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Research Focused on Real Treatment Presentation at 2007 National Association of Addiction Treatment Providers (NAATP) Conference, May 20-23, 2007, San.

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Presentation on theme: "Research Focused on Real Treatment Presentation at 2007 National Association of Addiction Treatment Providers (NAATP) Conference, May 20-23, 2007, San."— Presentation transcript:

1 Research Focused on Real Treatment Presentation at 2007 National Association of Addiction Treatment Providers (NAATP) Conference, May 20-23, 2007, San Diego, CA. The opinions are those of the authors and do not reflect official positions of the association or government. Available on line at or by contacting Joan Unsicker at 720 West Chestnut, Bloomington, IL 61701, phone: (309) , fax: (309) ,

2 2 The Panel Michael L. Dennis, Ph.D. Director, GAIN Coordinating Center, Lighthouse Institute, Chestnut Health Systems, Bloomington, IL Cara Renzelli, Ph.D., Director of Research and Evaluation, Gateway Rehabilitation Center, Pittsburgh, PA Sigurd Zielke, Ph.D., Clinical Specialist (Adolescents), Fairbanks, Indianapolis, IN Valerie J. Slaymaker, Ph.D.,Director, Butler Center for Research, Hazelden, Center City, MN Erin Deneke, Ph.D., Director of Research, Caron Treatment Centers, Wernersville, PA Susan Gordon, Ph.D., Research Director, Seabrook House, Seabrook, NJ

3 3 What do we mean by research? Management by objectives and milestones (budget, plans, internal funds) Performance Monitoring (e.g, Oryx, NOMS, GPRA, internal and external funds) Group problem solving to improve performance overal or for a subgroup (e.g, NIATX, Drug Courts) Program Development and Evaluation (e.g., Private, state or CSAT grants) Development and Replication of Evidenced Based Practices (e.g., CSAT, NIH grants) Quasi-Experiments and Randomized Experiments (e.g, NIH grants)

4 4 As you move down this list It requires better and more consistent leadership, communications, and trust (particularly for a problem solving type approach) Often requires patient or staff incentives as the burden goes up Often requires building of infrastructure (workforce, equipment, systems) or changes in organizational culture that may take several years to be completed The level of staff qualifications and experience goes up (typically from MA to Ph.D. with prior experience/grants) The types of funding shifts (from direct service to state/foundation to CSAT to NIH) The time to get funding gets longer and the likelihood of funding goes down (e.g., NIDA/NIAAA only fund the top 10-13% of applicants and that typically takes 1.5 to 2 years to get from the time the proposal is submitted) May require collaboration with outside vendors (e.g. to help implement an evidenced based practice) or experts (e.g., in a specific analytic technique)

5 5 Cara Renzelli, Ph.D., Director of Research and Evaluation, Gateway Rehabilitation Center Gateway Rehabilitation Centers mission is to enable people affected by or at risk of addictive diseases and other mental and emotional disorders to lead healthy and productive lives through prevention, education, treatment, and research.

6 6 Gateways Range of Services Genesis – Prevention – Evaluation – Detoxification – Inpatient – Outpatient Extended Care – Halfway Houses Corrections Ohio – Neil Kennedy Recovery Clinic

7 7 Research Activities - Internal Projects Study of detoxification medication Exploration of gambling problems in our treatment population Evaluation of teen leadership institute Development and implementation of outcomes monitoring system Assists on performance improvement initiatives

8 8 Research Activities - External Projects Gateway has long history of collaboration with university-based research…recent endeavors include 1980s & 1990s – Washington and Jefferson College and Indiana University of Pennsylvania: inpatient and outpatient treatment outcomes 1992 – today – University of Pittsburgh Medical Center, WPIC: Pittsburgh Adolescent Alcohol Research Center 2003 – 2005 – University of Pittsburgh, School of Social Work: study of adult outcomes and spirituality 2006 – present – Washington University, School of Medicine: prescription abuse study

9 9 Development and Implementation of Outcomes Monitoring System Need for outcome data (Why measure?) Domains (What to measure?) Time points (When to measure?) Staffing needs (Who will measure and where?) Practical applications (How will we use the data?)

