Transcript Ethical Issues in Treatment

Knowledge Application Programs (KAPS)
in Faith-based Reentry Community
Substance Abuse Treatment Settings
Saturday May 17, 2013
Cheryl A. Branch, MS,
Community Trainer, UCLA-ISAP PSATTC
2012-2013 Faith-based Education &
Training Series
Faith-based Organizations

The next generation of prison ministries is
here. In response to the call for national
action to reduce alcohol & drug abuse
health disparities LAM congregations
developed a plan to promote EBPs in small
to mid size AOD treatment and counseling
providers in South LA and partnered with
UCLA PSATTC.

Knowledge Application Programs (KAPs) are an
opportunity for FBOs to participate and
practice EBPs
Bridging The Gap

In California,
publicly funded
addiction services
are impacted by
increasingly a need
to understand
Prisoner Reentry
Realignment Sentencing Created New
Populations in California
Current offense
violent/serious/
sex-related
Current offense is
not violent/serious/
sex-related, but prior
offense(s) was
Parole
State
prison
PRCS
(Post-release
Community
Supervision)
Jail
only
Neither current offense
nor prior offense was
violent/serious/sexrelated
County
Sentence
(Local
Prison
Term)
(1170(h)
Jail +
Mandatory
Supervision
Mandatory
Supervision
only
The Landscape for Addressing the Alcohol and Drug
Treatment and Health Care Needs of the Reentry
Population Has Changed
• Recession of 2008 had a
major impact on counties’
health care safety nets
So, how do you
decide what to do?
Prison and Parole Tend to Have a
Number of Chronic Health Conditions
State
Physical Health
(Lifetime)
Local
Prison
Parole
PRCS
Local
Custody
Asthma
14%
19%
11%*
13%
Diabetes
4%
2%
5%
6%
Hypertension
19%
20%
16%
16%
Hepatitis
14%
14%
13%
10%
Tuberculosis
14%
8%
7%
11%
1%
1%
0%
1%
Dental Problems
Since Admission
55%^
48%^
39%*
41%
Any physical
disability
43%^
40%^
34%
33%
HIV
^Indicates differences between Prison vs. Parole statistically significant at .05 level.
PRCS and Local Custody Tend to Be Physically
Healthier Than Prison/Parole Populations
State
Physical Health
(Lifetime)
Local
Prison
Parole
PRCS
Local
Custody
Asthma
14%
19%*
11%*
13%
Diabetes
4%
2%
5%
6%
Hypertension
19%
20%
16%
16%
Hepatitis
14%
14%
13%
10%
Tuberculosis
14%
8%
7%
11%
1%
1%
0%
1%
Dental Problems
Since Admission
55%
48%*
39%*
41%
Any physical
disability
43%
40%
34%
33%
HIV
*Indicates differences between Parole vs. PRCS statistically significant. State vs. Local also significant.
There Is More Serious Mental Illness
Among the Parole Population
State
MH Disorder/
Substance Abuse
Local
Prison
Parole
PRCS
Local
Custody
Ever Diagnosed
with MH Disorder
30%^
40%^
20%
18%
. . . with Manic
11%^
29%^
5%
4%
. . . with
Schizophrenia
8%^
18%^
1%
1%
22%^
31%^
13%
12%
. . . with Anxiety
9%^
17%^
7%
3%
Drug Abuse
53%
57%
64%
61%
Drug Dependence
40%
46%
53%
41%
. . . with Depression
^Indicates differences between Prison vs. Parole statistically significant at .05 level.
County Clients Tend to Have More Treatment Needs
with Respect to Drug Abuse/Dependence
State
MH Disorder/
Substance Abuse
Local
Prison
Parole
PRCS
Local
Custody
Ever Diagnosed
with MH Disorder
30%
40%*
20%*
18%
. . . with Manic
11%
29%*
5%*
4%
. . . with
Schizophrenia
8%
18%*
1%*
1%
22%
31%*
13%*
12%
9%
17%*
7%*
3%
Drug Abuse
53%
57%
64%
61%
Drug Dependence
40%
46%
53%
41%
. . . with Depression
. . . with Anxiety
*Indicates differences between Parole vs. PRCS statistically significant. All State vs. Local differences also significant.
Understanding the ‘New Normal’ in FB
Reentry Community Treatment Settings

In the new ones, the infrastructure will
have to include internal systems that:


support performance monitoring systems
assess impact of fidelity vs. adaptation on
outcomes of treatment provider

use of both KAP and non-KAP products, and provide
input to the scientific community regarding new
research priorities and service gaps for the substance
abuse treatment field.
Solutions
Knowledge Application Program (KAP)
SAMHSA's Knowledge Application Program
(KAP) provides substance abuse treatment
professionals (i.e. Faith-based Counselors,
Prevention Specialists) with publications,
online education, and other resources that
contain information on best treatment
practices.
 www.kap.samhsa.gov



You can access these resources online and no- cost!
Some materials available for non-English speaking
populations
Knowledge Application Programs (KAPS)

The KAP approach integrates science-based health
communications, social marketing, and knowledge transfer
activities into an evidence-based dissemination practice which
includes:
 Developing a culturally competent Knowledge Transfer Model
based on proven dissemination principles and practices
 Developing products and processes to present research
findings, best practices, and promising practices to the
field
 Using partnerships with organizations as an effective service
practice and as a strategy in creating effective distribution
channels.
 LAM is practicing the KAP approach to community
education and professional development for faith-based
clergy and laity addiction counselors
SAMHSA Center for Mental Health Services Knowledge Application Program (CMHS/KAP)
- Dedicated to supporting product
development and dissemination through
providing innovative use of media and
marketing that will advance the adoption
of evidenced -based and promising
practices in servicing persons with mental
illnesses and/or substance use disorders.
Different Types of KAPs
 SAMHSA
Protocol (TIP) Series
 SAMHSA Technical Assistance
Publications (TAPs)
 Periodicals
 ATTC’s
 Local quarterly LAC SAPC training
 Local ONTRACK Program Resources
(state)
How Are Evidence-Based Practices
Documented?
Gold Standard

