Enhancing NIDA’s Health Services Research: Update on the Blue Ribbon Task Force Report Wilson M. Compton, M.D., M.P.E. Director, Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse Department of Health and Human Services February 8, 2006 NIDA Advisory Council Meeting

Few Treatment Programs Use Treatment Innovations Roman, et al., Presentation at CTN Steering Committee Meeting, (N = 171 Administrators)

Few School-Based Prevention Programs Use Research-Based Programs (N = 1905 Schools) Ringwalt, et al. (2002), Prevention Science

To Reap Any Benefits From Scientific Knowledge It Needs To Be Used In Practice To Reap Any Benefits From Scientific Knowledge It Needs To Be Used In Practice

Developing an intervention is only one part of translating research into practice. Intervention Access and Engagement Provider knowledge and behavior Organization Structure and Climate External Environment (stigma, financing)

Task Force Charge Develop recommendations re: Diffusion of research findings into practice Utilization of CTN as a platform for health services research Organization & leadership of health services research within NIDA and other Federal agencies

Co-Chairs: Thomas McLellan, PhD, Constance Weisner, DrPH, MSW Andrea Barthwell, MD Caryn Blitz, PhD Rick Catalano, PhD Mady Chalk, PhD Linda Chinnia, MEd Lorraine Collins, PhD Wilson Compton, MD, MPE Michael Dennis, PhD Richard Frank, PhD Warren Hewitt, MS James Inciardi, PhD Marguerita Lightfoot, PhD Isaac Montoya, PhD Claire Sterk, PhD Janet Wood, MBA, MEd NIDA Blue Ribbon Task Force on Health Services Research NIDA Blue Ribbon Task Force on Health Services Research

NIDA’s Responses to the Blue Ribbon Report Briefing for Dr. Zerhouni Conference in Philadelphia on Health Services Research Briefing for ONDCP Publication in Journal of Substance Abuse Treatment Addressing Recommendations… Charting a Course for Health Services Research at NIDA, 2005;29(3):

Organization of the Report Critical First Steps –Develop clear understanding of services research. –Increase portfolio on organizational, management, and financing. –Collaborate to develop standards for evidence based practices –Intra- and inter-agency collaborations

Multidisciplinary field of scientific inquiry that: Cost of Care Financing Organization Management Social Factors Technologies Access & Utilization Quality of Care For individuals, families, organizations & institutions, and communities & populations Personal & public health & well being Examines how: Affect: Individual Factors Critical #1: Defining Health Services Research

Critical #2: Enhance Research on Organization, Management, and Economic Issues Examples: Collaborating with CSAP on their national Strategic Prevention Framework. Encouraging applications: −Economics of Drug Abuse Treatment and Prevention Services (PA ) −Services Research in the National Drug Abuse Clinical Trials Network (PA ) −Economic Evaluation of Drug Abuse Treatment and Prevention Services for HIV/AIDS (PA )

Organization/Management Research Active Organization and/or Management Grants in Services Research Branch Note: In 2005 reissued Services Research PA (05-139) with emphasis on org/mgmt issues

Finding: Innovation is a Function of “Absorptive Capacity” Indicators: environmental scanning (journals, workshops, etc.) monitoring patient satisfaction professionalism (number of: master’s level/licensed/certified therapists, physicians, persons in recovery)

Economics Research Active Economic Grants in Services Research Branch Note: Reissued Economics PA (05-111) in 2005

Finding: Behavioral Intervention for Seropositive Youth is Cost Effective Intervention 11 Sessions to reduce transmission acts 82%↓in unprotected sex acts; sig↓ in HIV-negative or unknown partners; reduced substance use Cost Effectiveness Rotheram-Borus et al. (2001). AIDS Education & Prevention, 13, and Lee, Leibowitz & Rotheram-Borus. (2005). AIDS Education & Prevention, 17,

Finding: Life Course View of Addiction Shows Increased Benefit-Cost Zarkin, Dunlap, Hicks, & Mamo. (2005). Health Economics, 14,

Critical #3: Developing Standards for Evidence-based Practice Cochrane Collaboration Campbell Collaboration US Preventive Services Task Force Evidence-Based Practice Centers (AHRQ) Veterans Health Administration Federal Collaboration on What Works (DOJ) State Governments (e.g., Hawaii, Washington) Professional Associations (e.g., AA, ASAM, APA) SAMHSA’s National Registry of Effective Practices and Programs (NREPP)

Critical #4: Developing a Collaborative Research Processes Using CCTN and CJ-DATS Working with SAMHSA and other partners on linking Science to Services Braiding funding streams

Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) Research Centers Coordinating Center National Drug Abuse Treatment Clinical Trials Network (CTN)

The Science to Services Initiative Links with NIDA’s Blending Initiative Capacity-Building Collaboration Commitment Monitoring & Feedback Research & Development Dissemination & Implementation

