Presentation on theme: "September 16, 2005 Kevin D. Hennessy, Ph.D."— Presentation transcript:
1 Identifying and Implementing Evidence-Based Mental Health and Substance Abuse Services September 16, 2005Kevin D. Hennessy, Ph.D.Science to Service CoordinatorSubstance Abuse & Mental Health Services AdministrationU.S. Department of Health & Human Services
2 Vision Mission “A Life in the Community For Everyone” “Building Resilience & Facilitating Recovery”
4 How do we translate research into practice? A Cross-Cutting Principle: Science to Services/Evidence-Based PracticesHow do we translate research into practice?How do we connect services to science?
5 An old and well-defined problem Few research innovations are implemented successfully in typical health care settingsMany widely used interventions have little if any research supportMost in treatment don’t receive evidence-based interventionsMany reports exist documenting the problem and recommending actionsBridging the Gap Between Research and Practice: Forging Partnerships with Community-Based Drug and Alcohol Treatment (Institute of Medicine Report) – 1998Mental Health: A Report of the Surgeon General – 2000Achieving the Promise: Transforming Mental Health Care in America (The President’s New Freedom Mental Health Commission) – 2003Knowledge to practice gap remains at years
6 It takes 17 years to turn 14 per cent of original research 18%variableNegative resultsDickersin, 1987Submission46%0.5 yearKumar, 1992Koren, 1989AcceptanceNegative results0.6 yearKumar, 1992Publication17:14Expertopinion35%0.3 yearPoyer, 1982Balas, 1995Lack of numbersBibliographic databases50%yearsAntman, 1992Poynard, 1985Reviews, guidelines, textbook9.3 yearsInconsistentindexingImplementationIt takes 17 years to turn 14 per cent of original researchto the benefit of patient care
7 SAMHSA Activities for Reducing the Knowledge – Practice Gap Identify evidence-based practices (NREPP)Develop guides, manuals and other materialsEvidence-Based Practice Implementation Resource KitsDisseminate materials and provide trainings through regional centersCenters for the Application of Prevention Technology (CAPTs)Addiction Technology Transfer Centers (ATTCs)Center for Mental Health Services Technical Assistance CentersCreate interagency and private-public partnerships
8 National Registry of Evidence-based Programs and Practices (NREPP) Purpose: A voluntary rating and classification system for mental health and substance abuse prevention and treatment interventions.Goal: NREPP will become a leading national resource for science-based information on substance abuse and mental health prevention and treatment interventions.
9 NREPP Timeline1998…Started with a focus on substance abuse prevention as the National Registry of Effective Prevention Programs…reviewed and rated over 1,100 substance abuse prevention programsinformation on over 150 Model, Effective, and Promising Programs on web site (2004…initial expansion of system to include substance abuse treatment, mental health promotion, and mental health treatment programs
10 NREPP Current StatusFormal public comment process by SAMHSA this summerNotice in August 26th Federal RegisterAvailable through SAMHSA web site – access through “Quick Picks” on SAMHSA’s home page (Written comments due no later than October 25thU.S. Mail – SAMHSA, c/o NREPP Notice, 1 Choke Cherry Road, Rockville, MD 20877Electronic Mail –Posting of recently completed reviews (using older NREPP system) by Fall 2005No new reviews until 2006New NREPP Website will be launched in 2006:
11 NREPP: Comprehensive & Transparent Scientists independently evaluate and classify outcomes for programs/practices based on statistical significance, replications and 16 evidence quality criteriaProgram impact and practical significance will be reported through effect sizesFor status programs, additional information on implementation, training, quality tools, staffing, costs, etc. will be provided
12 NREPP: Comprehensive and Transparent Review results will be posted on the new NREPP websiteBy 2006 Web site will feature:Outcomes searchable databaseLinks to educational materials on review criteriaSelf-assessment tool for candidate programsLinks to technical assistance centers and supports
13 NREPP: Draft Rating Criteria Two Types of CriteriaEvidence Rating Criteria“Utility Descriptors”
14 NREPP: Evidence Rating Criteria 16 evidence rating criteria applied to each program outcome (0 to 4 scale).Include:Theory-driven selection of measures & analytic methodsReliabilityValidityIntervention and comparison fidelityAssurances to participantsStandardized Data CollectionSelection biasAttrition and missing dataAnalysis meets data assumptions
15 NREPP: “Utility Descriptors” Look beyond scientific evidence and ensure that programs are able to be implemented.Assessments also made of the following:ImplementationQuality MonitoringUnintended or Adverse EventsPopulation CoverageCultural RelevanceStaffingCost
16 NREPP: Questions to the Public From the August 26th Federal Register Notice (FRN)Is proposed system objective, transparent, efficient, and scientifically defensible?How might SAMHSA engage stakeholders in determining priority review areas?How best to use statistical significance and measures of effect size in NREPP?Beneficial to use multiple categories of effectiveness?Approach to assessing and presenting cultural relevance?
17 NREPP: Questions to the Public From the August 26th Federal Register Notice (FRN) - continuedApproach to re-reviewing existing NREPP programs?Types of technical assistance needed to promote adoption of NREPP interventions?How best to involve consumers, families, and other non-scientists in NREPP?What, if any, guidance on use of NREPP interventions within block grants?How best to promote other sources – e.g., clinical judgement, consumer values, etc – in decisions regarding selection, delivery and financing of services?Panel to annually review NREPP operational and technical suggestions?
