# Presentation: 489455

## Enhancing NIDA’s Health Services Research:  Update on the Blue Ribbon Task Force Report

- Wilson M. Compton, M.D., M.P.E.
- Director, Division of Epidemiology, Services and Prevention Research
- National Institute on Drug Abuse
- Department of Health and Human Services

- February 8, 2006
- NIDA Advisory Council Meeting

## Few Treatment Programs Use Treatment Innovations

- Roman, et al.,  Presentation at CTN Steering Committee Meeting, 2002.

- (N = 171 Administrators)

## Few School-Based Prevention Programs Use Research-Based Programs

- (N = 1905 Schools)

**Ringwalt, et al. (2002), *****Prevention Science***

##  To Reap Any Benefits

** ****From Scientific Knowledge**
** ****It Needs To Be *****Used***** In Practice**

## Developing an intervention is only one part of translating research into practice.

**Intervention**

**Access **
**and Engagement**

**Provider knowledge and behavior**

**Organization Structure and Climate**

**External Environment (stigma, financing)**

**Notes:**
I think this slide is a nice visual to emphasize that it is not just about having evidence – there are a lot of things that impact on the use of that evidence and what evidence is needed to improve the lives of those with mental illnesses.  We need to research all these interfaces --- in fact, we are doing that now.  We are developing the sciences of dissemination/implementation, and adaptation (of EBPs)

## Task Force Charge

**Task Force Charge**

- Develop recommendations re:
- Diffusion of research findings into practice
- Utilization of CTN as a platform for health services research
- Organization & leadership of health services research within NIDA and other Federal agencies

## NIDA Blue Ribbon Task Force on

***Co-Chairs:***** **
**     ****Thomas McLellan, PhD,**
**     ****Constance Weisner, DrPH, MSW**
**     ****Andrea Barthwell, MD****	****	**
**      ****Caryn Blitz, PhD**
**      ****Rick Catalano, PhD****	****	**
**      ****Mady Chalk, PhD****	****	**
**      ****Linda Chinnia, MEd****	****	**
**      ****Lorraine Collins, PhD****	****	**
**      ****Wilson Compton, MD, MPE****	**
**      ****Michael Dennis, PhD**
**      ****Richard Frank, PhD****	**
**      ****Warren Hewitt, MS**
**      ****James Inciardi, PhD**
**      ****Marguerita Lightfoot, PhD**
**      ****Isaac Montoya, PhD**
**      ****Claire Sterk, PhD**
**      ****Janet Wood, MBA, MEd**

**NIDA Blue Ribbon Task Force on**
** ****Health Services Research **

## NIDA’s Responses to the Blue Ribbon Report

**Briefing for Dr. Zerhouni**
**Conference in Philadelphia on Health Services Research**
**Briefing for ONDCP**
**Publication in Journal of Substance Abuse Treatment**
**Addressing Recommendations...**

***Charting a Course for Health Services Research at NIDA, 2005;29(3):167-172**** *

## Organization of the Report

**Organization of the Report**

- Critical First Steps
- Develop clear understanding of services research.
- Increase portfolio on organizational, management, and financing.
- Collaborate to develop standards for evidence based practices
- Intra- and inter-agency collaborations

## Multidisciplinary field of scientific inquiry that:

**Cost of Care**

**Financing**

**Organization**

**Management**

**Social Factors**

**Technologies**

**Access & Utilization**

**Quality of Care**

**For individuals, families, organizations & institutions, and communities & populations**

**Personal & public health & well being**

- Examines how:

- Affect:

**Individual Factors**

**Critical #1:  Defining Health Services Research**

**Notes:**
Our mission has remained the same, but the Blue Ribbon Task Force has motivated us to begin a concerted effort to convey to all audiences the scope and sophistication of drug abuse services research and the ways in which services research can serve NIDA’s broader mission to improve the public’s health and well being.    

