory A Aarons
- Department of Psychiatry, 9500 Gilman Dr. (0812), University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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McNeely J, Mazumdar M, Appleton N, Bunting AM, Polyn A, Floyd S, Sharma A, Shelley D, Cleland CM. Leveraging technology to address unhealthy drug use in primary care: Effectiveness of the Substance use Screening and Intervention Tool (SUSIT). Subst Abus 2022; 43:564-572. [PMID: 34586976 PMCID: PMC9968463 DOI: 10.1080/08897077.2021.1975868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda M. Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonia Polyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven Floyd
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Akarsh Sharma
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University Global School of Public Health
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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John WS, Zhu H, Greenblatt LH, Wu LT. Recent and active problematic substance use among primary care patients: Results from the alcohol, smoking, and substance involvement screening test in a multisite study. Subst Abus 2021; 42:487-492. [PMID: 33797348 PMCID: PMC9822781 DOI: 10.1080/08897077.2021.1901176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Primary care settings provide salient opportunities for identifying patients with problematic substance use and addressing unmet treatment need. The aim of this study was to examine the extent and correlates of problematic substance use by substance-specific risk categories among primary care patients to inform screening/intervention efforts. Methods: Data were analyzed from 2000 adult primary care patients aged ≥18 years (56% female) across 5 clinics in the eastern U.S. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Prevalence and ASSIST-defined risk-level of tobacco use, alcohol use, and nonmedical/illicit drug use was examined. Multinomial logistic regression models analyzed the demographic correlates of substance use risk-levels. Results: Among the total sample, the prevalence of any past 3-month use was 53.9% for alcohol, 42.0% for tobacco, 24.2% for any illicit/Rx drug, and 5.3% for opioids; the prevalence of ASSIST-defined moderate/high-risk use was 45.1% for tobacco, 29.0% for any illicit/Rx drug, 14.2% for alcohol, and 9.1% for opioids. Differences in the extent and risk-levels of substance use by sex, race/ethnicity, and age group were observed. Adjusted logistic regression showed that male sex, white race, not being married, and having less education were associated with increased odds of moderate/high-risk use scores for each substance category; older ages (versus ages 18-25 years) were associated with increased odds of moderate/high-risk opioid use. Conclusions: Intervention need for problematic substance use was prevalent in this sample. Providers should maintain awareness and screen for problematic substance use more consistently in identified high risk populations.
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Affiliation(s)
- William S. John
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lawrence H. Greenblatt
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA
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Maranda MJ, Magura S, Gugerty R, Lee MJ, Landsverk JA, Rolls-Reutz J, Green B. State behavioral health agency website references to evidence-based program registers. EVALUATION AND PROGRAM PLANNING 2021; 85:101906. [PMID: 33567376 PMCID: PMC7932747 DOI: 10.1016/j.evalprogplan.2021.101906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/19/2020] [Accepted: 01/18/2021] [Indexed: 05/27/2023]
Abstract
PURPOSE Evidence-based program registers (EBPRs) are important tools for facilitating the use of evidence-based practices or programs (EBPs) by state statutory agencies responsible for behavioral healthcare, broadly defined as substance misuse, mental health, HIV/AIDS prevention, child welfare, and offender rehabilitation. There are currently no data on the purposes for which such state agencies reference EBPRs on their official websites. METHOD A webscraping method was used to identify and classify relevant "hits", defined as a state behavioral health webpage with single or multiple references to a study EBPR. A total of 778 hits (unique combinations of webpage and register) were coded. Up to three codes were applied to each hit for the "reasons for the EBPR reference" (EBPR use) dimension, one code was applied to each hit for the "purpose of the EBPR reference" and "intended audience of the webpage containing the hit" dimensions, and up to two codes were applied to each hit for the "funding mentions" dimension. RESULTS Three EBPRs out of 28 accounted for 73.6% of the hits. The most frequent reason for referencing EBPRs were as a resource for selecting EBPs or validating existing programs and practices. The references tended to appear in reports from the state, in training materials, or guidelines. The references tended to address broad groups of behavioral healthcare professionals. EBPRs were frequently referenced in the context of federal block grants or other federal funding. CONCLUSIONS Increasing state agencies' awareness and use of the entire range of existing EBPRs may improve implementation of EBPs nationally.