Braiding Funding Streams Adolescent Services Including Brief Interventions (FY2003 with SAMHSA) Assessment and Brief Interventions in Primary Care (FY2004 with SAMHSA) NIDA Funding Research on CSAP’s National SPF-SIG Program (FY2004) Service to Science Grants (with SAMHSA) for State Substance Abuse Authorities (FY2005) and Community Based Organizations (FY2006)

Task Force Recommendations 1. Prevention Services Research (5) 2. Treatment Services Research (8) 3. Leading and Managing Services Research at NIDA (6) 4. Services Research Collaborations within the NIH and with External Partners (5)

Task Force Recommendations: Prevention Services Research Supporting randomized controlled trials Studying prevention in nonacademic settings Developing system to monitor epidemiology of problem behaviors Studying best practices Studying diffusion of prevention practices

Prevention at NIDA: Randomized Clinical Trials

Task Force Recommendations: Treatment Services Research Studying commonly used interventions & practices Examining range of settings Studying the full spectrum of service needs Studying diffusion of innovation Improving fit of research questions & methods Developing and refining research methods Studying effects of organization/management, economics, and policies Integrating economics research into portfolio

Calls for Research on Usual Care Enhancing State Capacity to Foster Adoption of Science-Based Practices (RFA DA ) 18 applications 7 awards (5 treatment, 2 prevention) Enhancing Practice Improvement in Community- Based Care (RFA DA ) 70 applications Review pending

Treatment Services at NIDA: Randomized Clinical Trials

Evaluate Causal Associations Examples of Responses: Encouraging experimental designs where feasible: −In studies conducted with CSAP −In criminal justice studies, such as CJ-DATS −In Department of Education drug testing demonstration grants Scientific meeting on new methods to test causal inferences (with the NIDA/NIMH/ NIAAA/SAMHSA/AHRQ/HRSA Conference)

Task Force Recommendations: Leadership & Management Communicating consistent and clear conception of health services research at NIDA Integrating services research across divisions and branches Update application review criteria and orient IRG members Enhancing dissemination of services findings Being proactive in developing proposal solicitations

A Comprehensive Framework for Implementation Research Clinical Practices Program Components Systemic Factors Financial Health Care Infrastructure Legal/Regulatory Education & Training Research & Knowledge Transfer Org Structure & Culture Patient Engagement Staffing Info & Clinical Care Systems Initial Services Engage & Sustain Therapeutic Interventions Assessment National Quality Forum (2005)

Task Force Recommendations: Collaboration Develop and monitor the services research agenda Improve technology transfer Develop standards for evidence-based interventions Promote and publicize evidence-based interventions Improve methods for drug abuse services research Work with Federal Agencies, State Directors, providers and consumers to:

Researcher-Practitioner Collaborations CCTN, CJ-DATS – PA and RFAs 2005 Meeting on Community Partnerships in Research: Setting an Agenda 2006 RFA: Enhancing Practice Improvement in Community-based Care

Researcher-Funder Collaborations NIDA-Single State Agencies –2005 RFA: Enhancing State Capacity to Foster Adoption of EBPs –2005 Presentation at NASADAD –2006 Grantees meeting NIDA-SAMHSA

Examples of co-sponsored projects NIDA funding cross-site evaluation of SPF-SIG NIDA-CSAP cofunding of Hawkin’s Communities that Care; Dishion’s WIC study Expertise from services research disciplines in CTN and DTRD projects Health services researcher hired in CCTN Collaborative Research Processes

Co-sponsored RFAs and PAs Dissemination & Implementation Research in Health (PA ) Mechanism for Time-Sensitive Research Opportunities (PAR ) Enhancing State Capacity to Foster Adoption of Science-based Practices (RFA-DA ) Enhancing Practice Improvement in Community-based Care (RFA-DA ) Health Services Research for Drug & Alcohol Use (PA ) Economics of Prevention & Treatment of Drug & Alcohol Abuse (PA ) Services Research in the NIDA CTN (PA ) Collaborative Research Processes

Co-sponsored scientific meetings Foster care (NIDA, Child Welfare League of America) - Tobacco use Quitlines (NIDA, CDC, NCI, CTCRI, Health Canada) - Complexities of Co-occurring Conditions (NIDA, NIMH, NIAAA, SAMHSA, AHRQ, HRSA) - Community Partnerships in Research: Setting a Research Agenda (NIDA, NIMH, SAMHSA) - Role of Faith-inclusive Practices in Drug & Alcohol Abuse Research Dissemination Research (NIDA, NIAAA) - Returning Veterans (NIDA, NIAAA, NIMH, SAMHSA) - Children of Parents in the Criminal Justice System Collaborative Research Processes

Challenges Faced 1.Budgetary constraints 2.Entrenched bureaucracies 3.Personnel changes among collaborators

Summary: NIDA has been addressing ALL aspects of the Blue Ribbon Task Force Report Research on commonly used practices. Emphasize causal study designs. Collaborate on standards for evidence-based practice. Develop collaborative research process within NIDA and with other agencies, practitioners, and state agencies.