Transcript EBP With Latinos - Rhonda G Patrick, LCSW, MPA

Gaps in Substance Use Treatment
Presented by:
Rhonda G. Patrick, LCSW, MPA
Evidence Based Practices
 What is it?
“The integration of best research evidence with clinical expertise
and patient values.”
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Treatment based on the best available science
Respect for the expertise of the clinician
Acknowledgement and incorporation of patient values
Institute of Medicine, 2001
Evidence Based Practices
 What is it?
“EBP is a process in which the practitioner combines well
researched interventions with clinical experience, ethics, client
preferences, and culture to guide and inform the delivery of
treatments and services.”
National Association of Social Workers
Evidence Based Practices
 Why EBP?
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Concerns related to cost and effectiveness of substance abuse
treatment.
Delineation of a rational approach to allocation of scarce
resources.
Mitigation against a system in which treatment practices are based
solely on practice wisdom.
Finding the “best” available treatment or policy that reduces the
harm and costs of substance abuse.
Research & Knowledge
 What do we know?
 We have validated measurement tools
 We have replicable biopsychosocial predictors of substance
related events and outcomes
 We have a number of efficacious treatments of varying
intensity and duration that produce benefits across a range
of problem severity.
Research & Knowledge
 What do we don’t know?
 Much treatment research has proceeded without the benefit
of theory, the mechanisms of action of many efficacious
treatments are poorly understood.
 Patterns of substance use, abuse, remission and relapse are
highly variable over time between and across individuals in
treated and untreated samples. We do not have an
understanding of the influence of contextual factors.
Research & Knowledge
 What do we don’t know?
 The reach and impact of efficacious treatments into the
affected population remains suboptimal. Most people with
substance use disorder do not seek professional care, a
subset recover on their own, and most available treatments
target the majority with more serious problems.
Research & Knowledge
What do we know about Hispanic substance users?
 Younger users of alcohol and drug have more serious social problems as
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they age. Consequences are greater the younger you start.
Cultural dissonance is occurring, especially for immigrated families.
The closer you are to the routes of trade the higher your risk.
Most will not and do not seek assistance through formal networks of care.
There are regional substance use differences, however across the board
alcohol and marijuana abuse impact a significant portion of the Latino
community.
There are differences in subpopulations of the Latino group in substance use
severity, retention and outcome.
Research & Knowledge
What do we don’t know about Hispanic substance users?
 What are the circumstances of Hispanics in their own communities (i.e.,
community context);
 What service delivery models are tailored to Hispanics’ circumstances and
special needs;
 What are the client, provider, and system barriers to utilization of substance
abuse services;
 How do we establish links between drug abuse services, social services, and
other service sectors to optimize treatment outcomes.
Bridging the Gap: Community
Characterize the local Hispanic community in terms of structure, cultural composition,
and relations with the larger non- Hispanic community. Consider the role of
community unemployment, residential segregation, proximity to centers of drug
trade, and numbers of retail alcohol outlets in communities were Hispanics live as
risk factors.
Understand community factors that might prevent or promote use of alcohol or drugs.
Develop community research partnerships can help elucidate how services need to be
adapted for a particular community group or segment (e.g., Hispanic gang-involved
youth, outreach) and identify how feasible and acceptable are the planned
community interventions.
Utilize a community participatory research framework: involve local community
members and community-based organizations in community-based research. This
research involves capacity building in intervention, services research for community
leaders; learning about community needs and structure for researchers; and
exploring the potential for alternative, community-based models of care to enhance
service delivery by addressing local needs.
Bridging the Gap: Service Delivery
Test the effectiveness of community-based therapeutic
approaches that take advantage of natural supports (religious
organizations) and of those that bring evidence-based
treatments to non-clinical environments (e.g., academic
community-partnerships).
Evaluate and test collaborative research partnerships with
Hispanic community members that identify new and innovative
approaches to drug abuse treatment services.
Test community-level interventions that facilitate recovery and
reintegration of drug users within their Hispanic communities.
Bridging the Gaps: Barriers
Test the effects of improved communication between caregivers
and Hispanic clientele and its impact on retention in
pharmacologic and cognitive substance abuse treatments.
Assess programs on Latino’s health literacy for entry and
engagement in care and decision-making in substance abuse
treatments.
Evaluate the impact of insurance coverage on access to substance
abuse services, sustained attendance in drug treatments and
relapse recovery.
Test system interventions to redesign complicated admissions
systems, improve patient engagement at intake, accommodate
flexible scheduling, and reduced provider burden.
Bridging the Gap: Linkages
Generate information that can be used to develop and
test a workable model of community-based delivery in
Hispanic communities, including research that
identifies untapped, informal Hispanic communitybased resources.
Develop and evaluate best practices that focus on the
integration of social, health and drug abuse services
and that can optimize treatment outcomes for
Hispanic service users.
Bridging the Gap: Other Issues
 Speaking a Common Language
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How we define the problem
How we define the outcome
How we define the measurement
 Documenting Effectiveness
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Informal Publications
Formal Publications
 Increasing Funding for Research and Services
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Making Addiction a Priority
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Economic Costs
Social Costs
Evidence Based Substance Use
Treatment: Where do we find them?
 National Registry of Evidence-Based Programs and
Practices
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Created in 2007
List SAMSHA Model Treatment Programs
Defines EBP as “approaches t prevention or treatment based in theory
and have undergone scientific evaluation.”
Submissions are “reviewed” by experts with doctorial degrees,
evaluation research experience and clinical experience.
Many more prevention/intervention programs.
Searchable by target population needs
Evidence Based Substance Use
Treatment: Where do we find them?
 Agency for Healthcare Research and Quality
 National Guidelines Clearinghouse
 Search by topic area.
 Can compare multiple guidelines across variety of criteria
and classifications.
 Can download information to PDA’s.
 Rigorous selection and review process
Evidence Based Substance Use
Treatment: Where do we find them?
 Co-Occurring Disorder Center for Excellence
 Foster infusion and adoption of evidence and consensus based treatment and
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program innovation into clinical and organization practice.
Created in 2003
Intended for the co-occurring disorder service system
Provides descriptions of interventions
Describes intervention implementation
References related to EBPs
Evidence Based Substance Use
Treatment: Where do we find them?
 Technology Transfer Centers
 14 Regionally based addiction technology transfer centers
 Bridging the gap between science and practice
 Addiction Science Made Easy Program
 Intended for addiction treatment professionals
 Provides descriptions of interventions
 Describes intervention implementation
 References related to EBPs
Evidence Based Substance Use
Treatment: Where do we find them?
 National Drug Abuse Treatment Clinical Trials Network
 The CTN provides an enterprise in which the National Institute on Drug Abuse, treatment
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researchers, and community-based service providers cooperatively develop, validate,
refine, and deliver new treatment options to patients in community-level clinical practice.
This unique partnership between community treatment providers and academic research
leaders aims to achieve the following objectives:
Conducting studies of behavioral, pharmacological, and integrated behavioral and
pharmacological treatment interventions of therapeutic effect in rigorous, multi-site
clinical trials to determine effectiveness across a broad range of community-based
treatment settings and diversified patient populations; and
Ensuring the transfer of research results to physicians, clinicians, providers, and patients.
Regional “Nodes”
Service providers attached to various regional nodes