Multiple randomized clinical trials

Consensus reviews of available science

Expert opinion based on clinical observation
Second Tier
Third Tier
Process Benchmarking In Action
•How do they
do it?
•The
identification
of “best
practices?”
In Plain Terms, Please

It’s about:








Critical Thinking,
Standardized Approaches
Collective Work Teams
Lots of Reading and Writing
Disciplined Procedures & Systems
Follow the Plan—all the time
Balancing idea each client is different and the same
It is not your program’s daily
schedule
Evidence-Based Practices
for Alcohol Treatment
Brief intervention
 Social skills training
 Motivational enhancement
 Community reinforcement
 Behavioral contracting

Scientifically-Based Approaches
to Addiction Treatment

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Cognitive–behavioral interventions
Community reinforcement
Motivational enhancement therapy
12-step facilitation
Contingency management
Pharmacological therapies
Systems treatment
What Does All This Mean?
We have an opportunity to improve
treatment services.
 There are effective and cost-efficient
treatments available for alcohol and
drug dependence.
 Need solutions for Changing
Environment in local agencies (i.e. SAPC,

DMH, DPSS, Probation, LAUSD, Courts)
In Summary
Summary
Defined evidence-based practice
 Considered barriers to adoption
 Noted counselor endorsements and
recommendations for manuals
 Described an evidence-based practice model
 Discussed how manuals fit within that model

Sources of Evidence-Based
Information on the Web

Managed Care


Dual Disorders


dartmouth.edu/~psychrc
Stimulant Treatment


samhsa.gov/mcnew
matrixcenter.com
Drug Abuse Treatment

ibr.tcu.edu
Sources of Evidence-Based
Information on the Web

Drug Abuse Treatment


Alcoholism Treatment


niaaa.nih.gov
Addiction Medicine


nida.nih.gov
asam.org
HIV/AIDS

cdc.gov/idu/
Sources of Evidence-Based
Information on the Web

Prevention


Technology Transfer


unr.edu/westcapt
nattc.org
Addiction Science

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utexas.edu/research/asrec
http://gainscenter.samhsa.gov/topical_resources/
ebps.asp
http://www.nrepp.samhsa.gov/Learnlanding.aspx
http://store.samhsa.gov/list/series?name=Eviden
ce-Based-Practices-KITs
An Evidence-Based
Treatment Model for
Improving Practice
1
Core Components of
Comprehensive Services
Medical
Financial
Core
Housing &
Treatment
Transportation
Intake
Assessmen
t
Child
Care
Treatment
Plans
Group/Individ
ual Counseling
Abstinence
Based
Pharmacotherapy
Mental
Health
Urine
Monitoring
Case
Manageme
nt
Continuing
Care
Self-Help
(AA/NA)
Family
AIDS /
HIV
Risks
Vocational
Legal
Educational
Elements of a Treatment
Process Model
Patient
Factors
Detox
Psychological
Functioning,
OP-DF
Motivation,
TC/Res
& Problem
Severity
OP-MM
?
Sufficient
Retention
Drug
Use
Crime
Social
Relations
Post-treatment
Cognitive and behavioral
components with therapeutic impact
TCU Treatment Process Model
Motiv
Patient
Attributes
at Intake
Early
Engageme
nt
Early
Recover
y
Program
Behavioral
Participation Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Engagement
Simpson, 2001 (Addiction)
“Sequence” of Recovery Stages
Patient
Readiness
for Tx
Program
Participation
Behavioral
Change
Adequate
Stay in Tx
Therapeutic
Relationship
Cognitive
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Targeted Interventions
Get Focused!!
Interventions Should
Maintain This Process
Motiv
Patient
Attributes
at Intake
Early
Engageme
nt
Early
Recover
y
Program
Behavioral
Participation Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Induction to Treatment
(Motivational Enhancement)
Motiv
Patient
Attributes
at Intake
Early
Engagemen
t
Early
Recovery
Program
Participation
Behavioral
Change
Sufficient
Retention
Problem
Recognition
Desire
for Help
Readiness
for Treatment
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Counseling Enhancements
(Cognitive “Mapping”)
Motiv
Patient
Attributes
at Intake
Early
Engagemen
t
Early
Recovery
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Contingency Management
(Token Rewards)
Motiv
Patient
Attributes
at Intake
Early
Engagemen
t
Early
Recovery
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Specialized Interventions
(Skills-Based Counseling Manuals)
Motiv
Patient
Attributes
at Intake
Early
Engagemen
t
Early
Recovery
Program
Participation
Behavioral
Change
Supportive
Networks
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Evidence-Based Treatment Model
Induction
Motiv
Patient
Attributes
at Intake
Staff
Attributes
& Skills
Program
Characteristics
Behavioral
Strategies
Early
Engageme
nt
Family &
Friends
Personal Health Services
Early
Recover
y
Supportive
Networks
Program
Behavioral
Participation Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Enhanced
Counseling
Social Skills
Training
Social Support Services
Simpson, 2001 (Addiction)
How to Order KAPs
To order publications, contact
SAMHSA at
http://store.samhsa.gov or
1-877-SAMHSA-7
(1-877-726-4727) (English and Español) or
call 800-487-4889
(TDD hearing impaired) and ask for an
information specialist