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

2. 1.Barriers to implementing EBP’s 2.NREPP 3.DENS 4.CASPAR 5.NIDA/ATTC Blending Teams Technology and EBP’s TRI science addiction

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

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

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

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

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

8. 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 National Registry of Evidence-based Programs and Practices (NREPP) TRI science addiction

9. 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 TRI science addiction

10. 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 Legacy Programs… TRI science addiction

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

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

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

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

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

16. 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 TRI science addiction

17. 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 TRI science addiction

18. TRI science 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 TRI science addiction

19. 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 TRI science addiction

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

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

22. 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 TRI science addiction

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

24. 8 A national system collecting standardized, automated information (using ASI) 8 that is clinically important and policy relevant 8 on people entering addiction treatment and their treatment programs TRI science addiction The Drug Evaluation Network System DENS

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

26. A. Thomas McLellan TRI science addiction

27. 7 Sections of the ASI 1.Medical 2.Employment/Support 3.Drug 4.Alcohol 5.Legal 6.Family/Social 7.Psychiatric TRI science addiction

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

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

31. It Writes a Narrative Summary?

32. Software: Hints & Comments

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

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

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

36. Gender Differences TRI science addiction

37. Gender Differences TRI science addiction

38. Gender Differences TRI science addiction

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

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

41. 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 TRI science addiction

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

43. 1.Conduct assessment (ASI) 2.Identify problems 3.Prioritize problems 4.Develop goals to address problems (TP) 5.Write Treatment Plan including referrals not available at your site (CASPAR) Assessment to Treatment Planning Therapeutic Thread TRI science addiction

44. 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) TRI science addiction

45. 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 TRI science addiction

46. 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 TRI science addiction

47. Resource Guide TRI science addiction

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

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

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

51. Procedures Counselors provided their ASI and TP for 5 patients TRI staff interviewed patients 2 and 4 weeks post-admission to see how many and what types of services they received Matches between the (1) ASI and TP and (2) the ASI and Services Received were evaluated TRI science addiction

52. Results Results from the first CASPAR study on increasing services- patient match and the number of services received with ASI Treatment Care Planning TRI science addiction

53. Findings TRI science addiction

54. Hypothesis 1 Patients whose counselors receive the EA Training will receive Treatment Plans that better match their problems identified at admission TRI science addiction

55. % Matched: ASI to TCP All p<.05 TRI science addiction

56. Hypothesis 2 Patients whose counselors receive the EA Training will receive more services TRI science addiction

57. Number of Services Received D/A, Med, Emp, Psych all p<.05 TRI science addiction

58. Hypothesis 3 Patients whose counselors receive the EA Training will receive Treatment Services that better match their problems identified at admission TRI science addiction

59. % Matched: ASI to Services Received D/A, Med & Emp all *p<.05 TRI science addiction

60. Hypothesis 4 Patients whose counselors receive the EA Training will remain in treatment longer and be more likely to complete treatment TRI science addiction

61. Percent Retained at 45 Days TRI science addiction

62. Percent Retained at 90 Days TRI science addiction

63. Unexpected Finding Counselors who received the EA Training remained on the job longer TRI science addiction

64. Percent Who Quit by 6 Months TRI science addiction

65. Limitations This study evaluated the type and number of services but not the quality of services received No pre-study measures Study was limited to Philadelphia area treatment programs TRI science addiction

66. Conclusion Counselors are willing to be trained & use an electronic resource guide Resource guide fosters better treatment planning and more appropriate service utilization NOT YET CLEAR IF THIS WILL LEAD TO BETTER PATIENT OUTCOMES TRI science addiction

67. NIDA CASPAR 2 The CASPAR 2 NIDA grant will be conducted in 3 counties outside of Philadelphia, and will use a pre-post design TRI science addiction

68. CASPAR 2 The CASPAR 2 grant will collect data from 20 treatment programs and 400 patients TRI science addiction

69. Creating an Electronic Resource Guide: Linking Services to Client Needs NIDA Grant # RO1 DA015125 TRI science addiction

70. Purpose and Background Provide guidelines and instructions for community-based SA treatment programs to develop a customized resource guide for use by counselors to increase services received by clients TRI science addiction

71. Purpose and Background Suggestions and time estimates are based on having developed resource guides for 3 studies in the following areas: Philadelphia County Bucks, Montgomery, and Delaware Counties in PA Southern New Jersey TRI science addiction

72. Why Create an Electronic RG? Services for many problem areas identified during assessment are not available within traditional community-based treatment programs Counselors have difficulty finding resources for these services TRI science addiction

73. Why Create an Electronic RG? Paper resource guides are available but there is a need for materials that are 1. More user-friendly 2. More easily-updated 3. Useful for counselors TRI science addiction

