Presentation on theme: "Identifying and Implementing Evidence-Based Mental Health and Substance Abuse Services Kevin D. Hennessy, Ph.D. Science to Service Coordinator Substance."— Presentation transcript:
Identifying and Implementing Evidence-Based Mental Health and Substance Abuse Services Kevin D. Hennessy, Ph.D. Science to Service Coordinator Substance Abuse & Mental Health Services Administration U.S. Department of Health & Human Services September 16, 2005
A Life in the Community For Everyone Building Resilience & Facilitating Recovery
A Cross-Cutting Principle: Science to Services/Evidence-Based Practices How do we translate research into practice? How do we connect services to science?
Few research innovations are implemented successfully in typical health care settings Many widely used interventions have little if any research support Most in treatment dont receive evidence-based interventions Many reports exist documenting the problem and recommending actions Bridging the Gap Between Research and Practice: Forging Partnerships with Community-Based Drug and Alcohol Treatment (Institute of Medicine Report) – 1998 Mental Health: A Report of the Surgeon General – 2000 Achieving the Promise: Transforming Mental Health Care in America (The Presidents New Freedom Mental Health Commission) – 2003 Knowledge to practice gap remains at years An old and well-defined problem
Publication Bibliographic databases Submission Reviews, guidelines, textbook Negative results variable 0.3 year years 50% 46% 18% 35% 0.6 year 0.5 year 9.3 years It takes 17 years to turn 14 per cent of original research to the benefit of patient care to the benefit of patient care Dickersin, 1987 Koren, 1989 Balas, 1995 Poynard, 1985 Kumar, 1992 Poyer, 1982 Antman, 1992 Negative results Lack of numbers Expert opinion Inconsistent indexing 17:14 Original research Acceptance Implementation
Identify evidence-based practices (NREPP) Develop guides, manuals and other materials Evidence-Based Practice Implementation Resource Kits Disseminate materials and provide trainings through regional centers Centers for the Application of Prevention Technology (CAPTs) Addiction Technology Transfer Centers (ATTCs) Center for Mental Health Services Technical Assistance Centers Create interagency and private-public partnerships SAMHSA Activities for Reducing the Knowledge – Practice Gap
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.
NREPP Timeline 1998…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 programs information on over 150 Model, Effective, and Promising Programs on web site (www.modelprograms.samhsa.gov) 2004…initial expansion of system to include substance abuse treatment, mental health promotion, and mental health treatment programs
NREPP Current Status Formal public comment process by SAMHSA this summer Notice in August 26 th Federal Register Available through SAMHSA web site – access through Quick Picks on SAMHSAs home page (www.samhsa.gov)www.samhsa.gov Written comments due no later than October 25 th U.S. Mail – SAMHSA, c/o NREPP Notice, 1 Choke Cherry Road, Rockville, MD Electronic Mail – Posting of recently completed reviews (using older NREPP system) by Fall 2005 No new reviews until 2006 New NREPP Website will be launched in 2006:
NREPP: Comprehensive & Transparent Comprehensive Scientists independently evaluate and classify outcomes for programs/practices based on statistical significance, replications and 16 evidence quality criteria Program impact and practical significance will be reported through effect sizes For status programs, additional information on implementation, training, quality tools, staffing, costs, etc. will be provided
NREPP: Comprehensive and Transparent Transparent Review results will be posted on the new NREPP website By 2006 Web site will feature: Outcomes searchable database Links to educational materials on review criteria Self-assessment tool for candidate programs Links to technical assistance centers and supports
NREPP: Draft Rating Criteria Two Types of Criteria Evidence Rating Criteria Utility Descriptors
NREPP: Evidence Rating Criteria 16 evidence rating criteria applied to each program outcome (0 to 4 scale). Include: Theory-driven selection of measures & analytic methods Reliability Validity Intervention and comparison fidelity Assurances to participants Standardized Data Collection Selection bias Attrition and missing data Analysis meets data assumptions
NREPP: Utility Descriptors Look beyond scientific evidence and ensure that programs are able to be implemented. Assessments also made of the following: Implementation Quality Monitoring Unintended or Adverse Events Population Coverage Cultural Relevance Staffing Cost
NREPP: Questions to the Public From the August 26 th 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?
NREPP: Questions to the Public From the August 26 th Federal Register Notice (FRN) - continued Approach 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?
NREPPs Reach Influences SAMHSA discretionary and block grant investments Serves as a resource for states and communities seeking to implement evidence-based Mental Health & Substance Abuse prevention and treatment services Provides an important tool for both public and private purchasers in selection of effective services
What type of Products? Training Manuals Evidence-based Implementation Resource Kits (CMHS) Interactive Web-based Technical Support (Prevention Platform) Treatment Improvement Protocols (TIPs) Quick Reference Cards & Pocket-size Guides Fact Sheets, Brochures, Reports, and Periodicals Publications and Materials on Best Practices in Mental Health and Substance Abuse Prevention & Treatment
Who Uses the Products? Program Administrators & Staff Clinicians Policymakers Consumers Where to Find the Products: For SA Treatment go to For SA Prevention go to For Mental Health go to Publications and Materials on Best Practices in Mental Health and Substance Abuse Prevention & Treatment
Focus on six practices Assertive community treatment Family psychoeducation Supported employment Integrated dual disorders treatment Illness management and recovery skills Standardized pharmacological treatment Two Phases I – Development (Fall 2000 – Summer 2002) II – Pilot-Testing (Summer 2002 – Summer 2005) More information is available through SAMHSAs web site (www.samhsa.gov) under Mental Health System Transformationwww.samhsa.gov Evidence-Based Practice Implementation Resource Kits
Kits have targeted and distinct components for: Consumers Family and Other Supports Practitioners and Clinical Supervisors Mental Health Program Leaders Public Mental Health Authorities/Administrators Kits include: Research summaries Information sheets for all stakeholders Tip sheets for program leaders and administrators Program manuals/workbooks for practitioners Introductory and training/demonstration videos Fidelity assessment tools and cultural competence statements Outcome measures Evidence-Based Practice Implementation Resource Kits
Centers for the Application of Prevention Technology Materials, Trainings & Technical Assistance for Prevention Purpose: Assist States and Communities in the application of evidence-based substance abuse prevention programs, practices, and policies Goal: To increase the impact of prevention
Materials, Trainings & Technical Assistance for Treatment SAMHSAs Addiction Technology Transfer Centers Purpose: To transmit the latest knowledge, skills and attitudes of professional addiction treatment practice Goal: To enhance clinical practice
Currently 55 Centers provide a range of services – many are free but charges may apply for some: Technical assistance Information and referrals On-site consultation Training Library services Publications Other resources More information is available through SAMHSAs web site: Center for Mental Health Services Research, Training and TA Centers
Collaborations with National Institutes of Health to jointly fund state planning grants facilitating implementation of evidence-based practices –RFA-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) Promoting Interagency Partnerships
Partnership between: SAMHSAs 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 – Creating Public – Private Partnerships
Focus on elements of health care redesign detailed in Crossing the Quality Chasm (Institute of Medicine, 2001) –Apply evidence to health care delivery –Align payment policies with quality improvement –Prepare the workforce –Use information technology Advancing Science to Service Efforts and Reducing the Knowledge – Practice Gap
The future is here. Its just not widely distributed yet. In Conclusion