The University of Georgia Training and exposure to evidence-based practices: Changing attitudes among the addiction treatment workforce J. Aaron Johnson, Ph.D. Meredith Huey Dye, MA The University of Georgia With research grant support from the National Institute on Drug Abuse (R01DA14976 and R01DA14482)

The University of Georgia Background Significant efforts devoted to moving evidence-based treatment from research settings into community-based treatment programs –Development of treatment techniques, including medications and psycho-social approaches –Testing and disseminating these EBPs – NIDA CTN, SAMHSA ATTC’s, RWJF initiatives –Our research – devoted to identifying barriers as well as factors facilitating adoption/implementation

The University of Georgia Background (cont.) Research in other organizations - attitudes of members critical to successful implementation of new innovation Previous research on innovation adoption in addiction treatment: –“Exposure” to buprenorphine through specific training or use by program led to more positive attitudes among counselors (Knudsen et al., 2005) –Counselor computer access relatively high, use of internet to learn about new techniques low = possible “technology gap” in diffusion of EBPs (Ducharme et al, 2005)

The University of Georgia Research Questions What is the impact of training and exposure to EBPs on counselor attitudes toward pharmaceutical and behavioral interventions? What are the implications of these findings on current efforts to disseminate EBPs into community-based treatment programs?

The University of Georgia The National Treatment Center Study Monitoring the organization, management, delivery, and content of addiction treatment in the U.S. Includes Nationally Representative Samples of : –Privately-funded treatment programs (N=401) –Publicly-funded treatment programs (N=362) Programs must offer a level of care for addiction treatment at least equivalent to structured outpatient as defined by ASAM –Excludes: methadone maintenance-only facilities, clinicians in private practice, DUI-only programs, halfway houses

The University of Georgia NTCS Instrument Design Multiple data collection methods used: –Detailed on-site interviews with program administrator  Focus - organizational characteristics, services offered, use of innovations –Mail questionnaire from program administrator  Focus - leadership and management practices –Mail questionnaire from counselors  Focus - services received by clients, attitudes toward innovations –Brief telephone follow-ups w/ program administrator at six month intervals  Focus - major program changes Today’s presentation: data from counselor questionnaires collected between November 2004 and July 2006 (N=880)

The University of Georgia Counselor Demographics Female64.5% Race/Ethnicity Caucasian63.6% African American25.1% Hispanic6.7% Master’s degree or higher41.3% In Recovery46.1% Mean age (in years)45.5 Mean yrs in field9.4 Mean yrs at program5.4

The University of Georgia Counselor Training and Access to Computers w/ Internet Formal “in-house” training (hrs)29.0 Cont. Ed. Outside Program (hrs)32.1 Computer/Internet Access No Computer/Internet26.5% Shared Computer/Internet19.4% Own Computer/Internet54.1%

The University of Georgia Prevalence of “Exposure” to EBPs Buprenorphine (October 2002) Acamprosate (July 2004) METVouchers Used in Program (1=yes) 15.3%9.8%80.1%34.4% Specific Training (1-7) How Acceptable (1-7)

The University of Georgia Counselor “Exposure” and Attitudes toward EBPs BuprenorphineAcamprosateMETVouchers Used in Program 5.88**5.76**6.34**5.54** Not Used in Program In each case counselors report significantly more positive attitudes toward EBPs when exposed to those practices.

The University of Georgia Computer Access & Attitudes toward EBPs BuprenorphineAcamprosateMETVouchers No Computer Shared Computer Own Computer 4.96**4.69**6.38*5.17 Counselors report significantly more positive attitudes toward EBPs when provided with their own computer/internet access

The University of Georgia Regression Models BuprenorphineAcamprosateMETVouchers Gender (1=male) -- Age Educ (Masters +) ++ In Recovery + Cont. Ed. Hrs - Specific Training ++++ Used in Program ++++ Comp./w internet +

The University of Georgia Discussion Regardless of whether pharmacological or psychosocial, “Exposure” to specific EBPs has significant impact on counselors’ attitudes toward those practices Only attitudes toward psychosocial therapies impacted by counselor education Having access to computer w/ internet has limited impact on attitudes Males have significantly more negative attitudes toward use of MET and vouchers than females?

The University of Georgia Conclusion/Implications On-site training and testing of EBPs will likely have significant positive impact on counselor attitudes Dissemination of information via computer (CD-ROM, website, etc.) will likely have little impact (limited access, limited time) For Psychosocial EBPs, might consider tailoring training to specific genders

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