Conducting trials in community settings: the provider perspective

Making Collaboration Work: Key Components of Practice/Research Partnerships

Drawing on our experiences as researchers and community-based providers, this paper outlines several key components of successful practice/research collaboration: forming equal partnerships, bilateral communication, ensuring nonhierarchical collaborations, and appropriate dissemination of outcomes. Many concrete benefits can result from collaborative research projects, including additional services, program development, and training for service agency staff. Building partnerships takes time and a good amount of planning and negotiation prior to writing proposals. However, these collaborations can result in more effective efforts to solve common problems and reach common goals.

Implementation and acceptability of Mindful Awareness in Body-oriented Therapy in women's substance use disorder treatment

OBJECTIVES

The purpose of this study was to examine the implementation and acceptability of Mindful Awareness in Body-oriented Therapy (MABT), a novel adjunctive approach to substance use disorder (SUD) treatment. The primary aims of the study were to examine implementation of MABT as an adjunct to addiction treatment, and MABT acceptability to study participants and treatment staff.

METHODS

MABT was delivered to participants randomly assigned to the intervention in a larger ongoing trial. This study focuses only on the implementation and acceptability of the intervention, as outcomes are not yet available. MABT was delivered once weekly for 8 weeks (1.5-hour sessions) and spanned inpatient and outpatient programs at a women-only treatment facility. Descriptive statistics were used to examine participant recruitment and retention to the intervention. To measure MABT acceptability, survey and written questionnaires were administered; analysis involved descriptive statistics and content analysis using Atlas.ti software.

RESULTS

Thirty-one (31) of the women enrolled in the study were randomized to MABT. Eighteen (18) participants completed 75%-100% of the MABT sessions. Intervention implementation required flexibility on the part of both the researchers and the clinic staff, and minor changes were made to successfully implement MABT as an adjunct to usual care. MABT was perceived to increase emotional awareness and provide new tools to cope with stress, and to positively influence SUD treatment by facilitating emotion regulation.

CONCLUSIONS

It was feasible to implement MABT and to recruit and retain women to MABT in women's chemical-dependency treatment. MABT acceptability and perceived benefit was high.

Developing a new system to measure outcomes in a service coordination program for youth with severe emotional disturbance

This paper presents information on re-developing an outcome evaluation for a state-funded program providing service coordination utilizing wraparound to youth with severe emotional disturbance (SED) and their families. Originally funded by the Robert Wood Johnson Foundation, the Kentucky IMPACT program has existed statewide since 1990. Changing data needs and limitations of the original evaluation required revamping the program's data collection system. The new evaluation uses the extant knowledge base to improve: (1) design, (2) measures, and (3) utility. A pre-post design with multiple follow-ups provides the framework for data collection. An ecological framework provides a conceptual structure for selecting measures focusing on both the service recipients and their environment. Data collection via a personal digital assistant (PDA) ensures utility of the data for both consumers and researchers. Issues ranging from conceptualization to implementation of the project as well as lessons learned are discussed.

Methamphetamine users entering treatment: characteristics of the methamphetamine treatment project sample

The Center for Substance Abuse Treatment funded the Metamphetamine Treatment Project to evaluate and compare treatment approaches for methamphetamine users. As part of this study, drug use patterns, history of physical or sexual abuse, history of suicidality, and psychopathology were assessed in 1,016 methamphetamine-dependent outpatients entering treatment between 1999 and 2001 at eight sites across the western United States. The sample was predominately female and racially diverse. The mean age of the participants was 32.8 years. Most were methamphetamine smokers, but there were marked regional variations. Suicidality and physical or sexual abuse were common and measures of current psychopathology were high. These clinical issues were associated with more frequent use of methamphetamine and, more strongly, with concurrent use of other drugs. Therefore, the relationship between polydrug use and psychopathology in methamphetamine users warrants further investigation.

Implementation of a statewide outcome monitoring system: lessons learned from substance abuse treatment provider staff

The authors analyze the pilot implementation of a statewide automated outcome monitoring system (OMS) in California, using the perspectives of substance abuse treatment providers responsible for its day-to-day operation. To gain a better understanding of changes experienced by staff and their perceptions of barriers and facilitators of implementation, they conducted 28 focus groups designed to inform midstream adjustments to the system prior to its possible roll-out. Qualitative analysis of the focus group data revealed five important factors influencing implementation: the treatment provider's ethos, the time-consuming nature of the OMS, staff buy-in, resources, and counselor and program discretion. Lessons learned underscored the importance of taking into consideration aspects of organizational change and institutional resources and infrastructure when implementing a major change such as an automated OMS. Findings might be useful to those designing and implementing similar systems or other large organizational change initiatives.