10 10 Outcomes Monitoring System Why we decided to create this system Time points – Data collected on ALL patients at 1, 3, 6, 12, and 24 months after discharge from final level of care – Collected by phone, mail, or personal interview Domains – Demographic – marital, employment, education – Criminal justice involvement – Additional post-discharge treatment – Relapse/abstinence – 12-step participation – Quality of life

11 11 Outcomes Monitoring System Staffing needs - Currently have one research director, one research assistant (RA), and a team of volunteers – All volunteers trained on basic research principles, data integrity, confidentiality – RA and volunteers collect data – RA manages collected data Quiet, private space required

12 12 Outcomes Monitoring System Practical applications – Provides a picture of patients functioning after they leave our care – Allows us to look for trends in the data that alert us to investigate further or take action – Gives other departments within the Gateway system information that may meet a general or specific need

13 13 Future Directions of the Research Department Increase the number and breadth of our in- house research and evaluation studies Expand outcomes system to begin assessments at admission, during treatment, and at discharge Expansion of survey domains Continue our work with university-affiliated researchers Form collaborations with other treatment facilities to seek funding for multi-site projects Extend dissemination efforts

14 14 Sigurd Zielke, D.Min. Clinical Specialist (Adolescents) Fairbanks Fairbanks is a nonprofit organization focused on recovery from alcohol and other drug problems, serving as a resource to improve the well-being of individuals, families and communities by offering hope and support through its programs and services.

15 15 Objectives To construct empirically-informed models and generate methods to enhance adolescent treatment and recovery support To create an evidence-informed mindset among our clinicians i.e., an evidence-informed clinical culture To secure external partners for the measurement of models and methods generated

16 16 Full Range of Adolescent Services Discovery (education) Detoxification Rehabilitation Residential Transitional Living Partial Hospitalization Intensive Outpatient Recovery Management I & II Hope Academy (Recovery High School)

17 17 Challenges to Adolescent Treatment & Recovery Support Historic application of adult models of treatment and recovery to adolescents Recent recognition by health services researchers… that adolescence is different from adulthood, and that the methods to identify, treat, and prevent illness need to be different (Zucker, 2006) Emergence of the new field of developmental psychopathology Explosion of neurobehavioral research Lack of coherent adolescent treatment and recovery support models that integrate 12-step recovery processes with recent neurobehavioral and developmental findings Need for empirical study of updated models

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20 20 Research Needs (i.e., Targets) Need for grounded identification of adolescent treatment, relapse and recovery issues (affirmation of practitioner knowledge) Need for extensive professional literature reviews Need for rigorous theoretical researchresulting in grounded, empirically-informed models Need to develop methodologies to enact models Need for clinical staff to utilize models/methodologies Need to establish fidelity standards Need to secure academic partners to measure the efficacy of the models/methodologies generated

21 21 Research Response: Projects Grounded video study of student behavior; over 2000 classrooms in light of neurobehavioral literature Focus group narrative analysis study of educators experiences with young students coming to school SI Joint hospital and university 2 year professional study of the literature on SI children/youth, addiction brain studies, and pathway findings A field-based action research study to enhance the school behavior of SI elementary students: grades one through fivetest of preliminary models Theoretical research---NBD White Paper (July 2007) Generation and utilization of empirically-informed methods: - 90 in 90: A Recovery Tool for School Success - Node link mapping of student relapses Establishing collaborations with academic/research partners

22 22 1.Identify/target clinical issues of persistent concern 2.Conduct field/grounded study of targeted concern to discern patterns of functioning 3.Identify strong lines empirical evidence that address targeted concerns 4.Synthesize findings of 2 and 3 into field- theory and models of practice 5.Use models to guide practice and create tools 6.Conduct quality improvement and pilot studies with external collaborators 7.Use data to affirm, amend, or disregard models/ practice Creating An Evidence-Informed Clinical Culture for The Treatment And Recovery Support of Adolescents 8.Share results: publication & training Critical Cultural Elements Identify curious clinicians Carve- out 1hr per week Keep collegial Keep multidisciplinary Provide readings Tie to writing and training

23 23 Valerie J. Slaymaker, Ph.D., Director of Hazeldens Butler Center for Research (BCR) Dedicated to improving recovery from addiction by conducting clinical and institutional research, collaborating with other research centers, and communicating scientific findings.

