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In the Diffusion of Innovations Everyone Changes: Linking Practice with Scientific Research

In the Diffusion of Innovations Everyone Changes: Linking Practice with Scientific Research. James L. Sorensen, Ph.D. University of California, San Francisco and San Francisco General Hospital. American Psychological Association

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In the Diffusion of Innovations Everyone Changes: Linking Practice with Scientific Research

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  1. In the Diffusion of Innovations Everyone Changes:Linking Practice with Scientific Research James L. Sorensen, Ph.D. University of California, San Francisco and San Francisco General Hospital. American Psychological Association San Francisco, CA (August 2007) Support from NIDA (U10DA15815, R01DA14922, R01DA014470, P50DA09253) and Robert Wood Johnson Foundation.. Rev. 8-14-07

  2. DISSEMINATION, DIFFUSION • Dissemination… • To scatter seed, far and wide • Diffusion is a two-way process… • An intermingling of molecules Everyone changes

  3. PREVIEW 1. Diffusion can be slow 2. Principles of successful diffusion • What are the needs in substance abuse? • Selected resources

  4. 1. DIFFUSION CAN BE SLOW • Why the long lag between knowledge and adoption? • Scurvy 194 years

  5. Illustration of Diffusion Barriers: The Dvorak Keyboard

  6. LIVING HISTORY OF DIFFUSION: The LCD Projector

  7. BRIEF HISTORY OF “PROJECTION” • 2nd Century Magic Lantern • 1888 discovery of liquid crystalline structure • 1950s Kodachrome…35 mm projectors • 2004 Last Slide Projector made by Kodak • 2010 LCD projector sales may top 7,000,000

  8. 2. WHAT AFFECTS DIFFUSION OF INNOVATIONS? • The nature of innovations • Complex? • Compatible? • The organizations (the target of adoption) • Organizational slack • Fit with the clients • Organizational climate • Champions of change • The dissemination process • Active and in-person techniques work better • Also are more costly

  9. 3. DISSEMINATION NEEDS IN SUBSTANCE ABUSE:Effective Treatments • Relapse Prevention • Supportive-Expressive Psychotherapy • Individualized Drug Counseling, • Motivational Enhancement Therapy, • Behavioral Therapy for Adolescents • Multidimensional Family Therapy for Adolescents • Multisystemic Therapy • Combined Behavioral and Nicotine Replacement Therapy for Nicotine Dependence Addiction • Community Reinforcement Approach Plus Vouchers • Voucher-based Reinforcement Therapy for Patients in Methadone Maintenance Treatment • Day Treatment with Abstinence Contingencies and Vouchers • Matrix Model of Drug Abuse Treatment 1 Adapted from National Institute on Drug Abuse, 1999. Principles of Drug Addiction Treatmetn: A Research Based Guide. Availabile at: http://www.nida.nih.gov/PODAT/PODAT4.html

  10. EVIDENCE-BASED INTERVENTIONS

  11. RESEARCH-DEVELOPED INTERVENTIONS • Behavioral Treatments • Motivational Interviewing • Contingency Management • Pharmacotherapy: • Naltrexone • Buprenorphine

  12. Buprenorphine in WiredApril 2005

  13. 4. RESOURCES • CTN Dissemination Library • Implementation Science • USF review

  14. Clinical Trials NetworkDissemination Library Technology Transfer in Drug Abuse Treatment http://ctndisseminationlibrary.org

  15. Implementation Science(new journal) http:// www.implementation science.com

  16. USF Review http://nirn.fmhi.usf.edu

  17. IN SUMMARY • Change is slow • And sometimes never happens (keyboard) • Many innovations can be useful in our field • Reasons for change are multifactorial • Need more information

  18. WHY LCD? • Flexible • Advances in technology • Trained workforce (compatible) • Dissemination methods?

  19. 3. Needs in Substance Abuse Area: WHY THE GAP? • Little overlap between common treatment methods and those with scientific evidence • Due in part to history of isolation from mainstream health care • Treatments came from an alternate system of care, compassionate peers • Resulting polarization of science vs. practice

  20. TREATMENT-DEVELOPED INTERVENTIONS • Self-Help Programs • Drug Courts

  21. An Alternative to Incarceration • Behavioral Health Court offers counseling to criminal defendants with psychological disorders. Cheaper than jail, it’s changing lives. San Francisco Chronicle 1-23-2006

  22. RESEARCH NEEDS RE. DISSEMINATION • Not much research in addictions area • Top-down versus partnership models • Adopt or Adapt (fidelity or reinvention?) • Measures of diffusion • Effectiveness of training

  23. DISSEMINATION RESEARCH NEEDS • What learning experiences are needed? • How do treatments work? (vs. black box) • What prevents “relapse?” (to old ways) • Individual & organizational differences? • What system factors matter?

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