Where have we been and where are we

Where have we been and where are we going? Dissemination in the CTN Elizabeth Wells Pacific Northwest Node April 2010

“There are important gaps between the knowledge gained from research, everyday practice in community-based drug abuse treatment programs, and governmental policies about drug abuse treatment at the local, state, and national levels. Much has been learned about drug abuse treatment at each of these levels—research, treatment, and policy. Yet these groups make too little use of one another's knowledge base. ” (Lamb, Greenlick & Mc. Carty, 1998) The Gap

“…most CTN nodes have more sites using at least some of the tested interventions, but why are not all sites using almost all “effective” interventions? I am definitely not suggesting these sites should be forced or even incentivized to do those interventions that the CTN has found to be effective. I am asking why more of these interventions are not being used especially among those who have had the most experience, or at least exposure to them? ” (Mc. Lellan, 2010) The Gap Revisited

A Brief History � Dissemination Subcommittee of SC 2001 -2002 � Subcommittee of the External Affairs Committee (EAC) 2002 -2005 � Research Utilization Committee 2005 – present Facilitates adoption of CTN-tested and successful interventions within the CTN. Facilitates sharing of cost effective dissemination strategies among Nodes, Blending Teams, or Federal and State partners. Assists Nodes in developing internal dissemination projects and developing partnerships for internal dissemination. Tracks and describes dissemination activities within the CTN. Promotes dissemination research using CTN as a platform. Reports to Executive Committee as required

Illustrious Chairs and NIDA Liasons CHAIRS Paula Horvatich / Richard Drandoff Greg Brigham John Hamilton Betsy Wells Jeffrey Selzer Steve Martino NIDA Mary Ann Stephens Theresa Montini Ming Shih Jack Stein Suman Rao King Ron Dobbins Denny Pintello Harold Perl

We had a lot of ideas.

Some ideas bore fruit.

Articles about Technology Transfer � Miller, W. R. , Sorensen, J. L. , Selzer, J. A. , & Brigham, G. S. (2006). Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. Journal of Substance Abuse Treatment, 31(1), 25 -39. � Miller, W. R. , Zweben, J. E. , & Johnson, W. R. (2005). Evidencebased treatment: Why, what, where, when, and how? Journal of Substance Abuse Treatment, 29, 267 -276. � Miller, W. R. & Manuel, J. K. (2008). How large must a treatment effect be before it matters to practitioners? An estimation method and demonstration. Drug and Alcohol Review, 27(5), 524 -528. � Stitzer, M. L. & Kellogg, S. (2007). Large-scale dissemination efforts in drug abuse treatment clinics. Pp. 241 -260 in S. T. Higgins, K. Silverman, & S. H. Heil (eds. ). Contingency Management in Substance Abuse Treatment. New York: Guilford Press.

CTN Platform Dissemination /Implementation Studies � Abraham, A. J. , Knudsen, H. K. , Rothrauff, T. C. , & Roman, P. M. (2010). The adoption of alcohol pharmacotherapies in the Clinical Trials Network: The influence of research network participation. , 275 -283. Journal of Substance Abuse Treatment , 38(3). � Baer, J. S. , Wells, E. A. , Rosengren, D. B. , Hartzler, B. , Beadnell, B. A. , & Dunn, C. (2009). Agency context and tailored training in technology transfer: A pilot evaluation of motivational interviewing training for community counselors. Journal of Substance Abuse Treatment, 37(2), 191202. � Haug, N. A. , Shopshire, M. , Tajima, B. M. , Gruber, V. , & Guydish, J. R. (2008). Adoption of evidence-based practices among substance abuse treatment providers. Journal of Drug Education, 38(2), 181 -192. � Guydish, J. R. , Tajima, B. M. , Manser, S. T. , & Jessup, M. A. (2007). Strategies to encourage adoption in multisite clinical trials. Journal of Substance Abuse Treatment, 32(2), 177 -188.

NIDA-SAMHSA (CTN-ATTC) Blending Products � Buprenorphine Treatment: A Training for Multidisciplinary Addiction Professionals. � Treatment Planning M. A. T. R. S. – Utilizing the ASI to Make Required Data Collection Useful. � Short Term Opioid Withdrawal Using Buprenorphine � Promoting Awareness of Motivation Incentives (PAMI) � Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA-STEP)

Additional supports related to Blending Products RUC Blending Product Workgoups Training of Trainer (TOT) events Across-node training needs assessments Local Trainings Regional Dissemination Conferences Interactive websites (e. g. , for technical assistance with Motivational Incentives)

NIDA Blending Conferences 2010 - Albuquerque, NM 2008 - Cincinnati, OH 2006 - Seattle, WA 2005 - Miami Beach, FL 2004 - Detroit, MI 2003 - Westminster, CO 2002 - New York, NY 2000 - Los Angeles, CA

CTN SC Dissemination Workshops � March 24, 2009 - Methods for Disseminating Evidence-based Treatments from the Frontlines of Community Treatment Programs Adapting Evidence-based Treatments to Clinical Practice: Contingency Management in Action The Use of Written Materials to Disseminate Information about Treatment and Recovery to Patients A Quality Improvement Initiative to Integrate Trauma Treatment in Clinical Services: The Case of Seeking Safety at Residence XII Dissemination of Evidence-base Treatments through Organizational Change: The Renewal Team Project at Connecticut Renaissance Disseminating Evidence-based Treatment through the CTN Dissemination Library: A Live Demonstration

http: //ctndisseminationlibrary. org

CTN Library by the Numb 3 rs Articles Sent to Users by the Library (Jan-Mar 2010: 104+) Visitors to the Library (Jan-Mar 2010: 3977 already!) After the Workshop!

∙ Implementing Evidence-Based Treatments ∙ Dissemination Workshop Online Methods from the Frontlines of Community Treatment Programs Promotional push (free CEUs!) began in March - flyer and email sent widely. March 8 - March 31: Went from 0 test-takers to 60! From a substance abuse counselor in Oregon: “The web information was easy to access and I like the variety in the workshop discussions. . . It was designed with me in mind. If I can do it, anyone can!” Get started at the CTN Dissemination Library: http: //ctndisseminationlibrary. org

“…most CTN nodes have more sites using at least some of the tested interventions, but why are not all sites using almost all “effective” interventions? I am definitely not suggesting these sites should be forced or even incentivized to do those interventions that the CTN has found to be effective. I am asking why more of these interventions are not being used especially among those who have had the most experience, or at least exposure to them? ” (Mc. Lellan, 2010) The Gap Revisited

“This meets a need our patients have and it provides a more standard way of dealing with it. ” “Is the outcome you obtained worth what it will cost me to train counselors and supervise them? ” “Will the extra cost be justified in producing a lasting effect on my clients? ” “We don’t have trained medical personnel available. ” “The State won’t pay us for that. ” “The patients really liked participating and responded well to the intervention. ” “Data we collected indicated our patients were doing well with this intervention. ” “It was easy to learn, and the counselors liked delivering it. ” “We’re a drug-free, abstinencebased program. ” “ The format fit within what the state supports. ” “We’re just a small program. ”

How Can the RUC Help Close the Gap? CONTINUE TO… Foster training nationally and in the nodes Support development of new Blending Products Encourage platform studies of technology transfer methods Assess training needs Provide technical assistance to CTPs trying to implement EBPs CONSIDER… Fostering bidirectional dialogue about what CTN interventions should be adopted Encouraging ongoing collection of economic evaluations in CTN protocols to inform providers’ decisions Disseminating economic data broadly to nodes and CTP partners