Implementing and Sustaining Evidence-Based Drug Treatment in Criminal Justice Settings

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Implementing and Sustaining Evidence-Based Drug
Treatment in Criminal Justice Settings

• Conference Consensus Plenary
• Steven Belenko, Ph.D. Harry K. Wexler, Ph.D.
• Center on Evidence-based Interventions for Crime
  and
• Addiction (CEICA)
• Conference
• Philadelphia, PA
• December 6-7, 2006

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GENERAL ISSUES

• Alignment cant have successful implementation
  without org and systems change. So need to Invest
  in org change to sustain EBP
• CJ obstacles need to be recognized
• Dont know much about dissemination
• EB principles more important than EB practices.
  Easier to implement.
• Economic issues, analyses (CBE, CE)
• Importance of rigorous description of
  intervention and program operations
• Language issue research terminology is not
  understood. Improve communication, establish
  common values

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GENERAL ISSUES

• Legislators want to know benefits of the program,
  whats value added, effect on costs
• Use of different methods which are appropriate to
  the questions to inform policy. Focus on the
  questions that are relevant to practice and
  policy
• Move away from EB interventions and toward
  performance measurement and let programs decide
  what they want to do
• Need standardized measures that are useful to
  inform rational decision making. Possible to
  construct a common metric to allow comparisons
  across programs. Standardization and consistency
• Program needs immediate feedback so cant wait
  outcomes interim, proximal measures

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GENERAL ISSUES

• Need to be modest about expectations
• Need to consider what is feasible in rural areas
• Protection against adverse events, unintended
  consequences
• Public safety is the fundamental value, along
  with reduced drug use, life functioning
• Relevance, org culture, shortage of resources,
  having consistent messages
• Resources needed to support org change
• Social issues not always included in research

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GENERAL ISSUES

• Broken service system difficult to implement
  EBP in such a system
• Need to adapt interventions to the real world
• Use of performance measures with protocol
  (efficacy trial) as benchmark. Performance
  outcome monitoring
• Workforce issue, line staff resistance, training
  and attitudes, staff development etc.

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Policy Maker

• Change law school curricula, enhance training at
  college, in-service, credentialing levels
• Consider marketing messages to change public
  perceptions and build support for CJ TX programs
• Education for decision makers so that they can
  become informed consumers
• Federal funding for training and TA is limited
• Make money contingent on EBP use economic
  incentives

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Policy Maker

• No infrastructure to guide info sharing
  development of manuals etc. State oversight is
  limited
• Policymakers are looking for outcome measures to
  make the case for funding
• Policymakers need to understand limits of
  research and the cost and time to do it
• Political aspects CJ EBP is risky because
  consequences of failure are large. In deciding
  what criteria to use.

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Practitioner

• Be careful about changing things too quickly
  otherwise there is a pushback
• Cross-disciplinary training
• Train at delivery system level
• How to adapt manuals
• Infrastructure issues affect fidelity
• Manual can be used to train and maintain
  integrity
• Traditional training methods dont work
• Use incentives to adopt EBP

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Consumer

• Be aware of and respect consumer perspective
• CJ client needs to be an active voice in the
  research and how to improve treatment, helping
  define outcomes
• Stigma
• Using clients to define the research Qs what is
  of relevance to them? How do we get to the
  issues that are important and how to use clients
  to validate the findings and develop training and
  dissemination strategies

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Researcher

• Better job communicating what we know to
  policymakers, need to educate politician,
  translate language
• Clinical trials can inform clinical practice, but
  there are some limitations and need to be
  enhanced with other methods (consensus)
• Complexity of different levels and systems and
  perspectives
• Conceptual model that incorporates stages of
  change
• Field to lab instead of lab to field
• Focus on Qs relevant to the policy community

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Researcher

• Is the field mature enough to support RCTs (i.e.
  medical/FDA model)? Support alternative criteria
  for EBP. Inhibits program ideas.
• Issues of equal protection and due process make
  it difficult to do RCTs
• Medical model of RCTs not as useful, but more
  useful if it includes other measures of org,
  implementation, etc.
• Naturalistic descriptions of organizational
  structures and cultures

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Researcher

• Need good outcome and process measures to guide
  decision making. Think about the audience for the
  outcome measures and simplify the measures for
  policy makers and practitioners
• Adaptability vs. fidelity most programs dont
  have good outcome or fidelity measures
• Need to study the training process and see what
  works

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Researcher

• Outcomes put in context of other issues social
  context, systems, org, staff capabilities,
  workload, get away from research-centered
  approach to measures and outcomes
• Staff need to document and collect what is going
  on, but data need to be relevant to staff
• Study things which are relevant to policy makers

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Action Step Examples

• Adapt manuals
• Online training resources
• Needs assessment of the field
• Embed trained person in the program to facilitate
  implementation of EBP
• Need written agreements

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• THANKS TO ALL FOR A GREAT CONFERENCE!