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Affiliation(s)
- Michael J Maranda
- Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo MI 49008, USA
| | - Stephen Magura
- Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo MI 49008, USA.
| | | | - Miranda J Lee
- Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo MI 49008, USA
| | - John A Landsverk
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401, USA
| | - Jennifer Rolls-Reutz
- Chadwick Center for Children and Families, 3020 Children's Way-Mailcode 5131, San Diego CA 92123, USA
| | - Brandn Green
- Development Services Group Inc., 7315 Wisconsin Avenue, 800 East Bethesda, MD 20814-3210, USA
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021. [PMID: 33588878 DOI: 10.1186/s13012‐021‐01082‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021; 16:18. [PMID: 33588878 PMCID: PMC7885555 DOI: 10.1186/s13012-021-01082-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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Palmer A, Rossier Markus A. Supporting Physical-Behavioral Health Integration Using Medicaid Managed Care Organizations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:316-322. [PMID: 31664558 DOI: 10.1007/s10488-019-00986-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper describes key findings of two states that sought to integrate physical and behavioral health services by delivering them through one Medicaid managed care contract. The purpose was to explore how managed care organizations (MCOs) could improve physical and behavioral health integration. Promising practices include leveraging data accumulated by MCOs about beneficiaries to support providers and enhanced case management, encouraging MCOs to pay providers for care coordination and care collocation, and offering protections to providers and beneficiaries. Finally, in the absence of a shared vision among key stakeholders regarding how to best promote integrated care, a state can make progress by promoting stakeholder innovation.
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Affiliation(s)
- Ashley Palmer
- IBM Watson Health, 7700 Old Georgetown Road, Bethesda, MD, 20814, USA.
- Health Policy and Management at George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA.
| | - Anne Rossier Markus
- Health Policy and Management at George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
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14
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Walker SC, Sedlar G, Berliner L, Rodriguez FI, Davis PA, Johnson S, Leith J. Advancing the state-level tracking of evidence-based practices: a case study. Int J Ment Health Syst 2019; 13:25. [PMID: 31007712 PMCID: PMC6457070 DOI: 10.1186/s13033-019-0280-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background Despite a sustained focus by policymakers and researchers on improving the standard of clinical care in public mental health services, the use of evidence-based practice remains low. Among other challenges, this reflects the difficulty of translating clinical research into useable policy that can be feasibly funded and monitored by state or large healthcare systems. Case presentation In this paper we present a case study of Washington State’s strategy for monitoring the use of clinical elements at the session level for all Medicaid-funded children’s mental health services. The implementation of this strategy reflects policy actions to promote effective practice while also actively influencing multiple other levels of the implementation ecology. The approach is informed by the Policy Ecology Framework, the Consolidated Framework for Implementation Research, the evidence-based policymaking literature, and common ontology and clinical elements models. Conclusions We found the strategy developed in Washington State to be a feasible method of collecting session level information about the use of effective clinical mental health practices. In addition, the approach appears to be having influence on multiple layers of the implementation ecology that could be explored through further study.
