The Process of Innovation: Best Practices

1. The Process of Innovation: Best Practices A “How-To” Guide

2. A Note to Viewers The following slides were gathered and/or prepared for the ADAA Management Conference, October 2004, for a workshop on The Process of Innovation. These slides should give you an orientation about how to approach change within your organization and promote a best practice. Page 1

3. A Note to Viewers There are many ways to learn, which this workshop promotes. Regardless of the following approaches, rigor and thoroughness is recommended for planning. You can then leaving as little to chance as possible but encourage collaboration, initiative and creativity from your staff. 1) The Workbook approach: You will notice references to the Change Book created by ATTC. 2) The Iowa Consortium: Dr. Cohen has created checklists that can be used to assist the process. These were adapted from a report “Evidence-Based Practices”: An Implementation Guide for Community Based Substance Abuse Treatment Agencies” by the IOWA Consortium for Substance Abuse Research and Evaluation. 3) Dwayne Simpson and the TCU group model: Slides are included with accompanying notes that depict a visual approach to planning. You will find among the web site references on the last slides a link to this group. You can then use some very helpful assessment tools for evaluating your agencies readiness for change and program needs. Peter R. Cohen MD, Medical Director, ADAA, October 25, 2004 Page 2

4. The Process of Innovation Participants Will Be Able To • Identify a number of current evidence-based practices • Apply a method for assessing their program’s readiness for adopting evidence-based practices • Apply the steps for organizational change for implementing evidence-based practices

5. Our Step-Wise Approach • Choose a case • Assess the Institution and Patient’s Needs • Choose an EVP • Assess the Readiness for Change • Choose a Model for Change • Carry out the Ten Steps • Evaluate Your Change

6. Ten Steps of EffectiveChange Initiatives 1. Identify the problem 2. Organize a team 3. Identify an outcome 4. Assess your organization 5. Assess your audience From the Change Book (www.nattc.org, 2002)

7. Ten Steps of EffectiveChange Initiatives 6. Identify the approach 7. Design action & maintenance plans 8. Implement the plans 9. Evaluate your plans 10. Revise your plans

8. Organizational Readiness for Change (ORC) • Motivation • Program Needs • Training Needs • Pressures OrganizationalDynamics • Staff: • Growth • Efficacy • Influence • Adaptability • Orientation • Climate: • Mission • Cohesion • Autonomy • Communication • Stress • Change • Resources • Offices/Staffing • Training • Equipment Program variations ?

9. Program Change Model Institutional & Personal Readiness Reception & Utility • Satisfaction • Ease of use • Values fit Motivation Resources Stages of Transfer Program Change Staff • 1-Exposure • (Training) • Lecture • Self Study • Workshop • Consultant 2-Adoption (Leadership decision) • Services • Process • Mgmt Time & Place 3-Implementation (Exploratory use) Program Improve- ment 4-Practice (Routine use) Organizational Dynamics Institutional Supports • Monitoring • Feedback • Rewards Climatefor Change Staff Attributes From Simpson, 2002 (JSAT)

10. A 3-4 Mos After 6-9 Mos After 3-4 Mos Before 6 Mos Before B Program Staff Program Staff Program Staff & Patients Program Staff & Patients C PTN ORC/CEST Follow-up Evaluation ORC/CEST & PTN D Workshop Planning & Evaluation Design Workshop Plans A B C D • Workshop Sessions: • Psychosocial Skills • Induction Strategies • Cognitive (Mapping) • Assessments Program Change?

11. An Evidence-Based Treatment Model for Improving Practice D. Dwayne Simpsonand Colleagues Texas Christian University

12. DATOS IBR Institute of Behavioral Researchat Texas Christian University The IBR specializes in the study of drug abuse treatment – including new interventions, therapeutic process, and outcomes. IBR HOME PAGE WHAT’S NEW ABOUT IBR STAFF PROJECTS NEWSLETTERS PUBLICATIONS PRESENTATIONS MANUALS FORMS OTHER LINKS Search Contents Site map • Spotlight…_______________ • New studies on “transferring research to practice” were recently published in a special issue of Journal of Substance Abuse Treatment • The latest Research Roundup Newsletter is out, focusing on IBR technology transfer research • Handouts from presentations available • Core Forms & Research Summaries available • Publication Abstracts available TCU Resource Collections: National Treatment Evaluations Correctional Treatment Evaluations Treatment Process Counseling Manuals Cognitive Interventions Technology Transfer Client/Treatment Assessments SITE GUIDES: • New Activities…___________ • The IBR Website is redesigned to streamline access and highlight integrated sets of materials – manuals, forms, findings – in specialized Resource Collections Summary PowerPoint Presentations www.ibr.tcu.edu

13. Elements of a Treatment Process Model Detox Patient Factors ? OP-DF Sufficient Retention Drug Use PsychologicalFunctioning, Motivation, & ProblemSeverity TC/Res Crime Social Relations OP-MM Posttreatment Cognitive and behavioralcomponents with therapeutic impact

14. Motiv Patient Attributes at Intake TCU Treatment Process Model Early Engagement Early Recovery Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Engagement Simpson, 2001 (Addiction)

15. Drug Use Crime Social Relations Posttreatment “Sequence” of Recovery Stages Patient Readiness for Tx Program Participation Behavioral Change AdequateStay in Tx Therapeutic Relationship Cognitive Change Targeted Interventions Get Focused!!

16. Interventions Should Maintain This Process Motiv Patient Attributes at Intake Early Engagement Early Recovery Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Simpson, 2001 (Addiction)

17. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Induction to Treatment(Motivational Enhancement) ProblemRecognition Desirefor Help Readinessfor Treatment Simpson & Joe, 1993 (Pt); Blankenship et al.,1999 (PJ); Sia, Dansereau, & Czuchry, 2000 (JSAT)

18. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Counseling Enhancements(Cognitive “Mapping”) Dansereau et al., 1993 (JCP), 1995 (PAB); Joe et al., 1997 (JNMD); Pitre et al., 1998 (JSAT)

19. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Contingency Management(Token Rewards) Rowan-Szal et al., 1994 (JSAT); 1997 (JMA); Griffith, Rowan-Szal et al., 2000 (DAD)

20. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Specialized Interventions(Skills-Based Counseling Manuals) Supportive Networks Bartholomew et al., 1994 (JPD); 2000 (JSAT); Hiller et al., 1996 (SUM)

21. Motiv Patient Attributes at Intake Program Characteristics Staff Attributes & Skills Evidence-Based Treatment Model Induction Behavioral Strategies Family & Friends Personal Health Services Supportive Networks Early Engagement Early Recovery Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Posttreatment Enhanced Counseling Social Skills Training Social Support Services Simpson, 2001 (Addiction)

22. Summary • Defined evidence-based practice • Considered barriers to adoption • Noted counselor endorsements and recommendations for manuals • Described an evidence-based practice model • Discussed how manuals fit within that model

34. Sources of Evidence-Based Information on the Web • Managed Care • samhsa.gov/mcnew • Dual Disorders • dartmouth.edu/~psychrc • Stimulant Treatment • matrixcenter.com • Drug Abuse Treatment • ibr.tcu.edu

35. Sources of Evidence-Based Information on the Web • Drug Abuse Treatment • nida.nih.gov • Alcoholism Treatment • niaaa.nih.gov • Addiction Medicine • asam.org • HIV/AIDS • cdc.gov/idu/

36. Sources of Evidence-Based Information on the Web • Prevention • unr.edu/westcapt • Technology Transfer • nattc.org • Addiction Science • utexas.edu/research/asrec