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MARRCH 2007 Annual Conference October 30, 2007

MARRCH 2007 Annual Conference October 30, 2007. science. TRI. addiction. Adding Technology to the Use of Evidence-Based Practices Deni Carise, Ph.D. Treatment Research Institute University of Pennsylvania. science. TRI. addiction. Technology and EBP’s. Barriers to implementing EBP’s

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MARRCH 2007 Annual Conference October 30, 2007

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  1. MARRCH 2007 Annual ConferenceOctober 30, 2007 science TRI addiction Adding Technology to the Use of Evidence-Based Practices Deni Carise, Ph.D. Treatment Research Institute University of Pennsylvania

  2. science TRI addiction Technology and EBP’s Barriers to implementing EBP’s NREPP DENS CASPAR NIDA/ATTC Blending Teams

  3. science TRI addiction The Research-Practice Gap Medications, behavioral therapies, and clinical interventions: tested & shown effective in clinical trials

  4. science TRI addiction The Research-Practice Gap But, very low rates of adoption of these EBP’s. Possible factors contributing to this Finance, complexity, organizational structure, policy issues

  5. science TRI addiction The Research-Practice Gap Counselors report Finance, Training & Supervision barriers are the greatest contributors to the research-practice gap

  6. science TRI addiction The Research-Practice Gap New therapies won’t be adopted if: they cannot be supported by managers and funding agencies. the training and supervision burden is overwhelming

  7. science TRI addiction Training Barrier Decreased funding + Increased licensing, accrediting, and funding compliance requirements Decreased clinical training and Increased attention to administrative issues Of 400 national substance abuse treatment centers, 20% had no staff training budget. 

  8. science TRI addiction National Registry of Evidence-based Programs and Practices (NREPP) NREPP is a service of Substance Abuse and Mental Health Services Administration (SAMHSA) • Began in 1997 • A searchable database of interventions for the prevention and treatment of mental and substance abuse disorders

  9. science TRI addiction NREPP Programs • To date 150 programs in the database • NREPP recently changed the criteria and previously approved programs are listed under Legacy Programs on the website

  10. science TRI addiction Legacy Programs… • Reviewed between 1997-2004 • Part of CSAP’s Model Programs Initiative • Model Programs - science-based, effective & readily available for dissemination • Effective Programs - science-based, consistently achieved positive outcomes • Promising Programs - science-based, show at least some positive outcomes

  11. science TRI addiction Criteria for Submission to NREPP • Quality of research • Readiness for Dissemination • Descriptive Information

  12. science TRI addiction Quality of Research • Reliability of outcome measures • Validity of outcome measures • Intervention fidelity • Missing data and attrition • Potential confounding variables • Appropriateness of analysis

  13. science TRI addiction Readiness for Dissemination • Availability of materials • Availability of training and support resources • Availability of quality assurance procedures

  14. science TRI addiction For more info See NREPP’s website: www.nrepp.samhsa.gov

  15. science TRI addiction Moving to Evidenced-Based Practices… An example with the DENS ASI Software Program from Evergreen Treatment Services Seattle, Washington

  16. science TRI addiction Identify the Problem • Track systematically the nature of patients and their presenting problems • Match treatment services to unmet patient needs • Track patient outcomes for program evaluation and for funding and political purposes

  17. science TRI addiction Identify Outcomes • Conduct all intakes using the Addiction Severity Index (ASI) • Have ASI intake data stored in agency database • Use ASI information as initial treatment planning guide • Use ASI data for program evaluation

  18. science science TRI TRI addiction addiction Assess the Organization • All intake workers will need training in ASI administration and then on-going Q.A. for reliability • All intake workers will need training on computerized ASI • Treatment supervisors and counselors will need training in how to interpret ASI assessment

  19. science TRI addiction Assess the Organization (cont’d) • Need supervision to insure patient’s needs, identified at intake, are being addressed in treatment planning and delivery • I.T. Coordinator will need to maintain database

  20. science TRI addiction Assess the Audience • Regulatory agencies • Funding sources • Political entities • Board of Directors • Staff

