Dissemination of Evidence-based Practices (EBPs) in Substance Abuse Treatment The Matrix Model Of Intensive Outpatient Treatment Jeanne Obert, MFT, MSM Co-founder and Executive Director Matrix Institute on Addictions (A non-profit 501c3 public charity)

Defining Features of Matrix Model Treatments Comprehensive, manual-driven, one year program with simple, well-organized instructions. Developed from grassroots, clinical program with empirically-based interventions added where they seem to work. Patient handouts accompany each session and patient workbook contains written and illustrated concepts.

CSAT and Hazelden both published the treatment manuals and are working with Matrix to provide high quality dissemination and training

The DISSEMINATION DILEMMA was SPEED OF DISSEMINATION (i.e. train-the-trainers) EFFECTIVNESS (highly-selective) (highly-intensive) VS.

Matrix Model dissemination derived from D. Simpson’s Stages of Adaptation (2002) Step I - Exposure (to new ideas) Step 2 - Adoption (formal decision to try change) Step 3 - Implementation (provider tests use of innovation) Step 4 - Practice (incorporation of innovation into regular use) As well as the Motivational Interviewing Network of Trainers (MINT) and the CARF certification process

Matrix Model Dissemination MM basic training Key supervisor training Site certification <30 people 2 days 3-8 people 2.5 days Requested by Key Supervisor Program running for >6 months 2 or 3 yr. certification

Key Concepts of Matrix Dissemination Efforts  Qualities that make a great trainer are not necessarily the same as qualities as those that make a good supervisor and change agent (underlying assumption of train-the-trainer model)  Matrix trainers need to be people who have experience using the model and adapting it to various populations and situations. They are very limited in number and work directly for Matrix.  Supervisors are the key on-site people to advocate for fidelity to the model and make sure staff are well-trained. Some of them will eventually do the visits to sites requesting certification. Matrix works to develop a strong Key Supervisor network  Certified sites will eventually give us completion and other data.

Progress and Problems to date Progress Basic trainings – = more than 400 trainings completed in 47 states and on 5 continents –More than 6,000 people trained Key supervisor trainings Started in 2006 More than 350 Key supervisors trained Certification Program Started in sites presently certified Problems Too many people obtaining the manuals and implementing the program with no training Difficult to manage the Key Supervisor list serve in a way that is helpful to all Need to find the resources to do an annual Key Supervisor meeting (we’ve had 2) Difficult to find the resources to collect and organize the data from the certified sites

References and Acknowledgements University of South Florida, The National Implementation Research Network, “Implementation Research: A Synthesis of the Literature – 2005 Simpson, D. D. (2002). A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment, 22(4), Individuals outside Matrix who contributed to the conceptualization and implementation: Steve Gallon, Ph.D.H. Westley Clark, M.D., J.D., M.P.H. Walter Ling, M.D.William Miller, Ph.D. Richard Rawson, Ph.D.Cheryl Gallagher

Matrix Institute on Addictions 1850 Sawtelle Blvd., Suite 470 Los Angeles, CA (310) Matrix Institute on Addictions 1850 Sawtelle Blvd., Suite 470 Los Angeles, CA (310)

Step 1 – Exposure to New Ideas External forces providing impetus for exposure: 1.Providers looking for answers to working with methamphetamine abusers 2.States and counties requiring programs to use evidence- based treatment models (NREPP) 3.Manuals widely advertised and disseminated with recommendations for getting trained

Step I – Exposure to New Ideas Sales of Matrix Manuals –Hazelden = 2200 manuals in 4 years plus over 800 adolescent manuals in 3 years in 50 states plus Guam and the Virgin Islands –Internationally = Europe (Ireland, Finland, Portugal, Spain and Netherlands), Africa, Middle East (Lebanon), Asia (Korea, Japan, Taiwan, Vietnam, Thailand), Australia and Saipan.

Step 2 – Adoption (Formal decision to try change) Evidence of decision to change may be the scheduling of the core training Decision to adopt may follow the core training and then evidence of decision may be selecting and sending a Key Supervisor for further training

Step 2 - Adoption 2 Day Core Training (Adult and Adolescent) –From , more than 400 trainings completed in 47 states and on 5 continents. –More than 6,000 people trained.

Step 3 - Implementation  Key Supervisor Training started in 2006  More than 350 Key Supervisors trained (in groups of 8 or fewer) to: 1. Assess fidelity using standardized instruments 2. Train new staff (when turnover occurs) 3. Supervise clinicians delivering the Matrix Model 4. Work with administration to advocate for fidelity 5. Implement program in unique settings 6. Set up and organize a culturally specific program 7. Educate community partners about the new model of treatment

Matrix Model Key Supervisor Strong champion who can serve as a change agent/purveyor in the adoption process Serves as a liaison between Matrix and adopting program Helps educate staff and administrators about new program Clinical leader who knows the model well and can help others learn

Step 3 - Implementation (Provider tests use of innovation) List serve discussions help Key Supervisors with implementation issues. Annual Key Supervisor conference allows for sharing of information and encouragement. Fidelity Checklists are part of the Key Supervisor Training and serve as the basis for continuous quality improvement.

Step 4 – Practice (incorporation of innovation into regular use) Key Supervisors are trained in: –How to set up and organize a culturally specific program –How to supervise clinical staff delivering the program –How to educate community partners about the new model of treatment –How to train new staff when turn-over occurs Key Supervisors can request Certification after 6 months of operation. Certification process provides official recognition that a program is operating with fidelity.

Step 4 - Practice Certification Program = beginning 2009 –Response to demand from the field – particularly funding sources –Requires a site to have been trained, to have an onsite Key Supervisor and to have been implementing Model for more than 6 months. –Matrix Model Fidelity Instruments (adapted from the CSAT Methamphetamine Treatment Project) used –Sites granted 2 or 3 year certifications with data reporting requirements