Evidence Based Practices

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Evidence Based Practices

• Gaps in Substance Use Treatment
• Presented by
• Rhonda G. Patrick, LCSW, MPA

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Evidence Based Practices

• What is it?
• The integration of best research evidence with
  clinical expertise and patient values.
• Treatment based on the best available science
• Respect for the expertise of the clinician
• Acknowledgement and incorporation of patient
  values
• Institute of Medicine, 2001

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Evidence Based Practices

• What is it?
• EBP is a process in which the practitioner
  combines well researched interventions with
  clinical experience, ethics, client preferences,
  and culture to guide and inform the delivery of
  treatments and services.
• National Association of Social Workers

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Evidence Based Practices

• Why EBP?
• Concerns related to cost and effectiveness of
  substance abuse treatment.
• Delineation of a rational approach to allocation
  of scarce resources.
• Mitigation against a system in which treatment
  practices are based solely on practice wisdom.
• Finding the best available treatment or policy
  that reduces the harm and costs of substance
  abuse.

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Research Knowledge

• What do we know?
• We have validated measurement tools
• We have replicable biopsychosocial predictors of
  substance related events and outcomes
• We have a number of efficacious treatments of
  varying intensity and duration that produce
  benefits across a range of problem severity.

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Research Knowledge

• What do we dont know?
• Much treatment research has proceeded without the
  benefit of theory, the mechanisms of action of
  many efficacious treatments are poorly
  understood.
• Patterns of substance use, abuse, remission and
  relapse are highly variable over time between and
  across individuals in treated and untreated
  samples. We do not have an understanding of the
  influence of contextual factors.

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Research Knowledge

• What do we dont know?
• The reach and impact of efficacious treatments
  into the affected population remains suboptimal.
  Most people with substance use disorder do not
  seek professional care, a subset recover on their
  own, and most available treatments target the
  majority with more serious problems.

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Research Knowledge

• What do we know about Hispanic substance users?
• Younger users of alcohol and drug have more
  serious social problems as they age.
  Consequences are greater the younger you start.
• Cultural dissonance is occurring, especially for
  immigrated families.
• The closer you are to the routes of trade the
  higher your risk.
• Most will not and do not seek assistance through
  formal networks of care.
• There are regional substance use differences,
  however across the board alcohol and marijuana
  abuse impact a significant portion of the Latino
  community.
• There are differences in subpopulations of the
  Latino group in substance use severity, retention
  and outcome.

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Research Knowledge

• What do we dont know about Hispanic substance
  users?
• What are the circumstances of Hispanics in their
  own communities (i.e., community context)
• What service delivery models are tailored to
  Hispanics circumstances and special needs
• What are the client, provider, and system
  barriers to utilization of substance abuse
  services
• How do we establish links between drug abuse
  services, social services, and other service
  sectors to optimize treatment outcomes.

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Bridging the Gap Community

• Characterize the local Hispanic community in
  terms of structure, cultural composition, and
  relations with the larger non- Hispanic
  community. Consider the role of community
  unemployment, residential segregation, proximity
  to centers of drug trade, and numbers of retail
  alcohol outlets in communities were Hispanics
  live as risk factors.
• Understand community factors that might prevent
  or promote use of alcohol or drugs.
• Develop community research partnerships can help
  elucidate how services need to be adapted for a
  particular community group or segment (e.g.,
  Hispanic gang-involved youth, outreach) and
  identify how feasible and acceptable are the
  planned community interventions.
• Utilize a community participatory research
  framework involve local community members and
  community-based organizations in community-based
  research. This research involves capacity
  building in intervention, services research for
  community leaders learning about community needs
  and structure for researchers and exploring the
  potential for alternative, community-based models
  of care to enhance service delivery by addressing
  local needs.