  21. science TRI addiction Identify the Approach • Training • Intake staff • Counselors & supervisors • IT Coordinator • Acquire resources • ASI Software • Desktop computers

  22. science TRI addiction Implement the Plans • Training – don’t underestimate time necessary for this component; skill building can’t be rushed • Resource acquisition – make sure you forecast all of the necessary expenses • Pay attention to staff concerns and morale

  23. The Move to EBPs science TRI addiction How can technology help? The DENS System The CASPAR Projects THE ATTC Blending Teams

  24. science TRI addiction The Drug Evaluation Network System DENS • A national system collecting standardized, automated information (using ASI) • that is clinically important and policy relevant • on people entering addiction treatment and their treatment programs

  25. science TRI addiction The Addiction Severity Index • Developed by Tom McLellan & colleagues at University of Pennsylvania • Standardized, semi-structured, multi-focused screening and assessment tool

  26. A. Thomas McLellan science TRI addiction

  27. science TRI addiction 7 Sections of the ASI • Medical • Employment/Support • Drug • Alcohol • Legal • Family/Social • Psychiatric

  28. DENS System science TRI addiction • Benefits to the Counselor • Benefits for Program: Aggregate Reporting • Leads to benefits for Clients

  29. science TRI addiction DENS Software Automates collection of the ASI data Provides: Automated error-checks Comprehensive intake assessment Room for additional comments Automated narrative summary Comprehensive treatment plan

  30. DENS ASI Software science TRI addiction • Software designed with input from clinicians • Assumed most users have little/no computer experience • Can enter comments for every ASI item

  31. It Writes a Narrative Summary?

  32. Software: Hints & Comments

  33. How Do You Tailor Treatment to: science TRI addiction Groups of clients who you know have different drug problems?

  34. It is widely believed that males and females have very different drug/alcohol use patterns, histories and problems science TRI addiction An Example with Gender Differences

  35. science TRI addiction Gender Differences? N=60,952

  36. science TRI addiction Gender Differences

  37. science TRI addiction Gender Differences

  38. science TRI addiction Gender Differences

  39. Among substance abusers entering treatment, divided by gender, differences in substance use variables are the least impressive More impressive are differences in Lifetime and Past 30 days data - personal health and social functioning variables science TRI addiction Summary

  40. science TRI addiction CASPAR Computer Assisted System for Patient Assessment and Referrals

  41. science TRI addiction Background “Wrap-around” services have been shown to improve treatment outcomes But… …few services available in contemporary treatment programs …finding “wrap-around” services can be difficult

  42. science TRI addiction Problem-Services Linkage • Alcohol • Drugs • Medical • Employment • Psychiatric (e.g. Employ - related services GED training Resume Development Job Finding Mentoring Sessions Training Loans Treatment Research Institute

  43. science TRI addiction Assessment to Treatment Planning • Conduct assessment (ASI) • Identify problems • Prioritize problems • Develop goals to address problems (TP) • Write Treatment Plan including referrals not available at your site (CASPAR) Therapeutic Thread

  44. science TRI addiction What about this “Resource Guide”? • Electronic source of local, free and low cost programs and agencies • Contains a wide range of services including: • Mental health • Job training • Financial support • Emergency services (food, clothing, housing, shelters)

  45. science TRI addiction Why Was the RG Developed? • The ASI obtains information on many areas of the client’s life, identifying problems that may require treatment and/or assistance • Often there are more problem areas that need to be addressed than can be accomplished by any one counselor or agency alone

  46. science TRI addiction Why Was the RG Developed? The Resource Guide makes it easier for counselors to address client needs that cannot be met at their agency by providing referrals

  47. science TRI addiction Resource Guide

  48. science TRI addiction A Software Screen Example Highlight a keyword here. Click here for all services matching the keyword. Click here to enter patient’s zip code.

  49. science TRI addiction A Software Screen Example Click here to print this page. Click here to view other programs provided by this agency.

  50. 10 Programs Group 1 - SA 5 Programs Standard Group 2 - EA 5 Programs Enhanced 15 Counselors 18 Counselors 33 Counselors 131 Subjects 57 Patients 74 Patients Study Design

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