##  Critical #2: Enhance Research on Organization, Management, and Economic Issues

***Examples:***
- Collaborating with CSAP on their national Strategic Prevention Framework.
- Encouraging applications:
- Economics of Drug Abuse Treatment and Prevention Services (PA-05-111)
- Services Research in the National Drug Abuse Clinical Trials Network (PA-03-011)
- Economic Evaluation of Drug Abuse Treatment and Prevention Services for HIV/AIDS (PA-02-164)

## Organization/Management Research

**Active Organization and/or Management Grants in Services Research Branch**

*Note:  In 2005 reissued **Services** Research PA (05-139) with emphasis on org/mgmt issues*

**Notes:**
MacLeod and colleagues demonstrated in a RCT significant differences in 90-day continuous abstinence rates, with the combination treatment showing greater efficacy than NRT alone at both 3 months and 6 months. 

Zhu also studied the California quitline as an adjunct to NRT, but the control group was not compelling (those who dropped out of the counseling program).

Sydney, Australia

## Finding:  Innovation is a Function of “Absorptive Capacity”

- Indicators:
- environmental scanning (journals, workshops, etc.)
- monitoring patient satisfaction
- professionalism (number of: master’s level/licensed/certified therapists, physicians, persons in recovery)

**Notes:**
Absorptive capacity refers to how well equipped an organization is to learn/absorb new knowledge.

Clinic directors indicated the number of innovations from a list of 15, including 6 Pharmacological and 9 Behavioral evidence-based practices.

Structural equation model results showed significant causal paths between professionalism, scanning, and satisfaction surveying and the number of adopted innovations.  

The model also showed that scanning and satisfaction were each influenced by professionalism factors.

Note that the number of recovering counselors was a negative influence, however, SEM coefficients in this analysis convert to absolute values.

There are other factors that affect innovation, organizational culture is emerging as a prime influence.  The absorptive capacity model is one element in an organization's culture.

## Economics Research

**Active Economic Grants in Services Research Branch**

*Note:  Reissued Economics PA (05-111) in 2005*

**Notes:**
MacLeod and colleagues demonstrated in a RCT significant differences in 90-day continuous abstinence rates, with the combination treatment showing greater efficacy than NRT alone at both 3 months and 6 months. 

Zhu also studied the California quitline as an adjunct to NRT, but the control group was not compelling (those who dropped out of the counseling program).

Sydney, Australia

## Finding:  Behavioral Intervention for Seropositive Youth is Cost Effective

- _Intervention_
- 11 Sessions to reduce transmission acts
- 82%↓in unprotected sex acts; sig↓ in HIV-negative or unknown partners; reduced substance use

_**Cost Effectiveness**_

- Rotheram-Borus et al. (2001). AIDS Education & Prevention, 13, 42-54  and
- Lee, Leibowitz & Rotheram-Borus.  (2005). AIDS Education & Prevention, 17, 105-118.

**Notes:**
MacLeod and colleagues demonstrated in a RCT significant differences in 90-day continuous abstinence rates, with the combination treatment showing greater efficacy than NRT alone at both 3 months and 6 months. 

Zhu also studied the California quitline as an adjunct to NRT, but the control group was not compelling (those who dropped out of the counseling program).

Sydney, Australia

## Finding:  Life Course View of Addiction Shows Increased Benefit-Cost

- Zarkin, Dunlap, Hicks, & Mamo.  (2005). Health Economics, 14, 1133-1150.

**Notes:**
MacLeod and colleagues demonstrated in a RCT significant differences in 90-day continuous abstinence rates, with the combination treatment showing greater efficacy than NRT alone at both 3 months and 6 months. 

Zhu also studied the California quitline as an adjunct to NRT, but the control group was not compelling (those who dropped out of the counseling program).