24 24 BCR Structure Two doctoral-level research staff One FT research assistant (others as funded) Data collections staff

25 25 BCR Activities Institutional research and evaluation Clinical research and collaboration Consultation Knowledge dissemination

26 26 Institutional Research & Evaluation Outcomes data collection & reporting – 1, 6, and 12 month follow-ups – Use and functional outcomes Special populations and reports – BCBS – Methamphetamine Outcomes Study – Family Program – Scale development

27 27 Clinical Research & Collaboration Milestones of Recovery studies Phone-based Case Management Huss Research Chairs on Late Life Addiction Youth, AA and Treatment Processes study University of Minnesota Youth & Neuroimaging study

28 28 Knowledge Dissemination Research Update Substance Abuse Research Forum Dan Anderson Research Award Conference presentations Published manuscripts

29 29 Erin Deneke, Ph.D., Director of Research Caron Treatment Centers ?? Mission Or Logo

30 30 Range of Services Inpatient Care – – Mens Primary – Womens Primary – Adolescent – Relapse – Young Adult Male Program (YAMP) Extended Care – – Men, Women, and Adolescents Family Education Program Center for Self-Development Caron Outpatient Counseling

31 31 Current Research Activities Focused Continuing Care – In collaboration with Treatment Research Institute Chronic Pain Study – In collaboration with University of Pennsylvania and Reading Hospital – Funded by NIDA Chronic Pain sub-study – In collaboration with Reading Hospital Menstrual cycle and cravings study Menopause and addiction study

32 32 Caron Research Staffing Director of Research – – Design, develop, coordinate, and implement intramural and extramural research projects. – Data analysis, reporting, publishing, and presentations Research Administrator – – Participant recruitment and data collection – Data entry – Assist with literature reviews Research Committee – – Review ongoing studies and outcomes – Evaluation of new or proposed projects – advantages/disadvantages both for internal as well as external studies – Act as an informal Human Subjects Review Board – all projects would be approved through committee for implementation at Caron. Physicians Advisory Committee – – Cutting edge treatment practices – Best research methodology – Members include: Charles OBrien, M.D.; David Mee-Lee, M.D.; Hoover Adger, M.D.; Sheila Blume, M.D., C.A.C.

33 33 Focused Continuing Care Available to all patients once leaving inpatient treatment – Adult only at this time – Will move to adolescent units Monthly follow-up contacts by phone for 12 months by focused continuing care specialists (5) – Check in with patients to see how they are progressing in their recovery – Data collection on such variables as AA attendance, sponsorship, mental health issues, follow-up care, and family issues Ability to analyze data at various points through 1 year post treatment Outcome oriented – Both quantitative and qualitative data Provide information on possible programmatic changes Unit specific data

34 34 Moving towards the Future Increase the number of intramural projects occurring at Caron Increase collaboration with other agencies and universities Encourage more extramural research activities Increase number of sources for outside funding of projects Improve dissemination of information through published articles, conferences, presentations, and information available to consumers Assist in marketing and public relation endeavors by providing media relevant information

35 35 Susan Gordon, Ph.D., Director of Research, Seabrook House To help families find the courage to recover.

36 36 Seabrook Research Goals Process and outcomes evaluation of two residential treatment programs Grant funding to increase/enhance clinical programs Participation in NIDA CTN

37 37 Seabrook Evaluation Project: MatriArk Family Program Residential treatment facility Low income women and children 10 short-term (28 days) patients 37 long-term (6 – 12 months) patients 12-step treatment approach Funded through state and local government

38 38 MatriArk Goals In-treatment Reunification of women with young children during treatment Increase healthy pregnancies and births Post-treatment Increase abstinence Increase 12-step participation Increase bio-psycho-social functioning