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Affiliation(s)
- Sarah Cusworth Walker
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Georganna Sedlar
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Trauma, 401 Broadway, Seattle, WA 98104 USA
| | - Felix I Rodriguez
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Paul A Davis
- Washington State Health Care Authority, 626 8th Ave SE, Olympia, WA 98501 USA
| | - Savannah Johnson
- 4Duke University, 2127 Campus Drive, Box 90065, Durham, NC 27708 USA
| | - Jessica Leith
- 1Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE Campus Parkway, Box 358015, Seattle, WA 98105 USA
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15
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Petry NM, Alessi SM, Rash CJ, Barry D, Carroll KM. A randomized trial of contingency management reinforcing attendance at treatment: Do duration and timing of reinforcement matter? J Consult Clin Psychol 2018; 86:799-809. [PMID: 30265039 PMCID: PMC6166435 DOI: 10.1037/ccp0000330] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Contingency management (CM) interventions that reinforce attendance have rarely been evaluated in terms of reducing drug use. Using a sequential randomized design, this study examined the efficacy of three attendance CM conditions compared to usual care (UC) on drug use outcomes. It evaluated whether the duration (6 vs. 12 weeks) and timing (early vs. later treatment) of CM delivery impact treatment response. METHOD Upon initiating outpatient treatment, patients with cocaine use disorders (N = 360) were randomized to UC or CM for attending treatment for 6 weeks. At week 6, patients (n = 308) were rerandomized to UC or CM for another 6 weeks, with assignment stratified on current functioning. Samples were screened for illicit drugs twice weekly for 12 weeks. RESULTS Patients randomized to CM at both time-points attended more sessions and achieved more abstinence than those never randomized to CM. Relative to UC, receiving attendance CM in weeks 1-6 only was not efficacious, but those receiving attendance CM in weeks 7-12 only evidenced some benefits compared to those who never received CM. Twelve weeks of attendance CM was more efficacious than 6 weeks. No between-groups differences in drug use were noted at follow-ups, but days attended treatment and proportion negative samples during treatment were associated with long-term cocaine abstinence. CONCLUSIONS Attendance-based CM increases treatment participation and reduces drug use, with beneficial effects noted when CM is delivered over longer durations and during later phases of outpatient care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Danielle Barry
- University of Connecticut Health Center
- Edith Nourse Rogers Memorial VA Hospital
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16
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McNeely J, Kumar PC, Rieckmann T, Sedlander E, Farkas S, Chollak C, Kannry JL, Vega A, Waite EA, Peccoralo LA, Rosenthal RN, McCarty D, Rotrosen J. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addict Sci Clin Pract 2018; 13:8. [PMID: 29628018 PMCID: PMC5890352 DOI: 10.1186/s13722-018-0110-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background
Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Methods Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13–24, 2006). Results Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient’s substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual’s own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial.
Conclusions Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers. Electronic supplementary material The online version of this article (10.1186/s13722-018-0110-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA. .,Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Pritika C Kumar
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Traci Rieckmann
- Greenfield Health and Department of Psychiatry, Oregon Health and Science University, 9450 SW Barnes Suite 100, Portland, OR, 97225, USA
| | - Erica Sedlander
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Sarah Farkas
- Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Christine Chollak
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Joseph L Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Aida Vega
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Eva A Waite
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Lauren A Peccoralo
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Richard N Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, 1090 Amsterdam Avenue, New York, NY, 10025, USA
| | - Dennis McCarty
- OHSU-PSU School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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Abraham AJ, Andrews CM, Grogan CM, Pollack HA, D'Aunno T, Humphreys K, Friedmann PD. State-Targeted Funding and Technical Assistance to Increase Access to Medication Treatment for Opioid Use Disorder. Psychiatr Serv 2018; 69:448-455. [PMID: 29241428 PMCID: PMC6703818 DOI: 10.1176/appi.ps.201700196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE As the United States grapples with an opioid epidemic, expanding access to effective treatment for opioid use disorder is a major public health priority. Identifying effective policy tools that can be used to expand access to care is critically important. This article examines the relationship between state-targeted funding and technical assistance and adoption of three medications for treating opioid use disorder: oral naltrexone, injectable naltrexone, and buprenorphine. METHODS This study draws from the 2013-2014 wave of the National Drug Abuse Treatment System Survey, a nationally representative, longitudinal study of substance use disorder treatment programs. The sample includes data from 695 treatment programs (85.5% response rate) and representatives from single-state agencies in 49 states and Washington, D.C. (98% response rate). Logistic regression was used to examine the relationships of single-state agency targeted funding and technical assistance to availability of opioid use disorder medications among treatment programs. RESULTS State-targeted funding was associated with increased program-level adoption of oral naltrexone (adjusted odds ratio [AOR]=3.14, 95% confidence interval [CI]=1.49-6.60, p=.004) and buprenorphine (AOR=2.47, 95% CI=1.31-4.67, p=.006). Buprenorphine adoption was also correlated with state technical assistance to support medication provision (AOR=1.18, 95% CI=1.00-1.39, p=.049). CONCLUSIONS State-targeted funding for medications may be a viable policy lever for increasing access to opioid use disorder medications. Given the historically low rates of opioid use disorder medication adoption in treatment programs, single-state agency targeted funding is a potentially important tool to reduce mortality and morbidity associated with opioid disorders and misuse.
