1. RESEARCH OVERVIEW Traci Rieckmann, Ph.D. OREGON HEALTH AND SCIENCES UNIVERSITY DOUG NOVINS, M.D., UNIVERSITY OF COLORADO DENVER LAURIE MOORE, M.P.H. UNIVERSITY OF COLORADO DENVER NIDA Roundtable Meeting on Evidence-Based Treatments for Substance Abuse in Indian Country Frank Big Bear

2. Role of the Provider  Counselors/providers play significant role  quality of care  patient satisfaction and outcomes  implementation of new practices.  Provider support varies depending on intervention, counselor education level, and experience.  Adoption of new therapies requires marketing of interventions, supervision, exposure to the innovative, practice, and monitoring for adherence (Abraham, et al., 2009; Santisteban, Vega, & Suarez-Morales, 2006; Knudsen, et al., 2007).

3. The Current Workforce  Counseling workforce is estimated to include approximately 200,000 individuals (SAMHSA, 2013; Libretto et al, 2004).  Workforce analysis suggests majority of treatment professionals are Caucasian, middle- aged, and more often female than male (SAMHSA, 2013; Abraham, Ducharme, & Roman, 2009; Mulvey et al., 2003; Libretto et al., 2004).  Counseling workforce is projected to increase 20-24% by 2018 (SAMHSA, 2013).

4. Workforce Studies  Characteristics individual  Training  Credentials/competencies  Attitudes and experiences  Toward EBPs  Administration and leadership  Intentions to use innovation  Results often vary across:  Treatment Setting (funding sources: Public, private)  Time frame

5. Workforce Studies NIDA CTNNTCS SAMHSA (2013) Gender Male38%38.7%28.8% Female62%61.3%71.2% Race/Ethnicity White63%70.2%55.8% African American20%18.7%27.9% Hispanic/Latino12%11.1% (or “Other”)11.1% AI/AN0.7% Education Master’s or Doctorate42%42.5%50-55% Certification/License44% State 18% National 59.4% Certified; 32.9% Licensed 45-72% Credentialed

6. Transitions and Growth  Annual turnover rate is cited as being anywhere between 18% and 50% (Rothrauff et al., 2011; Eby, et al., 2010; Johnson et al., 2002; McNulty et al., 2007; Mclellan et al., 2003).  Projected growth across disciplines:  Substance Abuse & Behavioral Disorders Counselors21%  Mental Health Counselors24%  Mental Health & Substance Abuse Social Workers 20%  Psychologists 11% To date, no national study has focused on the characteristics of counselors working in AI/AN treatment programs.

7.  DATA ANALYSIS METHODS  Sample (n=192)  Analytic methods used  Descriptive analyses by program location (rural/urban) were completed on all variables that described either respondent, staff, or program characteristics;  Variables with p-values <=0.25 in a univariate regression with program location (rural/urban) were entered into logistic regression models that follow

8. TABLE 1a: Characteristics of Staff of 192 Substance Abuse Programs by Program Location Characteristic Total respondents (N=192) Urban Programs (n=50) Rural Programs (n=142) N%n%n% 51% or more of staff are AI/AN 7438.51428.06042.3 Staff with master’s or doctoral degree 16083.34386.011782.4 Tribal language spoken by one or more staff 6332.81632.04733.1 51% or more of staff in recovery 5528.7918.04632.4 Staff years of experience in program (mean, std dev) 5.6 (3.5)4.5 (2.7)6.0 (3.7)

9. TABLE 1b: Characteristics of Staff of 192 Substance Abuse Programs Participating in the Evidence-Based Practices Survey, by Program Location Characteristic Total respondents (N=192) Urban Programs (n=50) Rural Programs (n=142) n%n%n% 51% or more of staff are certified addictions counselors 8343.22040.06344.4 51% or more of staff are certified mental health counselors 3920.61122.52820.0 51% or more of staff are licensed counseling professionals* 8946.42550.06445.1 * Licensed addictions counselor, licensed clinical social worker, licensed clinical psychologist, physician, etc.

10. TABLE 1c: Characteristics of Staff of 192 Substance Abuse Programs Participating in the Evidence-Based Practices Survey, by Program Location Characteristic Total respondents (N=192) Urban Programs (n=50) Rural Programs (n=142) n%n%n% Traditional healers on staff 118 61.5 35 70.083 58.4 Veterans/Nat’l Guard members on staff 7539.12448.05135.9 LGBT on staff 3820.01530.02316.2 Disciplines represented on staff Addictions 18395.34998.013494.4 Mental health 14173.44182.010070.4 Social work 12665.63264.09466.2 Education 5227.11530.03726.1 Nursing 3820.01734.02114.8 Medicine/psychiatry 5729.72040.03726.1

11. TABLE 2a: Program Characteristics of 192 Substance Abuse Programs Participating in the Evidence-Based Practices Survey, by Program Location Characteristic Total respondents (N=192) Urban Programs (n=50) Rural Programs (n=142) n%n%n% Struggle to recruit / retain staff 9951.62040.07955.6 Collect treatment outcome data 12064.22654.29467.6 Utilize outside evaluator 7640.62960.44733.8 Utilize strategic planning to improve services 13170.54185.49064.8

12. TABLE 2b: Program Characteristics of 192 Substance Abuse Programs Participating in the Evidence-Based Practices Survey, by Program Location Characteristic Total respondents (N=192) Urban Programs (n=50) Rural Programs (n=142) n%n%n% Consider the use of EBPs as part of strategic planning process 10958.33470.47554.0 Formal method used to assess motivation for change 4627.51838.32823.3 Program participated in research/program evaluation study 5931.62450.03525.2

13. Table 3a. Logistic regression model predicting rural program location with staff characteristics as predictors. B-coefficientOdds ratio 95% Wald confidence limitsP-value Nursing discipline on staff -1.02990.3570.167-0.7650.0081 Traditional healing consultants on staff -0.86530.4210.212-0.8370.0137

14. Staffing Characteristics Programs in rural locations are LESS likely to  Have nurses on staff  Have traditional healing consultants on staff

15. Table 3b. Logistic regression model predicting rural program location with program characteristics as predictors. B- coefficient Odds ratio 95% Wald confidence limits P-value Program struggles to recruit / retain staff 0.94852.5821.2-5.5550.0152 AA – open group recovery services offered 0.95022.5861.145-5.8430.0223 Equine therapy offered1.84126.3041.142-34.7910.0346 Medication therapies offered -0.99160.3710.177-0.7760.0084 Pipe ceremonies offered-1.49020.2250.066-0.7710.0175 Cultural activities offered-1.97750.1380.048-0.3960.0002 Religious services offered1.09652.9941.035-8.6610.0431 Meditation services offered1.46284.3181.254-14.8740.0204

16. Program Characteristics  Struggle to recruit and retain staff  Offer AA-open group recovery services  Offer equine therapy  Offer religious and meditation services  Offer medication therapies  Offer pipe ceremonies and cultural activities Rural programs are MORE likely toRural programs are LESS likely to

17. Table 3c. Logistic regression model predicting rural program location with program assessment characteristics as predictors. B- coefficient Odds ratio 95% Wald confidence limits P-value Program collects data on treatment outcomes 1.04692.8491.311-6.1910.0082 Program uses an outside evaluator -1.18470.3060.139-0.6710.0031 Program participated in research or program evaluation study -0.85770.4240.202-0.8910.0236

18. Program Assessment  Collect data on treatment outcomes  Use an outside evaluator  Participate in research or program evaluation Rural programs are MORE likely toRural programs are LESS likely to