18 NREPP’s ReachInfluences SAMHSA discretionary and block grant investmentsServes as a resource for states and communities seeking to implement evidence-based Mental Health & Substance Abuse prevention and treatment servicesProvides an important tool for both public and private purchasers in selection of effective services
19 Publications and Materials on Best Practices in Mental Health and Substance Abuse Prevention & TreatmentWhat type of Products?Training ManualsEvidence-based Implementation Resource Kits (CMHS)Interactive Web-based Technical Support (Prevention Platform)Treatment Improvement Protocols (TIPs)Quick Reference Cards & Pocket-size GuidesFact Sheets, Brochures, Reports, and Periodicals
20 Publications and Materials on Best Practices in Mental Health and Substance Abuse Prevention & TreatmentWho Uses the Products?Program Administrators & StaffCliniciansPolicymakersConsumersWhere to Find the Products:For SA Treatment go toFor SA Prevention go toFor Mental Health go to
21 Evidence-Based Practice Implementation Resource Kits Focus on six practicesAssertive community treatmentFamily psychoeducationSupported employmentIntegrated dual disorders treatmentIllness management and recovery skillsStandardized pharmacological treatmentTwo PhasesI – Development (Fall 2000 – Summer 2002)II – Pilot-Testing (Summer 2002 – Summer 2005)More information is available through SAMHSA’s web site ( under “Mental Health System Transformation”
22 Evidence-Based Practice Implementation Resource Kits Kits have targeted and distinct components for:ConsumersFamily and Other SupportsPractitioners and Clinical SupervisorsMental Health Program LeadersPublic Mental Health Authorities/AdministratorsKits include:Research summariesInformation sheets for all stakeholdersTip sheets for program leaders and administratorsProgram manuals/workbooks for practitionersIntroductory and training/demonstration videosFidelity assessment tools and cultural competence statementsOutcome measures
23 Materials, Trainings & Technical Assistance for Prevention After evaluating and identifying evidence-based programs and practices through NREPP and producing materials and publications like Too smart to Start and the TIPs, the 3rd step is to disseminate the information.For Prevention, SAMHSA uses our Centers for the Application of Prevention Technology.The CAPTs are technical assistance providers that are organized in regions across the country.They assist States and community-based organizations in the application of evidence-based substance abuse prevention programs, practices, and policies.The CAPT system is a practical tool to increase the impact of the knowledge and experience that defines what works best in prevention programming.Centers for the Application of Prevention TechnologyPurpose: Assist States and Communities in the applicationof evidence-based substance abuse prevention programs,practices, and policiesGoal: To increase the impact of prevention
24 Materials, Trainings & Technical Assistance for Treatment The ATTCs are similar to the CAPTs but they focus on Treatment rather than prevention.The ATTCs bring together science, education and services to treat individuals and families affected by alcohol and other drug addictions.They get the latest knowledge, skills and experiences of treatment providers out into the field to enhance clinical practice.The ATTC Network operates as 14 individual Regional Centers and a National Office. At the regional level, individual Centers focus primarily on meeting the unique needs in their areas while also supporting national initiatives.I want to briefly mention the Pacific Southwest ATTC which encompasses the States of California, Arizona and New Mexico. This ATTC has had tremendous success. I mention it because the Conference organizer for this conference heads the Pacific Southwest ATTC – Rick Rawson. I’m sure Rick would be happy to discuss this ATTC at a later time with anyone who would like more details.SAMHSA’s Addiction Technology Transfer CentersPurpose: To transmit the latest knowledge, skills and attitudes of professional addiction treatment practiceGoal: To enhance clinical practice
25 Center for Mental Health Services Research, Training and TA Centers Currently 55 Centers provide a range of services – many are free but charges may apply for some:Technical assistanceInformation and referralsOn-site consultationTrainingLibrary servicesPublicationsOther resourcesMore information is available through SAMHSA’s web site:
26 Promoting Interagency Partnerships Collaborations with National Institutes of Health to jointly fund state planning grants facilitating implementation of evidence-based practicesRFA-MH – State Implementation of Evidence-Based Practices: Bridging Science and Service (with NIMH)RFA-MH – State Implementation of Evidence-Based Practices II: Bridging Science and Service (with NIMH)RFA-DA – Enhancing State Capacity to Foster Adoption of Science-Based Practices (with NIDA)
27 Creating Public – Private Partnerships Partnership between:SAMHSA’s Center for Substance Abuse Treatment (CSAT)Robert Wood Johnson Foundation (RWJF)Goals of improving organizational processes to facilitate client access and retention in addictions treatment. Initial successes include:Reduced Waiting Times by 31% (n=24)Reduced No-Shows by 22% (n=13)Increased Admissions by 25% (n=19)Increased Treatment Continuation Rates by 33% (n=8)More info available through web site –
28 Advancing Science to Service Efforts and Reducing the Knowledge – Practice Gap Focus on elements of health care redesign detailed in Crossing the Quality Chasm (Institute of Medicine, 2001)Apply evidence to health care deliveryAlign payment policies with quality improvementPrepare the workforceUse information technology
29 In Conclusion “The future is here. It’s just not widely distributed yet.”