# Presentation: 911406

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

Substance Abuse Health Services
Atlanta, October 24, 2003

- Director
- Division of Epidemiology, Services, and Prevention Research
- National Institute on Drug Abuse
- National Institutes of Health
- Department of Health and Human Services
*Substance Abuse Health Services*
- Atlanta, October 24, 2003

**Update from NIDA**

## Presentation Outline

- Health Services Research at NIDA
- Recent NIDA Activities
- Priorities
- Key Meetings and Other Activities
- NIH Roadmap:  Implications for health services research
- Update on NIDA’s Health Services Blue Ribbon Task Force

## National Institute on Drug Abuse

**National Institute on Drug Abuse**

**Office of the**
** ****Director**

**Center on AIDS &**
**Other Medical**
**Consequences**
** ****of Drug Abuse**

**Division of**
**Epidemiology, **
**Services & **
**Prevention **
**Research **

**Division of**
**Treatment Research**
**& Development**

**Center for the**
**Clinical Trials **
**Network**

## Health services is an integral component of NIDA’s mission of bringing science to bear on drug abuse and addiction.

## Health Services Research at NIDAPHS Act – Title IV (amended, 1992) 

- “....the general purpose of the National Institute on Drug Abuse is the conduct and support of biomedical and behavioral research, *health services research*, research training, and health information dissemination with respect to the prevention of drug abuse and the treatment of drug abusers.”

## But, what exactly do we mean by “health services” research and how does it fit within NIDA’s mission?

## Services Research at NIDA:The Bottom Line

- To understand how drug abuse prevention and treatment services are *and should be* delivered in “real-life” settings
- To harness research to improve service:
**Access**
**Quality, and **
**Cost effectiveness **

## NIDA Resources Funding of Services Research

## National Institute on Drug Abuse

**National Institute on Drug Abuse**

**Office of the**
** ****Director**

**Division of **
**Neuroscience**
** ****& Behavioral**
** ****Research**

**Office of**
**Extramural **
**Affairs**

**Office of Planning**
**& Resource**
** ****Management**

**Office of **
**Science Policy & **
**Communications**

**Center on AIDS &**
**Other Medical**
**Consequences**
** ****of Drug Abuse**

** ****Intramural **
**Research**
**Program**

**Division of**
**Epidemiology, **
**Services & **
**Prevention **
**Research **

**Division of**
**Treatment Research**
**& Development**

**Center for the**
**Clinical Trials **
**Network**

## DESPR’s Organizational Chart

## DESPR provides a foundation for NIDA’s 

**Public Health Mission.**

## DESPR will improve the nation’s public health by promoting integrated approaches to understand and address interactions between individuals and environments that contribute to the continuum of problems related to drug use.  Our goal is to develop scientific knowledge with clear application to practice and public policy.

## Recent NIDA Activies:  Priorities

## NIDA Priority Areas

- Prevention
- Treatment
- Training

## DESPR:  Five Year Goals

- Measurably improve public health prevention and treatment outcomes
- Demonstrate the interaction of modifiable environmental factors with each other and with genetic factors
- Develop functional transdisciplinary research teams

## Programs to Achieve DESPR’s Goals

- Studies on integrating drug abuse prevention and treatment into *primary care*
*Services system* studies for prevention and treatment to improve public health outcomes (e.g. criminal justice system)
- Take effective interventions to scale in “real-world” settings by testing strategies to enhance research *adoption and implementation*
*Training *programs for public health researchers

## Recent NIDA Activities:  Key Meetings and Other Activities

## Key Meetings

- Drug Abuse Treatment in Primary Care – July 2003
- DESPR Center Directors – June 2003
- What do schools really think about prevention research? – April 2003
- Beyond the Clinic Walls Joint NIMH/NIDA/NIAAA Services Research Conference – March 2003
- Social Work Infrastructure Grantees Meeting – January 2003

*Past:*

## Key Meetings

- Research on Treatment Processes – December 2003
- HIV Prevention in Adolescents – Feb/March 2004
- Co-occurring Disorders, Joint NIMH/NIDA/NIAAA/AHRQ/HRSA/SAMHSA Services Research Conference – April 2004
- Disseminating Drug Abuse Services – TRIP Conference Track Summer 2004
- Developing the next generation of DESPR centers – Summer 2004
- National Integrating Drug Abuse Treatment and Prevention into Primary Care – Fall 2004

*Future:*

## Other KeyActivities

- CTN and HIV/AIDS Program Committees of the NIDA Advisory Council
- Health Services Blue Ribbon Task Force
- Presentation to NIH Director on Joint NIH/SAMSHA Science to Services Activities
- Presentation to ONDCP Director on NIDA’s Services Program

## ONDCP Presentation Outline

- Overview of Services Research at NIDA
- Key Services Research Findings
- Services Research Current Grant Portfolio
- Future Directions in Services Research
- NIDA-SAMHSA Collaborations

## Key Services Research Findings

- ONDCP, July 2003

## Services Research is at the Core of NIDA’s Key Prevention and Treatment Publications

- ONDCP, July 2003

## Service Linkages are an Integral Part of Effective Drug Treatment

- ONDCP, July 2003

## Integrating Drug Abuse Treatment and Primary Medical Care is Useful

- Integrating drug treatment and medical services:
- results in increased use of medical services *(Friedman, 2001)*.
- is associated with less subsequent hospitalization *(Laine, et al.,  2001)*.
- is cost-effective *(Weisner, et al., 2001)*.