39 39 MatriArk Evaluation Goals Assess all eligible and willing patients – Admission and in-treatment – Discharge and one-year follow-up for treatment completers Assess grant funding objectives Identify strengths of the program Identify aspects of the program to improve

40 40 MatriArk Research Infrastructure PEOPLE: Staffing Research Director – Develop & implement project – Analyze results Research Assistant – In-treatment data collection and data entry Aftercare Case Manager – Post-treatment data collection – Post-treatment needs assessment

41 41 MatriArk Research Infrastructure PLACES: Facilities Private office space for patient interviews, follow-up calls THINGS: Resources Computer, network and internet Locked filing cabinets Separate telephone line and stationery for follow-ups Appreciation gifts for patient follow-ups

42 42 MatriArk Research Infrastructure Protocols Consent procedures Post-treatment follow-up procedures – Locating difficult participants Staff training and certification – Research ethics – Instrument administration Safety protocol for home visits

43 43 MatriArk Research Infrastructure Oversight Research and Education Advisory Committee – 10 SBH; 2 external members – Recommend research projects – Monitor ongoing research No I.R.B. – Not Federally funded research – Not clinical trial

44 44 MatriArk Assessments Evidence-based assessments – Reliable and valid – Measure goals and objectives Clinically-useful assessments – Applicable for treatment Appropriate response burden – Main task of patients is treatment – not research!

45 45 MatriArk Assessment Schedule Instrument AdmissionIn-TreatmentDischarge30-day Follow-Up 90-day Follow-up GAINInitial Tx Satisfaction 30 days Substance Abuse M90 ASIInitial DTCQX 30 days XX Pregnancy History Full Follow-up SCL-90 X 90 days X PSIXXX TSPQXXX UDSX 60 days+ X

46 46 MatriArk Recruitment

47 47 Michael Dennis, Ph.D., Director of the GAIN Coordinating Center, Chestnut Health Systems Improving the quality of human service interventions through applied research, publications, and training. - Lighthouse Institute Mission Improving assessment to facilitate evidence-based practices. - GCC Mission

48 48 Chestnuts Direct Clinical Services FY05 Admissions 1,000 to 9, to to 99 1 to 9 FY05 Admissions (n=9311) for Substance Abuse and Mental Health Services from 82 of Illinois 103 counties

49 49 Chestnut Global Partners International Employee Assistance

50 50 Major Study Geog. Areas LI-Research Facilities Started in 1985 and grew to 90 full/part time staff grossing $9 Million a year in external funds (NIH, SAMHSA, Foundations) LI-Research: Several major experiments, quasi-experiments and major surveys LI-Training and Publications: 100s of training days and largest collection of evidence-based treatment manuals EBTx Coordinating Center---Supports training, certification, and coaching of clinicians and clinical supervisors learning A-CRA and ACC GAIN Coordinating Center – supports training, certification and use of the GAIN to support diagnosis, placement, treatment planning, and research Chestnuts Lighthouse Institute (Research Division)

51 51 LIs Global Appraisal of Individual Needs (GAIN) Coordinating Center (GCC) VI 0 1 to to to 130 IN KS ME MS MT ND NE NV PR HI NM SD AL AR IA OK RI SC DC TN UT LA WV MN NC NJ AK MD PA GA ID KY VA MI NY OR CO CT TX NH IL MO AZ FL OH VT MA CA WY Statewide System* WA DE WI * Also being considered in FL, GA, NC, SC, TN DC `

52 52 It took a lot of time to get here… Started going for External CSAT/ NIH Funding Created GAIN Coordinating Center Started by Bill White to do Training and Evaluation

53 53 Multiple Co-occurring Problems are Correlated with Severity and Contribute to Chronicity 0% 20%40%60%80% 100% Health Distress Internal Disorders External Disorders Crime/Violence Criminal Justice System Involvement Dependent (n=1221) Abuse/Other (n=385) 0% 20% 40%60%80% 100% Dependent (n=3135) Abuse/Other (n=2617) Adolescents Adults Source: GAIN Coordinating Center Data Set Adolescents More likely to have externalizing disorders Adults more likely to have internalizing disorders[