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Bridging the Gap Service Delivery

• Test the effectiveness of community-based
  therapeutic approaches that take advantage of
  natural supports (religious organizations) and of
  those that bring evidence-based treatments to
  non-clinical environments (e.g., academic
  community-partnerships).
• Evaluate and test collaborative research
  partnerships with Hispanic community members that
  identify new and innovative approaches to drug
  abuse treatment services.
• Test community-level interventions that
  facilitate recovery and reintegration of drug
  users within their Hispanic communities.

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Bridging the Gaps Barriers

• Test the effects of improved communication
  between caregivers and Hispanic clientele and its
  impact on retention in pharmacologic and
  cognitive substance abuse treatments.
• Assess programs on Latinos health literacy for
  entry and engagement in care and decision-making
  in substance abuse treatments.
• Evaluate the impact of insurance coverage on
  access to substance abuse services, sustained
  attendance in drug treatments and relapse
  recovery.
• Test system interventions to redesign complicated
  admissions systems, improve patient engagement at
  intake, accommodate flexible scheduling, and
  reduced provider burden.

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Bridging the Gap Linkages

• Generate information that can be used to develop
  and test a workable model of community-based
  delivery in Hispanic communities, including
  research that identifies untapped, informal
  Hispanic community-based resources.
• Develop and evaluate best practices that focus on
  the integration of social, health and drug abuse
  services and that can optimize treatment outcomes
  for Hispanic service users.

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Bridging the Gap Other Issues

• Speaking a Common Language
• How we define the problem
• How we define the outcome
• How we define the measurement
• Documenting Effectiveness
• Informal Publications
• Formal Publications
• Increasing Funding for Research and Services
• Making Addiction a Priority
• Economic Costs
• Social Costs

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Evidence Based Substance Use Treatment Where do
we find them?

• National Registry of Evidence-Based Programs and
  Practices
• Created in 2007
• List SAMSHA Model Treatment Programs
• Defines EBP as approaches t prevention or
  treatment based in theory and have undergone
  scientific evaluation.
• Submissions are reviewed by experts with
  doctorial degrees, evaluation research experience
  and clinical experience.
• Many more prevention/intervention programs.
• Searchable by target population needs

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Evidence Based Substance Use Treatment Where do
we find them?

• Agency for Healthcare Research and Quality
• National Guidelines Clearinghouse
• Search by topic area.
• Can compare multiple guidelines across variety of
  criteria and classifications.
• Can download information to PDAs.
• Rigorous selection and review process

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Evidence Based Substance Use Treatment Where do
we find them?

• Co-Occurring Disorder Center for Excellence
• Foster infusion and adoption of evidence and
  consensus based treatment and program innovation
  into clinical and organization practice.
• Created in 2003
• Intended for the co-occurring disorder service
  system
• Provides descriptions of interventions
• Describes intervention implementation
• References related to EBPs

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Evidence Based Substance Use Treatment Where do
we find them?

• Technology Transfer Centers
• 14 Regionally based addiction technology transfer
  centers
• Bridging the gap between science and practice
• Addiction Science Made Easy Program
• Intended for addiction treatment professionals
• Provides descriptions of interventions
• Describes intervention implementation
• References related to EBPs

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Evidence Based Substance Use Treatment Where do
we find them?

• National Drug Abuse Treatment Clinical Trials
  Network
• The CTN provides an enterprise in which the
  National Institute on Drug Abuse, treatment
  researchers, and community-based service
  providers cooperatively develop, validate,
  refine, and deliver new treatment options to
  patients in community-level clinical practice.
  This unique partnership between community
  treatment providers and academic research leaders
  aims to achieve the following objectives
• Conducting studies of behavioral,
  pharmacological, and integrated behavioral and
  pharmacological treatment interventions of
  therapeutic effect in rigorous, multi-site
  clinical trials to determine effectiveness across
  a broad range of community-based treatment
  settings and diversified patient populations and
  
• Ensuring the transfer of research results to
  physicians, clinicians, providers, and patients.
• Regional Nodes
• Service providers attached to various regional
  nodes

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Discussion