Title: In the Diffusion of Innovations Everyone Changes: Linking Practice with Scientific Research
1In the Diffusion of Innovations Everyone
ChangesLinking Practice with Scientific
Research
- James L. Sorensen, Ph.D.
- University of California, San Francisco and San
Francisco General Hospital. - American Psychological Association
- San Francisco, CA (August 2007) Support from
NIDA (U10DA15815, R01DA14922, R01DA014470,
P50DA09253) and Robert Wood Johnson Foundation..
2DISSEMINATION, DIFFUSION
- Dissemination
- To scatter seed, far and wide
- Diffusion is a two-way process
- An intermingling of molecules
Everyone changes
3PREVIEW
- 1. Diffusion can be slow
- 2. Principles of successful diffusion
- What are the needs in substance abuse?
- Selected resources
41. DIFFUSION CAN BE SLOW
- Why the long lag between knowledge and adoption?
- Scurvy 194 years
5Illustration of Diffusion Barriers The Dvorak
Keyboard
6LIVING HISTORY OF DIFFUSION The LCD Projector
7 BRIEF HISTORY OF PROJECTION
- 2nd Century Magic Lantern
- 1888 discovery of liquid crystalline structure
- 1950s Kodachrome35 mm projectors
- 2004 Last Slide Projector made by Kodak
- 2010 LCD projector sales may top 7,000,000
82. WHAT AFFECTS DIFFUSION OF INNOVATIONS?
- The nature of innovations
- Complex?
- Compatible?
- The organizations (the target of adoption)
- Organizational slack
- Fit with the clients
- Organizational climate
- Champions of change
- The dissemination process
- Active and in-person techniques work better
- Also are more costly
93. DISSEMINATION NEEDS IN SUBSTANCE
ABUSEEffective Treatments
- Relapse Prevention
- Supportive-Expressive Psychotherapy
- Individualized Drug Counseling,
- Motivational Enhancement Therapy,
- Behavioral Therapy for Adolescents
- Multidimensional Family Therapy for Adolescents
- Multisystemic Therapy
- Combined Behavioral and Nicotine Replacement
Therapy for Nicotine Dependence Addiction - Community Reinforcement Approach Plus Vouchers
- Voucher-based Reinforcement Therapy for Patients
in Methadone Maintenance Treatment - Day Treatment with Abstinence Contingencies and
Vouchers - Matrix Model of Drug Abuse Treatment
- 1 Adapted from National Institute on Drug Abuse,
1999. Principles of Drug Addiction Treatmetn
A Research Based Guide. Availabile at
http//www.nida.nih.gov/PODAT/PODAT4.html
10EVIDENCE-BASED INTERVENTIONS
11RESEARCH-DEVELOPED INTERVENTIONS
- Behavioral Treatments
- Motivational Interviewing
- Contingency Management
- Pharmacotherapy
- Naltrexone
- Buprenorphine
12Buprenorphine in WiredApril 2005
134. RESOURCES
- CTN Dissemination Library
- Implementation Science
- USF review
14Clinical Trials NetworkDissemination Library
Technology Transfer in Drug Abuse
Treatment http//ctndisseminationlibrary.org
15Implementation Science(new journal)
http// www.implementation science.com
16USF Review
17IN SUMMARY
- Change is slow
- And sometimes never happens (keyboard)
- Many innovations can be useful in our field
- Reasons for change are multifactorial
- Need more information
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20WHY LCD?
- Flexible
- Advances in technology
- Trained workforce (compatible)
- Dissemination methods?
213. Needs in Substance Abuse Area WHY THE GAP?
- Little overlap between common treatment methods
and those with scientific evidence - Due in part to history of isolation from
mainstream health care - Treatments came from an alternate system of care,
compassionate peers - Resulting polarization of science vs. practice
22TREATMENT-DEVELOPED INTERVENTIONS
- Self-Help Programs
- Drug Courts
23An Alternative to Incarceration
- Behavioral Health Court offers counseling to
criminal defendants with psychological disorders.
Cheaper than jail, its changing lives.
- San Francisco Chronicle 1-23-2006
24RESEARCH NEEDS RE. DISSEMINATION
- Not much research in addictions area
- Top-down versus partnership models
- Adopt or Adapt (fidelity or reinvention?)
- Measures of diffusion
- Effectiveness of training
25DISSEMINATION RESEARCH NEEDS
- What learning experiences are needed?
- How do treatments work? (vs. black box)
- What prevents relapse? (to old ways)
- Individual organizational differences?
- What system factors matter?