Sydney, Australia

## Critical #3:  Developing Standards for Evidence-based Practice

- Cochrane Collaboration
- Campbell Collaboration
- US Preventive Services Task Force
- Evidence-Based Practice Centers (AHRQ)
- Veterans Health Administration
- Federal Collaboration on What Works (DOJ)
- State Governments (e.g., Hawaii, Washington)
- Professional Associations (e.g., AA, ASAM, APA)

_**SAMHSA’s National Registry of Effective Practices and Programs (NREPP)**_

## Critical #4:  Developing a Collaborative Research Processes

**Using CCTN and CJ-DATS**
**Working with SAMHSA and other partners on linking Science to Services**
**Braiding funding streams**

## Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) 

**Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) **

**National Drug Abuse**
**Treatment Clinical Trials **
**Network (CTN)**

## The Science to Services Initiative Links with NIDA’s Blending Initiative

## Braiding Funding Streams

**Braiding Funding Streams**

- Adolescent Services Including Brief Interventions (FY2003 with SAMHSA)
- Assessment and Brief Interventions in Primary Care  (FY2004 with SAMHSA*)*
- NIDA Funding Research on CSAP’s National SPF-SIG Program (FY2004)
- Service to Science Grants (with SAMHSA) for State Substance Abuse Authorities (FY2005) and _*Community  Based Organizations (FY2006)*_

## Task Force Recommendations

**1. **Prevention Services Research (5)
- 2. Treatment Services Research (8)
- 3. Leading and Managing Services       Research at NIDA (6)
- 4. Services Research Collaborations within the NIH and with External Partners (5)

## Task Force Recommendations:  Prevention Services Research

- Supporting randomized controlled trials
- Studying prevention in nonacademic settings
- Developing system to monitor epidemiology of problem behaviors
- Studying best practices
- Studying diffusion of prevention practices

## Prevention at NIDA:  Randomized Clinical Trials

**Prevention at NIDA:  Randomized Clinical Trials**

## Task Force Recommendations:Treatment Services Research

- Studying commonly used interventions & practices
- Examining range of settings
- Studying the full spectrum of service needs
- Studying diffusion of innovation
- Improving fit of research questions & methods
- Developing and refining research methods
- Studying effects of organization/management, economics, and policies
- Integrating economics research into portfolio

## Calls for Research on Usual Care

***Enhancing State Capacity to Foster Adoption of Science-Based Practices*****  (RFA DA-05-002)**
**  ****18 applications**
**    ****7 awards  (5 treatment, 2 prevention)**
***Enhancing Practice Improvement in Community-Based Care ***** (RFA DA-06-001)**
**  ****70 applications**
**  ****Review pending **
**	**
**	**

## Treatment Services at NIDA:  Randomized Clinical Trials

**Treatment Services at NIDA:  Randomized Clinical Trials**

## Evaluate Causal Associations

*Examples of Responses:*
- Encouraging experimental designs where feasible:
- In studies conducted with CSAP
- In criminal justice studies, such as CJ-DATS
- In Department of Education drug testing demonstration grants
- Scientific meeting on new methods to test causal inferences (with the  NIDA/NIMH/ NIAAA/SAMHSA/AHRQ/HRSA Conference)

## Task Force Recommendations: Leadership & Management

- Communicating consistent and clear conception of health services research at NIDA
- Integrating services research across divisions and branches
- Update application review criteria and orient IRG members
- Enhancing dissemination of services findings
- Being proactive in developing proposal solicitations

## A Comprehensive Framework for Implementation Research

**Clinical**
**Practices**

**Program**
**Components**

**Systemic Factors**

- Financial

- Health Care
- Infrastructure

- Legal/Regulatory

- Education &Training

- Research & Knowledge
- Transfer

**Org Structure**
**& Culture**

- Patient
- Engagement

**Staffing**

- Info &
- Clinical
- Care
- Systems

- Initial Services

- Engage &Sustain

- Therapeutic
- Interventions

- Assessment

- National Quality Forum (2005)

## Task Force Recommendations: Collaboration

- Develop and monitor the services research agenda
- Improve technology transfer
- Develop standards for evidence-based interventions
- Promote and publicize evidence-based interventions
- Improve methods for drug abuse services research

- Work with Federal Agencies, State Directors, providers and consumers to:

## Researcher-Practitioner Collaborations

- CCTN, CJ-DATS
-  PA and RFAs
- 2005 Meeting on Community Partnerships in Research:  Setting an Agenda
- 2006 RFA:  Enhancing Practice Improvement in Community-based Care

