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Using Evidence Based Interventions

Using Evidence Based Interventions. Stephen Brazill, MA, MAC. Agenda. Brief History Some things about research EBTs Implementation Resources. History. Where Have We Been?. History. Mid 1930s Alcoholics Anonymous 1950s Narcotics Anonymous The 1970s Hughes Act Research was scarce

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Using Evidence Based Interventions

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  1. Using Evidence Based Interventions Stephen Brazill, MA, MAC

  2. Agenda Brief History Some things about research EBTs Implementation Resources

  3. History Where Have We Been?

  4. History • Mid 1930s • Alcoholics Anonymous • 1950s • Narcotics Anonymous • The 1970s • Hughes Act • Research was scarce • Knowledge mostly folk science • For severe and chronic clients

  5. History • 1980s • Drug Free Workplace Act • EAPs • Inpatient centers grew and prospered • 1990s • Institute of Medicine report • Disconnect between research and practice • Bridging the Gap

  6. Today • Building the bridge • Evidence-based treatments • Outpatient treatment • Continuum of addictive behaviors None Mild Moderate Severe

  7. Now and Future • Ongoing research in academic and community settings • Improving dissemination of innovation • Improving implementation of evidence-based treatments • Client driven • Outcome driven • Maintenance vs. acute model

  8. Now and Future • Increased intervention via non-specialist systems • Health systems • Social systems • The barber shop? Dentist? • Religious communities • Schools systems • New(er) Delivery systems • Internet (meetings, chat room, Second Life, etc.) • Cell phone

  9. Does Treatment Work? Wrong Question

  10. What Treatments Work?

  11. What Does “Work” Mean? • Abstinence? • Reduced use? • Reduced psychiatric problems? • Reduced incarceration? • Increased employment? • Reduced medical problems? • Improved family functioning?

  12. What Treatments Work?For what clients?At what time?Delivered by who?

  13. How Do We Tell If Treatments Work?

  14. Levels of Evidence • Randomized clinical trials • Quasi-experimental studies • Correlational studies • Anecdotal case reports, professional opinion, best practice guidelines developed by consensus

  15. Research Definitions • Efficacy • Effectiveness

  16. Problems With Research • Uni-directional • Chosen by researchers • Controlled settings • Specific populations • Individual counseling

  17. Problems With Research • Training (cost, time, follow-through, drift) • Dissemination • Less than 50% of programs are using proven psychosocial interventions • 10-17 years for dissemination

  18. Solutions • Practice to research • Clinical Trials Network • Outcome research in community programs • Leadership focus on evidence-based program development and training

  19. How Research Helps Us Help Others

  20. What Research Does For Us • Helps clarify, guide and inform practice • Answers questions • Improves outcomes • Helps correct for human self-deception • “Addictive personality” • Confrontation • Victim impact panels

  21. What Research Does For Us • Dispels myths such as…… • Nothing works • One approach is superior to another • Everything works equally well

  22. Why Use Evidence-Based Treatments? • Ethical and humanitarian considerations • Public interest and moral obligation • Particularly when treatment is coerced

  23. Absence of Studies Does Not Mean That a Treatment Does Not Work

  24. Respect Research, But Do Not Revere It

  25. EBTs Vs. EBP • Evidence Based Treatment • Motivational Interviewing • Evidenced Based Practice • Allowing mothers to take kids with them to treatment • Hiring empathic counselors

  26. A Brief Review of Some Research Findings

  27. Top Brief intervention Social skills training Motivational enhancement Community reinforcement approach Behavior contracting Bottom Relaxation training Confrontation Psychotherapy General alcoholism counseling Education Miller & Hester 1995: Alcohol

  28. Top Brief intervention Motivational enhancement Community reinforcement approach Self-change manual Opiate Antagonists (Naltrexone) BSCT Bottom Relaxation training Confrontation Psychotherapy General alcoholism counseling Education Miller & Hester 2003: Alcohol (adapted post COMBINE)

  29. Miller, Zweben & Johnson 2005 • Cognitive-behavioral treatment • Community reinforcement approach • Motivational interviewing • Relapse prevention • Social skills training JSAT 29 (2005)

  30. Overview of Treatment Methods • Build client motivation, readiness and engage • Cognitive and behavior skills • Increasing positive rewards for non-use • Involve family and social networks • Think outside the skin • Appropriate medications

  31. A Resource Understanding Research Concepts: A Guide for Counselors http://www.danya.com/dlc/courselist.asp

  32. Building Motivation, Readiness,Engaging

  33. Important Client Factors • Goals • Values • Experiences • Expectations • Strengths • Cultural, ethnic and spiritual background • Biology • Motivation & readiness Assessing and Utilizing

  34. Stages of Change • Precontemplation • Contemplation • Preparation • Action • Maintenance Prochaska, Norcross, DiClemente Relapse

  35. Stages of Change • 80% of substance abusers are in precontemplation or contemplation • Define success by the movement from one stage to the next

  36. Predicting Change in Clients

  37. Predicting Change • Adherence to change efforts • Self-efficacy • Self-reported motivation • Engagement and retention • Quality of counseling relationship • Client speech

  38. Counselors and Helpers

  39. HARPWhat We Believe and Do Matters

  40. Building Motivation

  41. Influencing Motivation:What Doesn’t Work • Enlightenment • Education • Insight-oriented persuasion • Confrontation • Punishment

  42. Building Motivation:What Works

  43. Helper Traits That Help...…A Lot • Accurate empathy • Genuine • Unconditional positive regard

  44. Appears that the counselor to whom one is assigned makes considerably more difference than the specific treatment employed* *Najavits & Weiss, 1994

  45. Interpersonal Influence • Referral from your office 2X • Call or handwritten note 2X • Missed session/letter ½ drop out • AA w/member support 100% • AC reminder calls/calendar 2X

  46. Motivation • Is not a static client trait • Affected greatly by relationship with counselor • It is interpersonal • Measured by client language and observed behavior

  47. Change Talk D= Desire for Change (want, wish, like) A = Ability to Change (could, can) R = Reasons for Change (if……then…..) N = Need for Change (need, have to, got to) C = Commitment to Change (intention, decision) A = Activation (ready, prepared, willing) T = Taking Steps (tossed out cigarettes)

  48. Motivational Interviewing Is….. Motivational interviewing is a collaborative, person-centered, form of guiding to elicit and strengthen motivation for change Miller & Rollnick (2009)

  49. Motivational Interviewing • Helps increase client change and commitment talk • Helps reduce resistance • Helps engage clients • Plays well with other treatments • Synergistic effects

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