74. Things to Consider… Software Program: Data structure & storage Microsoft Access or Web-based Data entry fields - address, hours, fees, web address, etc. Standardized data dictionary TRI science addiction

75. Things to Consider… Functionality & Layout: Screen layout Search functions - basic and advanced Print functions Help function Mapquest function or public transportation services TRI science addiction

76. Step 1 – Identifying Services Identify types of services to be included: Free / low-cost services Location Hotlines Medical / Psychiatric services Legal services / Drivers license Women’s services Employment / Vocational services Recovery houses Estimated time required = 10 hours TRI science addiction

77. Step 2 – Identifying Agencies Locate available lists of resources / agencies Suggested sources: Paper resource guides Internet sources Counselor resources/smaller guides CJS Resource list United Way Our search resulted in 23 sources for the greater Philadelphia area Estimated time required = 80 hours TRI science addiction

78. Statistics on 3 Counties in PA Bucks County Montgomery County Delaware County Population (Source: U.S. Census Bureau 2006) 623,205775,688555,996 # of Programs included in the Resource Guide 6071275676 Total # of Programs included for these 3 counties= 2,558 TRI science addiction

79. Step 3 – Verifying Information Verified information by: Internet searches on all agencies Verification calls on random 10% sample Estimated time required: Verifying by telephone = 40 hours per 100 agencies Verifying by internet = 35 hours per 1000 agencies TRI science addiction

80. Verification Call Results Bucks, Montgomery, Delaware and surrounding Pennsylvania Counties N = 230 TRI science addiction

81. Step 4 – Deleting Agencies Delete agencies that are: 1.Duplicates 2.No longer deliver services listed 3.Not appropriate 4.Closed, Disconnected / No Answer Resulted in the deletion of 875 agencies for the present study Estimated time required = 15 hours TRI science addiction

82. Step 5 – Enter Program Info & Categorize Enter Program Info: Standardize data Data enter all program information Check accuracy Estimated time required: Entering program info - 80 hours/1000 agencies Categorizing - 20 hours/1000 agencies Est. total time - 280 hours

83. Step 5 – Enter Program Info & Categorize

84. Sample of a Program Info Screen

85. NIDA ATTC Blending Team Providing training, dissemination and technology transfer of EBP. An example with the Addiction Severity Index and Treatment Care Planning TRI science addiction

86. NIDA Blending Teams Who? –NIDA Researchers –SAMHSA's Addiction Technology Transfer Centers (ATTCs) What do they do? –Work together to develop ‘products’ based on research conducted within NIDA's Clinical Trials Network (CTN) and other supported research TRI science addiction

87. NIDA Blending Teams Why do they do it? –To give treatment providers the necessary tools to adopt science-based interventions in community-based programs –Create necessary tools to allow for the trouble-free adoption of science-based interventions in community-based programs TRI science addiction

88. Products Completed Buprenorphine Treatment: Training for Multidisciplinary Addiction Professionals Short-Term Opioid Withdrawal Using Buprenorphine M.A.T.R.S. Treatment Planning: Utilizing the Addiction Severity Index (ASI) NIDA Blending ‘Products’ TRI science addiction

89. In Development Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) Promoting Awareness of Motivational Incentives (PAMI) NIDA Blending ‘Products’ TRI science addiction

90. MATRS Treatment Planning NIDA Researchers –Deni Carise, Ph.D., TRI –Meghan Love, TRI –Tom McLellan, Ph.D., TRI AT TCs –Nancy Roget, Mountain West ATTC –Dick Spence, Gulf Coast ATTC –Pat Stilen, Mid-America ATTC TRI science addiction

91. NIDA Approved Products 6-hour classroom training Trainer script PowerPoint slides CD-Rom) Handouts Reference Lists/Examples M T R S! A

92. NIDA Approved Products 4-week online version Designed in Moodle course management system (CMS) (Free, open source software!) TRI science addiction

93. MATRS Training Package How ASI can be used in clinical and program evaluation activities Identifies differences between program-driven and individualized treatment planning processes TRI science addiction

94. MATRS Training Package Focus on process of treatment planning Defines guidelines and legal considerations in documenting client status TRI science addiction

95. Adapted Products Mountain West ATTC Curriculum Infusion Package TRI science addiction

96. TX. Plan Check list http://www.mattc.org/information/smart/ASI-SMART%20BIRP%20CHECKLIST.pdf Mid America ATTC

97. http://www.mattc.org/info rmation/smart/ASI- MART%20BIRP%20CH ECKLIST.pdf Mid America ATTC Documentation Checklist

98. In Blackboard Focus on skill development & application in clinical setting (12 hours) Mid-America ATTC On-Line 6-week Course

99. MATRS Treatment Planning Software In Development! TRI science addiction

100. Building a Master Problem List

101. Problem Statements

102. Building a Specific Problem Plan

103. Identifying Client Strengths

104. THANK YOU!!