## Researcher-Funder Collaborations

- NIDA-Single State Agencies
- 2005 RFA:  Enhancing State Capacity to Foster Adoption of EBPs
- 2005 Presentation at NASADAD
- 2006 Grantees meeting
-  NIDA-SAMHSA

## Examples of co-sponsored projects
	NIDA funding cross-site evaluation of SPF-SIG
	NIDA-CSAP cofunding of Hawkin’s Communities that Care; Dishion’s WIC study
Expertise from services research disciplines in CTN and DTRD projects
	Health services researcher hired in CCTN

- 	NIDA funding cross-site evaluation of SPF-SIG
- 	NIDA-CSAP cofunding of Hawkin’s Communities that Care; Dishion’s WIC study
_*Expertise from services research disciplines in CTN and DTRD projects*_
- 	Health services researcher hired in CCTN

**Collaborative Research Processes**

## Co-sponsored RFAs and PAs
Dissemination & Implementation Research in Health (PA-06-039) 
Mechanism for Time-Sensitive Research Opportunities          (PAR-05-150) 
Enhancing State Capacity to Foster Adoption of Science-based Practices (RFA-DA-05-002)
Enhancing Practice Improvement in Community-based Care   (RFA-DA-06-001)  
Health Services Research for Drug & Alcohol Use (PA-05-139)
Economics of Prevention & Treatment of Drug & Alcohol Abuse (PA-05-111)
Services Research in the NIDA CTN (PA-03-011)

- Dissemination & Implementation Research in Health (PA-06-039)
- Mechanism for Time-Sensitive Research Opportunities          (PAR-05-150)
- Enhancing State Capacity to Foster Adoption of Science-based Practices (RFA-DA-05-002)
- Enhancing Practice Improvement in Community-based Care   (RFA-DA-06-001)
- Health Services Research for Drug & Alcohol Use (PA-05-139)
- Economics of Prevention & Treatment of Drug & Alcohol Abuse (PA-05-111)
- Services Research in the NIDA CTN (PA-03-011)

**Collaborative Research Processes**

## Co-sponsored scientific meetings
2005	- Foster care (NIDA, Child Welfare League of America)
	- Tobacco use Quitlines (NIDA, CDC, NCI, CTCRI, Health Canada)
	- Complexities of Co-occurring Conditions (NIDA, NIMH, NIAAA, SAMHSA, AHRQ, HRSA)
	- Community Partnerships in Research:  Setting a Research Agenda (NIDA, NIMH, SAMHSA)
	- Role of Faith-inclusive Practices in Drug & Alcohol Abuse Research
2006	- Dissemination Research (NIDA, NIAAA)
	- Returning Veterans (NIDA, NIAAA, NIMH, SAMHSA)
	- Children of Parents in the Criminal Justice System

**2005****	**- Foster care (NIDA, Child Welfare League of America)
- 	- Tobacco use Quitlines (NIDA, CDC, NCI, CTCRI, Health Canada)
- 	- Complexities of Co-occurring Conditions (NIDA, NIMH, NIAAA, SAMHSA, AHRQ, HRSA)
- 	- Community Partnerships in Research:  Setting a Research Agenda (NIDA, NIMH, SAMHSA)
- 	- Role of Faith-inclusive Practices in Drug & Alcohol Abuse Research
**2006**	- Dissemination Research (NIDA, NIAAA)
- 	- Returning Veterans (NIDA, NIAAA, NIMH, SAMHSA)
- 	- Children of Parents in the Criminal Justice System

**Collaborative Research Processes**

## Challenges Faced

**	**

- Budgetary constraints
- Entrenched bureaucracies
- Personnel changes among collaborators

## Summary:  NIDA has been addressing ALL aspects of the Blue Ribbon Task Force Report

- Research on commonly used practices.
- Emphasize causal study designs.
- Collaborate on standards for evidence-based practice.
- Develop collaborative research process within NIDA and with other agencies, practitioners, and state agencies.