Transcript Link to Treatment Powerpoint Slides

TREATMENT CHARACTERISTICS & QUALITY:
CHALLENGES AND EBTs
DOUGLAS NOVINS, M.D.
UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS
NIDA Roundtable Meeting on Substance Use Disorders
among American Indian/Alaska Natives in Urban Settings
Topics to Cover





Challenges to Service Delivery (Qualitative)
EBT Knowledge (Qualitative)
EBT Engagement (Quantitative)
EBT Use (Quantitative)
Attitudes Towards EBTs & Perceived Cultural
Appropriateness (Qualitative and Quantitative)
Challenges for Service Delivery

Clinical challenges
 poverty
 trauma

histories
Infrastructure challenges
 not
having enough staff
 staff feeling burned out

not having enough time or resources
 Service
system challenges
 Not having enough housing
 Access to mental health treatment
Challenges for Service Delivery

Clinical challenges
 poverty
 trauma

histories
Infrastructure challenges
 not
having enough staff
 staff feeling burned out

not having enough time or resources
 Service
system challenges
 not having enough housing
 Access to mental health treatment
Knowledge of EBTs

Asked respondents in Phase 2 qualitative interviews
to define EBT. We analyzed their responses
“Pretty
simply
it’s
the
relative to Drake et. al.’s (2001) definition: “any
practice
that has been
established as
effective
treatment
techniques
that
through scientific research…”
have
been
researched
 Majority of respondents accuratly defined evidencebased
treatments.
and
have proven to be
 “effective” (80%)
effective in a population
 “research” (71%).
 Synonyms “empirical” (9%), “data” (9%), and “(it) works”
that’s
been
monitored.”
(28%).
Knowledge of EBTs

19% were unable to define an EBT.
“You know, I've heard
it, I've seen it on the
covers of the book.
But, no, [I don’t know
what it means].”
Knowledge of EBTs
 More detailed aspects of EBT definitions
“Then,
someone's going to write a
 Manual – 6%
curriculum,
manualize
it,
get
it
all
nice
and
 Replication – 3%
beautiful,
and
then, –they're
going to
 Hierarchy
of evidence
0%
implement it and see if it works. And, if it
works, then it'll be an evidence-based
practice and maybe it'll be [listed in]
NREPP…”
EBT Use
Psychosocial EBTs
see pros
using but
not
and
planning
not
permanent used in
not familiar interested in cons
on using permanent
use
past
Psychosocial Treatments
Cognitive Behavioral
Therapy
Motivational Interviewing
Relapse Prevention
Therapy
Twelve-Step Facilitation
Matrix Model
Contingency Mgmt
Behavioral Couples
Therapy
Community Reinforcement
& Family Training
Multisystemic Therapy
%w
rating ≥ mean
4
Rating
0
1
2
3
4
5
6
4.2
11.1
1.1
2.6
8.9
10.5
3.7
9.0
24.1
19.5
56.4
45.7
1.6
1.6
82.1
66.8
3.6
3.2
17.0
24.1
25.8
55.2
3.2
7.0
10.6
7.4
6.4
10.7
19.1
13.7
4.8
4.3
7.4
5.8
14.9
9.1
12.2
6.3
52.6
41.6
18.5
9.5
1.1
3.2
6.4
2.1
68.6
53.9
37.1
17.9
3.0
2.6
2.2
1.2
69.2
3.1
16.2
4.2
4.2
2.6
0.5
7.3
0.8
76.9
5.8
4.2
7.9
2.6
2.1
0.5
5.2
0.6
81.4
5.8
7.9
1.1
1.1
1.6
1.1
3.8
0.4
Novins et al. (in preparation) Use of Evidence-Based Treatments in Substance Abuse Treatment Programs Serving American
Indian and Alaska Native Communities.
Psychopharmacologic EBTs
Raw Ratings
Using
Not See pros
but not
Not intereste and Planning permane Perman Used in
Familiar
d in
cons on using
nt
ent use
past
0
1
2
3
4
5
6
Medication Treatments
Meds for Comorbidity
Meds for Relapse
Prevention
Meds for Withdrawal
Pct
With
Ratings Mean
≥4
Rating
37.8
4.2
11.1
3.7
7.4
35.3
0.5
43.2
2.1
26.5
32.6
14.8
25.3
24.9
15.8
5.8
2.6
9.5
6.8
16.4
15.3
2.1
1.6
28.0
23.7
1.9
1.6
Overall EBT Engagement
Mean Score
Psychological Treatments (with
CBT)
Psychological Treatments (without
CBT)
Medication Treatments
% of treatment % of participants with at
least one treatment
ratings ≥ 4
SD of Scores
rating ≥ 4
1.95
0.69
38.04%
95.8% (184/192)
1.74
1.88
0.72
1.29
32.49%
31.67%
54.2% (103/190)
92.2% (177/192)
Factors Associated with Greater EBT
Engagement - Psychosocial
Variable
B
SE
P
Direct, IHS638 compact, state block grant
funding, or tribal funds
0.32
0.13
0.01
Percent of clinical staff that are certified
addiction counselor (none versus 1-50%)
-0.41
0.19
0.04
Years of education for clinical staff
0.07
0.03
0.04
Program requires clinical staff to use EBTs
0.23
0.11
0.05
EBTs are considered in strategic planning
0.32
0.11
0.01
EBPAS Openness Scale
0.22
0.07
0.002
Factors Associated with Greater EBT
Engagement - Psychopharmacologic
Variable
B
SE
P
Serves adolescents
0.61
0.30
0.04
Medicaid or Fee for Service Funding
0.61
0.24
0.01
Percent of clinical staff that are in recovery (none
versus 1-50%)
-0.77
0.33
0.02
Years of education for clinical staff
0.22
0.08
0.01
EBT Implementation
70.0
60.0
Follow manual exactly
50.0
Use the parts thought most
helpful
40.0
Rewrote manual to make it
more culturally appropriate or
better fit with program
Don't use manual but use key
concepts
30.0
20.0
10.0
0.0
RPT
CBT
MI
12SF
MM
Attitudes Towards EBTs

Phase 2 results:
“Evidence
based
just appropriateness
means that–they
 Concerns
about cultural
42%
Western/Biomedical influence – 19% (negative)
have found
a certain treatment approach
 External mandates – 26%
or philosophy
that helps with a certain
 Tension between individualized care and manualized
treatmentsand
– 16%
population
it’s not true for all
 Resource drain – 13%
populations.”
Perceptions of Cultural Appropriateness of
EBTs: Latent Classes
100%
90%
80%
28%
50%
22%
70%
60%
Negative
Neutral
Positive
50%
40%
30%
20%
10%
0%
Class 1 (n=53)
Class 2 (n=96)
Class 3 (n=42)
CBT [CM, MM, BCT] (4/9)
Perceptions of Cultural Appropriateness of
EBTs: Latent Classes
90%
80%
70%
60%
50%
Negative
Neutral
Positive
40%
30%
20%
10%
0%
Class 1
Class 2
MI [RPT, CRFT, MST](4/9)
Class 3
Perceptions of Cultural Appropriateness of
EBTs: Latent Classes
70%
60%
50%
40%
Negative
Neutral
Positive
30%
20%
10%
0%
Class 1
Class 2
12-SF (1/9)
Class 3
Discussion





Challenges to Service Delivery (Qualitative)
EBT Knowledge (Qualitative)
EBT Engagement
EBT Use
Attitudes Towards EBTs & Perceived Cultural
Appropriateness (Qualitative and Quantitative)