- ONDCP, July 2003

## Yet, in spite of findings that research-proven services can be associated with enhanced outcomes many of these practices are not adopted or implemented widely.

- ONDCP, July 2003

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

- Ringwalt,  et al.,  in press.

- (N = 1905 Schools)

- ONDCP, July 2003

## Few Treatment Programs Use Treatment Innovations

- Roman, et al., Treatment Innovations in Publicly Funded Substance Abuse Treatment Centers: A Preliminary Report from the  Field: Presentation at CTN Steering Committee Meeting, 2002.

- (N = 171 Administrators)

- ONDCP, July 2003

## So, what is NIDA doing about the translation of research into practice?

- Studying ways to enhance translation of research to practice is a major emphasis in our current treatment and prevention services programs.

- ONDCP, July 2003

## Developing an Intervention (i.e. an “evidence-based-practice”) is only one piece of the translation puzzle

- ONDCP, July 2003

**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)

## Much of the Recent Services Research Portfolio Addresses:

- Adaptation of programs to community settings
- Fidelity of implementation
- Management, organization, and financing
- Sustainability of effective programs over time

- ONDCP, July 2003

## Exemplary Cross-Cutting Topic:

- Community-based System of Care

- ONDCP, July 2003

## Communities That Care (Hawkins, et al.)

- Focuses on environmental assessment, community readiness, and implementation of targeted strategies
- Current NIDA randomized clinical study in 26 communities across 7 states

- ONDCP, July 2003

## Community Prevention Planning Using Communities That Care (Hawkins, et al.)

- 1. _*M*__***obilize***_ the community
- 2. _***Assess***_ the environment (i.e. rates of risk, protection and problem behaviors) through surveys of children and parents which can be mapped
- 3. _***Prioritize***_ risk factors and protective factors for action
- 4. _***Select***_ tested interventions to address priority risk and protective factors

- ONDCP, July 2003

## 5. Implement effectively the interventions
6. Monitor changes in targeted risk and protective factors and problem behaviors
7. Adjust interventions as indicated by performance monitoring data

- 6. _***Monitor***_ changes in targeted risk and protective factors and problem behaviors
- 7. _***Adjust***_ interventions as indicated by performance monitoring data

- Community Prevention Planning Using Communities That Care (CTC)

- ONDCP, July 2003

## 1. Mobilize the community through meetings, activism, identifying and enlisting key stakeholders
2. Assess the environment (i.e. rates of risk, protection and problem behaviors) through surveys of children and parents which can be mapped
3. Prioritize risk factors and protective factors for action
4. Select tested interventions to address priority risk and protective factors

- 2. _***Assess***_ the environment (i.e. rates of risk, protection and problem behaviors) through surveys of children and parents which can be mapped
**3. Prioritize risk fa****cto****rs and protective factors for action**
**4. Select tested interventions to address priority risk and protective factors**

- ONDCP, July 2003

## Mapping the number of risk factors creates a 3-D map:

- ONDCP, July 2003

## Select Prevention Programs for Neighborhood #1 by Addressing the Higher Risks: 

- Attitudes favorable to substance use with
*Parent training*
*Changes in community and school policies *
- Early initiation of antisocial behavior:
*Parent training*
*Classroom management*
- Peer substance use:
*Refusal skills training*
*Afterschool recreation*

- ONDCP, July 2003

## Current Services Research Grant Portfolio

- ONDCP, July 2003

## NIDA Services-Related Research Grant Announcements Since 2000

- Program Announcements: 30
- Requests for Applications: 22

- ONDCP, July 2003

## Portfolio

- Over 200 current grants in prevention and treatment services covering:
- Effectiveness and Outcomes
- Access and Utilization
- Organization and Management
- Cost Effectiveness and Financing

- ONDCP, July 2003

## So, given the range and breadth of NIDA’s services grant portfolio, how do these studies correspond to the SAMHSA Knowledge Development and Application (KDA) programs? 