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Affiliation(s)
- Amanda J Abraham
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
| | - Christina M Andrews
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
| | - Colleen M Grogan
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
| | - Harold A Pollack
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
| | - Thomas D'Aunno
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
| | - Keith Humphreys
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
| | - Peter D Friedmann
- Dr. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia. Dr. Grogan and Dr. Pollack are with the School of Social Service Administration, University of Chicago, Chicago. Dr. D'Aunno is with the Wagner Graduate School of Public Service, New York University, New York. Dr. Humphreys is with the School of Medicine, Stanford University, Palo Alto, California. Dr. Friedmann is with the Department of Medicine, University of Massachusetts-Baystate and Baystate State Health System, Springfield, Massachusetts
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Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
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Accuracy of the Audio Computer Assisted Self Interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ACASI ASSIST) for identifying unhealthy substance use and substance use disorders in primary care patients. Drug Alcohol Depend 2016; 165:38-44. [PMID: 27344194 PMCID: PMC4962996 DOI: 10.1016/j.drugalcdep.2016.05.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/13/2016] [Accepted: 05/14/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND An Audio Computer-assisted Self Interview (ACASI) version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) could reduce barriers to substance use screening and assessment in primary care settings. This study evaluated the diagnostic accuracy of an ACASI ASSIST for identification of unhealthy substance use and substance use disorders (SUD). METHODS 399 adult patients were consecutively recruited from an urban safety-net primary care clinic. ACASI ASSIST scores for tobacco, alcohol, marijuana, and cocaine were compared against reference standard measures to assess the instrument's diagnostic accuracy for identifying unhealthy use and SUD, first using empirically-derived optimal cutoffs, and second using the currently recommended ASSIST cutoffs. RESULTS For identifying any unhealthy use, at the empirically-derived cutoffs the ACASI ASSIST had 93.6% sensitivity and 85.8% specificity (AUC=0.90) for tobacco, 85.9% sensitivity and 60.3% specificity (AUC=0.73), for alcohol in men, 100% sensitivity and 62.4% specificity (AUC=0.81) for alcohol in women, 94.6% sensitivity and 81.6% specificity (AUC=0.88) for marijuana, and 86.1% sensitivity, 84.0% specificity (AUC=0.85) for cocaine. For SUD, sensitivity ranged from 79% (for alcohol in males), to 100% (for tobacco), and specificity was 83% or higher (AUCs ranged 0.83-0.91). For substances other than tobacco, empirically-derived cutoff scores were lower than the standard cutoffs, and resulted in higher sensitivity and lower specificity for identifying unhealthy substance use. CONCLUSIONS The ACASI ASSIST is a valid measure of unhealthy use and SUD for substances that are commonly used by primary care patients, and could facilitate effective and efficient screening for substance use in medical settings.
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The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges. Curr Opin Pediatr 2016; 28:434-40. [PMID: 27152620 DOI: 10.1097/mop.0000000000000371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Screening, brief intervention and referral to treatment (SBIRT) offers a practical, integrated model for addressing substance use in primary care settings. This review provides an update of the research on SBIRT for adolescents in primary care, examines current dissemination challenges and suggests future research directions. RECENT FINDINGS A number of brief screening tools for adolescents have been developed and tested relative to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use disorders. Computerized previsit screening promotes standardization and is a more time-efficient alternative to provider interview. The adolescent brief intervention literature is growing, particularly with respect to technology-based tools, but is still limited, with evidence greatest for alcohol, and for motivational enhancement therapy interventions. Increasing SBIRT implementation in pediatric primary care remains a challenge. Using nonphysician behavioral health providers to deliver SBIRT, and embedding a screener and decision support tool in electronic medical record systems are strategies being investigated to promote SBIRT implementation. SUMMARY Substance use begins in adolescence, and pediatric SBIRT could help to achieve a population-level reduction of substance use-related harms. With a growing number of available tools, adolescent SBIRT effectiveness and feasibility are increasing, but more studies are needed to grow its evidence base, and elucidate strategies to increase implementation.
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