Transcript presentation

Knowledge translation and implementation of
frontline screening and early intervention for
substance abuse: why are we moving slowly?
Emily Campbell, MPH
CIHR Team in Substance Abuse Treatment
Research Coordinator, Addictions Unit
McGill University Health Centre (MUHC)
[email protected]
CIHR Team in Substance Abuse Treatment
Co-Investigators
Collaborators
Kathryn Gill, PhD (MUHC)
Gail Gauthier, PhD (MUHC)
Dara Charney, MD (MUHC)
Spyridoula Xenocostas, MSc
(CSSS de la Montagne (DLM))
Ann Macaulay, CM, MD
(Participatory Research at McGill
(PRAM))
Marlene Yuen, BA (CSSS DLM)
Donald Desrosiers, RN (CSSS DLM)
Anita Cugliandro, MA (CSSS DLM)
Jon Salsberg, PhD(c) (PRAM)
Jorge Palacios-Boix, MD (MUHC)
Ronald Fraser, MD (MUHC)
Juan C. Negrete, MD (MUHC)
Research Coordinator: Emily Campbell, MPH
Addiction Program Coordinator: Antonis Paraherakis, MSc
Research Assistant: Katie Boodhoo, BSc
Focus Group Leader, Qualitative & Quantitative Data Analysts
Rationale for the CIHR Team Project
New provincial action plans and
mandates in addictions from the
Quebec government
Screening, early (brief)
intervention and referral to
treatment
Natural laboratory for
studying the implementation
of evidence-based
interventions within multiple
primary care sites
Why screen in primary care settings?
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misuse of alcohol and other drugs is prevalent in many
clinical settings
substance use often linked to presenting symptoms
(e.g. injuries, hypertension, family problems, depression)
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given the setting, clinicians have a mandate to assess,
and ask questions related to risky behaviour
stigma can be minimized in non-specialized settings
detection of those at risk is a form of early
intervention and secondary prevention
Evidence-based screening & brief intervention
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WHO Alcohol, Smoking and Substance Involvement Screening
Test (ASSIST) and the ASSIST-linked brief interventions.
http://www.who.int/substance_abuse/publications/media_as
sist/en/index.html
Integrated Knowledge Translation
Those who must
live with the
results of the
innovation must
be involved in
the design and
execution of its
implementation,
to facilitate
ownership and
to decrease
resistance .
(Backer et al., 1995)
Collaborative Partnership: Throughout the
process of program implementation, the CIHR
TEAM has used an integrated knowledge
translation (iKT) strategy
equal partners
build collaborative mechanisms for knowledge
exchange
 joint decision making between researchers,
clinic supervisors, psychiatrists, addiction
specialists and frontline clinicians
 integrated approach with the insertion of an
addictions specialist into the CSSS for 18
months
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Project Overview at CSSS
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Time 1 (2010): Pre-implementation data collection: 34
participants (clinicians/managers): focus groups, interviews,
(explored knowledge, skills, attitudes, barriers, training
needs); questionnaires, chart review
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Training Program Implementation (2010-11): Addictions
Program Coordinator on site to help train and support staff
and program development
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Time 2 (2011): Post-data collection: 34 participants
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Time 3 (2013): Internal Addictions Specialist: Training,
consultation, co-intervention and support, questionnaire
Portrait of Current Practice
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Use of formal screening tools for alcohol/drugs is rare
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Most clinicians do not feel adequately equipped to
deal with clients with substance problems
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resistance to using formal tools
inadequately equipped to deal with dual diagnosis
Competing priorities; clients often present in crisis
Lack of knowledge of evidence-based practices for
substance abuse
Summary of Clinician Needs
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Practical, up-to-date knowledge of substance
abuse/addictions: case based, clinical practice
Intervening with co-morbid substance abuse and
psychiatric problems
Motivational approaches; dealing with resistance
Supervision by an Addictions Specialist
New screening tool: simple, clear, quick, practical
Improved collaboration with external resources
Training Groups
1) REPÈRES = Regroupement de
Personnes Ressources en dépendances
12 clinicians met with the APC for 3
hours every 3 weeks for, 8 sessions
didactic sessions: basic concepts of
alcohol and drug abuse, case
presentations and discussions (e.g. dual
diagnosis)
practice based training on screening
methods (DEBA-A/D, WHO ASSIST)
2) Brief Intervention (BI) Development
18 clinicians, small groups 2-4 people,
1-2 hours, 3-5 sessions
practice based pre-screening, screening
questions (repérage et detection),
feedback
exploration of screening for psychiatric
problems (depression, anxiety,
psychotic disorders, internet use)
referral to specialized treatment centres development of intervention plan and
(decision tree)
BI sessions
Changes from Time 1 to Time 2
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Changes in attitudes: heightened awareness regarding
addictions; increased comfort and openness in
addressing substance abuse
Minimal change in actual interventions
Tool Use: little use of screening tools
Training group knowledge transfer was limited
Systematic screening and brief interventions not
implemented (pre-screening implemented in 2012)
Full-time internal addictions worker: training/cointervention
Lessons Learned
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Didactic training methods (lectures, powerpoint
presentations) are not preferred by frontline staff,
material considered to be too complex/theoretical not
able to retain or use information
Case presentations and discussion + ongoing case
based supervision was the preferred method of
learning and considered to be most useful
Follow-up supervision post training
Adoption time frame for new practices is much slower
than expected
Slow Adoption Time Frame – Why?
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Difficult to implement?
 specialized training and on-going supervision required; lack
of knowledge: many staff do not have the skills to appraise,
apply and understand evidence-based practices
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Organizational climate?
 lack of time, lack of staff/turnover, lack of managerial
support, competing priorities, lack of access to resources
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Incompatibility with clinicians’ beliefs?
 screening and brief interventions conflict with belief that
substance abuse is difficult to treat, requires lengthy
treatment; focus on client priorities
Thank you!
Questions?
Emily Campbell, MPH
Research Coordinator, Addictions Unit
McGill University Health Centre
[email protected]