identifying and implementing evidence-based mental health and substance abuse services kevin d....
TRANSCRIPT
Identifying and Implementing Evidence-Based Mental Health and Substance Abuse Services
Kevin D. Hennessy, Ph.D.Science to Service CoordinatorSubstance Abuse & Mental Health Services AdministrationU.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 don’t 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) – 1998Mental Health: A Report of the Surgeon General – 2000Achieving the Promise: Transforming Mental Health Care in America (The President’s New Freedom Mental Health Commission) – 2003
Knowledge to practice gap remains at 15-20 years
An old and well-defined problem
Publication
Bibliographic databases
Submission
Reviews, guidelines, textbook
Negative results
variable
0.3 year
6. 0 - 13.0 years50%
46%
18%
35%
0.6 year
0.5 year
9.3 years
It takes 17 years to turn 14 per cent of original researchIt takes 17 years to turn 14 per cent of original research to the benefit of patient careto the benefit of patient care
Dickersin, 1987
Koren, 1989
Balas, 1995
Poynard, 1985
Kumar, 1992
Kumar, 1992
Poyer, 1982
Antman, 1992
Negative results
Lack of numbers
Expertopinion
Inconsistentindexing
17:14
Original research
Acceptance
Implementation
Identify evidence-based practices (NREPP)
Develop guides, manuals and other materialsEvidence-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
1998-2003…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
NREPPCurrent Status
Formal public comment process by SAMHSA this summerNotice in August 26th Federal RegisterAvailable through SAMHSA web site – access through “Quick Picks” on SAMHSA’s home page (www.samhsa.gov)Written comments due no later than October 25th
U.S. Mail – SAMHSA, c/o NREPP Notice, 1 Choke Cherry Road, Rockville, MD 20877Electronic Mail – [email protected]
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: www.nationalregistry.samhsa.gov
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 Criteria16 evidence rating criteria applied to each
program outcome (0 to 4 scale).
Include:Theory-driven selection of measures & analytic methodsReliabilityValidityIntervention and comparison fidelityAssurances to participantsStandardized Data CollectionSelection biasAttrition and missing dataAnalysis 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:ImplementationQuality MonitoringUnintended or Adverse EventsPopulation CoverageCultural RelevanceStaffing Cost
NREPP: Questions to the Public
From the August 26th 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 26th 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?
NREPP’s 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 & StaffCliniciansPolicymakersConsumers
Where to Find the Products:For SA Treatment go to www.kap.samhsa.govFor SA Prevention go to www.prevention.samhsa.govFor Mental Health go to www.mentalhealth.samhsa.gov
Publications and Materials on Best Practices in Mental Health and
Substance Abuse Prevention & Treatment
Focus on six practicesAssertive community treatmentFamily psychoeducationSupported employmentIntegrated dual disorders treatmentIllness management and recovery skillsStandardized pharmacological treatment
Two PhasesI – Development (Fall 2000 – Summer 2002)II – Pilot-Testing (Summer 2002 – Summer 2005)
More information is available through SAMHSA’s web site (www.samhsa.gov) under “Mental Health System Transformation”
Evidence-Based PracticeImplementation Resource Kits
Kits have targeted and distinct components for:ConsumersFamily and Other SupportsPractitioners and Clinical SupervisorsMental Health Program LeadersPublic Mental Health Authorities/Administrators
Kits include:Research summariesInformation sheets for all stakeholdersTip sheets for program leaders and administratorsProgram manuals/workbooks for practitionersIntroductory and training/demonstration videosFidelity assessment tools and cultural competence statementsOutcome measures
Evidence-Based PracticeImplementation Resource Kits
Centers for the Application of Prevention Technology
Materials, Trainings & Technical Assistancefor Prevention
www.captus.org
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 Assistancefor Treatment
SAMHSA’s Addiction Technology Transfer Centers
www.nattc.org
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 assistanceInformation and referralsOn-site consultationTrainingLibrary servicesPublicationsOther resources
More information is available through SAMHSA’s web site:www.mentalhealth.samhsa.gov/links/
Center for Mental Health ServicesResearch, Training and TA Centers
Collaborations with National Institutes of Health to jointly fund state planning grants facilitating implementation of evidence-based practices
– RFA-MH-03-007 – State Implementation of Evidence-Based Practices: Bridging Science and Service (with NIMH)
– RFA-MH-05-004 – State Implementation of Evidence-Based Practices II: Bridging Science and Service (with NIMH)
– RFA-DA-05-002 – Enhancing State Capacity to Foster Adoption of Science-Based Practices (with NIDA)
Promoting Interagency Partnerships
Partnership between:SAMHSA’s 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 – www.niatx.org
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.
It’s just not widely distributed yet.”
In Conclusion