When treatment meets research: clinical perspectives from the CSAT Methamphetamine Treatment Project

Integrating research-based treatments into clinical settings has become a priority in the substance abuse treatment field. This article examines the introduction of research, via manualized treatment (i.e., the Matrix Model), into community treatment settings that participated in the Center for Substance Abuse Treatment Methamphetamine Treatment Project, a multi-site randomized controlled trial (RCT) that provided free treatment to 1016 methamphetamine-dependent individuals. With both empirical (qualitative) and anecdotal data from those involved clinically in the project, the article utilizes the framework of practitioner concerns set forth by Addis, Wade, and Hatgis (1999) to assess the issues realized during the implementation of this manualized treatment. Despite fairly smooth implementation of the model, the authors conclude that introducing manualized treatment in the context of an RCT may not be the best way to bring research-based treatment into the practice world.

Collaboration and social inquiry: multiple meanings of a construct and its role in creating useful and valid knowledge

The concept of collaboration in community research and intervention, although not new, has grown tremendously in importance in the past 20 years. Yet, it is both a contested concept in terms of its intent and a still evolving idea in terms of its meaning and implications. The purpose of this monograph is to begin to "unpack" the collaboration construct in terms of its many meanings, rationales, goals, models, dynamics, and accomplishments. Although models of collaboration are often well articulated there is "partial paradigm acquisition" (E. J. Trickett, 1984) in terms of understanding their behavioral and ethical implications. There is more theology than conclusion. The promise of collaboration, although considerable, is still in need of multiple and varied empirical examples of how collaboration contributes to both the process and goals of community research and intervention, however defined. The monograph closes with a brief overview of what we have learned from reviewing this literature, an articulation of the kinds of questions that need to be addressed, and a series of recommendations for how to increase our understanding of the collaboration construct in community research and intervention.

Perceived Barriers to Research among Substance Use Treatment Providers

To help understand substance use treatment providers' attitudes about research, 164 providers completed surveys about experiences with research, perceived barriers, and training needs. Providers tended to consider their agencies' lack of research expertise to be less of a barrier to research than their agencies' focusing on clinical work rather than research. Providers with good or neutral research experience were less likely than others to consider agency's lack of research focus a barrier. However, only providers with good research experience were less likely than others to consider agency's clinical focus a barrier to research. Providers with bad research experience were the least interested in getting further research training. Implications for research are discussed.

Dancing with strangers: will U.S. substance abuse practice and research organizations build mutually productive relationships?

The scientific knowledge gained from research has not been extensively integrated into the U.S. substance abuse treatment system. A clear call to arms has been issued by the U.S. federal treatment and research agencies to bring research and practice together to create a better treatment system and a more responsive research agenda. The current federally sponsored initiatives to "close the gap" between research and practice are large and well funded. The field appears ready to change and realize the mutual benefits that can be achieved from the increased "bleeding" of research and practice. However, while the music has started and the partners seem willing, there are still many obstacles to a successful dance.

A successful researcher-practitioner collaboration in substance abuse treatment

The best efforts to improve substance abuse treatment come from the integration of practice and research. The purpose of this article is to discuss factors that contribute to fruitful research-practice collaborations using the example of our recent successful partnership between a group of treatment researchers and a group of substance abuse recovery houses operated by Fresh Start. The research effort was the Drug Evaluation Network System, a computer assisted method of integrating clinical research and policy relevant information into a standard admission interview. The article discusses several factors that were important in integrating this research effort into the treatment system. These factors included adequate advance preparation of clinical and research staff to employ the new system, overcoming bilateral biases, and determining the degree to which the clinicians' and researchers' missions are matched. The paper also discusses a range of general factors to consider in implementing and maintaining successful research-to-practice integrations.

The federal role in drug abuse technology transfer: a history and perspective

The past 30 years have seen a focus on substance abuse research in association with the creation of federal agencies specifically mandated to guide that effort. While research has been well supported and largely productive, there has been increasing concern with the slow pace of adoption of the findings from that research. The history of those efforts suggests a long-standing concern with knowledge development, and a continuing reliance on print media to achieve knowledge application. Nonetheless, evidence from other human service fields, and increasingly from the substance abuse field, indicates interpersonal strategies are dramatically more effective in achieving the individual and organizational behavior change needed to achieve technology transfer. Argument is made that the federal government remains the best, if not the only resource for promoting technology transfer. A paradigm is described to further federal efforts in this area, and structural elements suggested for the achievement of technology transfer goals.