- ONDCP, July 2003

## CSAT’s Knowledge Development and Application (KDA) Topics Since FY2000

- Special Populations
- Integrated Treatment, Screening, and Early Intervention
- Innovative Programs:
- Co-occurring disorders
- HIV/AIDS
- Rural health
- Office-based treatment
- Managed care
- Criminal justice

- ONDCP, July 2003

## Number of current NIDA services grants corresponding to CSAT’s KDA topics since FY2000

| Special Populations | 49 |
| --- | --- |
| Integrated Tx, Screening, etc. | 24 |
| Co-occurring Disorders | 16 |
| HIV/AIDS | 60 |
| Rural Health | 7 |
| Office-based Treatment | 5 |
| Managed Care | 10 |
| Criminal Justice | 31 |

- CSAT’s KDA Topics

- # NIDA Grants

- ONDCP, July 2003

## CSAP’s Knowledge Development and Application (KDA) Topics Since FY2000

- Community-based programs
- Mentoring and family strengthening programs
- HIV prevention
- Early childhood interventions
- Community disparities

- ONDCP, July 2003

## Number of current NIDA services grants corresponding to CSAP’s KDA topics since FY2000

- # NIDA Grants

| Community-based Programs | 45 |
| --- | --- |
| Mentoring/Family Strengthening  | 59 |
| HIV Prevention | 84 |
| Early Childhood Interventions | 31 |
| Community Disparities | 45 |

- ONDCP, July 2003

## We conclude that NIDA’s Services Research grants have addressed and continue to address the same issues as SAMHSA’s Knowledge Development initiatives

- ONDCP, July 2003

## NIDA-SAMHSACollaborations

## NIDA-SAMHSA Collaborations Build on the Joint NIH-SAMHSA Science to Services Initiative

- An inter-agency collaboration to accelerate the process of identifying and translating effective mental health and substance abuse treatment and preventive interventions into widespread practice.

## The Science to Services Cycle

**Collaboration**

**Commitment**

## The Science to Service Initiative:Major Activities To Date

- NIH grant writing technical assistance for SAMHSA program officials and grantees
- NIDA funding of research/practice liaisons in CSAT’s ATTCs
- NIDA providing ongoing consultation to SAMHSA regarding selection of effective interventions for implementation
- Linking NIDA and SAMHSA grant programs

## Linking NIDA and SAMHSA grant programs

- “Braiding” funding streams to enhance both research and services
- Each agency doing what it does best
- Examples:
- Adolescent Treatment and Services Research FY2003
- Service to Science Grants *(under consideration for future years)*

## NIH Roadmap

## NIH Roadmap

**New Pathways to Discovery**
- Building blocks, biological pathways and networks
- Molecular libraries and imaging
- Structural biology
- Bioinformatics and computational biology
- Nanomedicine
**Research Teams of the Future**
- High-risk research
- Interdisciplinary research
- Public-private partnerships
**Re-engineering the Clinical Research Enterprise**

## NIDA Health Services Research Blue Ribbon Task Force 

## Blue Ribbon Task Force:  Goal

- June, 2003 convened to advise on strategies for increasing the relevance and facilitating the utilization of research-based prevention and treatment interventions into practice and policies.

## Blue Ribbon Task Force:  Initial Charge

- Background review of NIDA’s programs.
- Develop a 5-year plan with an emphasis on:
- dissemination of research findings
- enhanced utilization of CTN
- examination of the organization and management of health services research at NIDA
- interactions among NIDA’s divisions and centers and other Federal agencies

## Blue Ribbon Task Force:  Membership 

_**16 Total Members**_
- Areas of expertise:*  Treatment, Prevention, Policy, State Authorities, Consumer Stakeholders*
*Chairs:*  Constance M. Weisner, A. Thomas McLellan
*Prevention:*  Claire Sterk, Richard Catalano, Karen Blitz, Marguerita Lightfoot, Linda Chinnia
*Treatment:*  Isaac Montoya, Richard Frank, Michael L. Dennis, R. Lorraine Collins, James A. Inciardi, Janet Wood
*Federal:*  Andrea Barthwell, Wilson Compton, Mady Chalk

## Blue Ribbon Task Force:  Timeline 

- July 2003 - 2 day meeting of Task Force
- Review portfolio and NIDA procedures
- Outline report
- October 2003 - Conference call and 2 day meeting
- Draft recommendations
- Determine report finalization procedures
- January 2004 - 2 day meeting
- Reconcile review comments
- Finalize report content
- February 2004 - Report submitted

## Blue Ribbon Task Force: Report Outline 

- Preface/Executive Summary
- Defining Services Research for NIDA
- Future Directions:  Task Force Recommendations
- Defining Services Research Needs and Priorities
- Practice and Systems-level *Treatment Services* Research Recommendations
- Practice and Systems-level *Prevention Services* Research Recommendations
- Organizing and Managing Services Research within NIDA
- Developing Collaborations within NIH and Outside
- Next Steps

## NIDA Health Services Research Blue Ribbon Task Force 

*What can you do?*

- Volunteer to be a reviewer!

## Summary 

- Services research is alive and well at the National Institute on Drug Abuse
- Key themes are:
- The increasing pressure to solve the dissemination problems
- The importance of inter-agency collaboration

## Division of Epidemiology, Services and Prevention Research

***Providing a foundation for NIDA’s public health mission.***