54 54 Substance Use Careers are Longer, the Younger the Age of First Use Percent in Recovery Years from first use to 1+ years abstinence % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Dennis et al 2005 (n=1,271) under 15* * Age of 1 st Use Groups * p<.05 (different from 21+)

55 55 Substance Use Careers are Shorter the Sooner People get to Treatment Percent in Recovery Years from first use to 1+ years abstinence % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Dennis et al 2005 (n=1,271) * 10-19* Years to 1 st Tx Groups * p<.05 (different from 20+)

56 56 It Takes Decades and Multiple Episodes of Treatment Years from first Tx to 1+ years abstinence Median duration of 9 years (IQR: 3 to 23) and 3 to 4 episodes of care Percent in Recovery 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: Dennis et al 2005 (n=1,271)

57 57 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Using (N=661) 1 to 12 ms (N=232) 1 to 3 yrs (N=127) 3 to 5 yrs (N=65) 5 to 8 yrs (N=77) % Days of Psych Prob (of 30 days) % Above Poverty Line % Days Worked For Pay (of 22) % of Clean and Sober Friens % Days of Illegal Activity (of 30 days ) Other Aspects of Recovery by Duration of Abstinence of 8 Years 1-12 Months: Immediate increase in clean and sober friend 1-3 Years: Decrease in Illegal Activity; Increase in Psych Problems 3-5 Years: Improved Vocational and Financial Status 5-8 Years: Improved Psychological Status Source: Dennis, Foss & Scott (under review)

58 58 The Cyclical Course of Relapse, Incarceration, Treatment and Recovery: Adults In the Community Using (53% stable) In Treatment (21% stable) In Recovery (58% stable) Incarcerated (37% stable) 6% 13% 8% 30% 8% 25% 31% 4% 44% 7% 29% 7% Treatment is the most likely path to recovery P not the same in both directions Source: Scott et al 2005 Avg of 32% change status each quarter

59 59 RMCs Impact on Time to Treatment Re-Entry 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% Days to Re-Admission (from 3 month interview) Percent Readmitted 1+ Times 55% ERI-2 RMC* (n=221) 37% ERI-2 OM (n=224) *Cohen's d=+0.41 Wilcoxon-Gehen Statistic (df=1) =16.56, p < = -384 days The size of the effect is growing every quarter Source: Dennis & Scott, in press; Scott & Dennis, under review

60 60 RMCs Impact on Adult Outcomes 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% of 630 Days Abstinent (d=0.29)* of 7 Subsequent Quarters in Need (d= -0.32) * of 90 Days Abstinent (d= 0.23)* of 11 Sx of Abuse/Dependence (d= -0.23)* Still in need of Tx (d= -0.24) * Percentage OM RMC * p<.05 68% 49% 68% 27% 57% 76% 37% 76% 19% 46% Months 4-24 Final Interview Significant Increase in Abstinence RMC Broke the Run Less Likely to be in Need of Treatment Less Symptoms Source: Dennis & Scott, in press; Scott & Dennis, under review

61 61 Contact Information Michael L. Dennis, Ph.D. Director, GAIN Coordinating Center, Lighthouse Institute, Chestnut Health Systems (720 West Chestnut, Bloomington, IL 61701, Phone: , Web: Cara Renzelli, Ph.D., Director of Research and Evaluation, Gateway Rehabilitation Center (100 Moffett Run Road, Aliquippa, PA, 15001; Phone: x1104; E- mail: Sigurd Zielke, Ph.D., Clinical Specialist (Adolescents), Fairbanks ( 8102 Clearvista Parkway,. Indianapolis, IN 4625, Phone: , ) Valerie J. Slaymaker, Ph.D.,Director, Butler Center for Research, Hazelden (P O Box 11 (BC 4), Center City, MN ; Phone: ; E- mail: Erin Deneke, Ph.D., Director of Research, Caron Treatment Centers (Galen Hall Road, P.O. Box 150, Wernersville, PA 19565, Phone: , Susan Gordon, Ph.D., Research Director, Seabrook House (133 Polk Lane, Seabrook, NJ 08302, Phone: , ext. 5803, )

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