Diffusion of research in practice in Substance Abuse Treatment: A knowledge adoption study

of gender sensitive treatment

Deborah Rugs, Ph.D.

Holly Hills, Ph.D.

Roger Peters, Ph.D.

University of South Florida

Louis de la Parte Florida Mental Health Institute

Department of Mental Health Law and Policy

Tampa PIC

This CSAT/SAMHSA funded project seeks to “bridge the gap” between researchers, treatment providers, criminal justice professionals, policy makers, and consumers to improve service delivery to persons with substance use disorders involved the criminal justice system.

Funded Collaborative Partners include: FMHI/USF, DACCO, Inc., ACTS, Inc., Operation PAR, Inc., FADAA, and the Hillsborough County Sheriff’s Office

Project Partners

Stakeholders Treatment Providers Researchers Policymakers Consumers

Liaison Groups Education/Training Community Support Services Self-Help, Faith Community

Recruit stakeholders Establish formal organization Conduct needs assessment Develop locally defined

practice/research agenda Develop stakeholder-endorsed

implementation plan

Phase I: PIC Development

Phase II:PIC Implementation

Infrastructure Support Network Enhancement Implement Knowledge Adoption Studies

Knowledge Adoption (KA) Study Approach

KA Study foci identified through Community Needs Assessment

• Gender-Sensitive Treatment (GST)• Co-Occurring Disorders Treatment (CDT)

KA Study Goal: Test the effectiveness of implementing evidence-based clinical protocol identified in Pilot Study, through use of an Opinion Leader network

Dissemination Method: Use of Opinion Leaders

Opinion Leaders are identified by peer counselors as respected for their knowledge in a particular topic area

Opinion Leaders are trained in the use of an evidence-based treatment curriculum

Opinion Leaders then train their peer counselors and supervise the application of the curriculum

Changes in counselor behaviors and attitudes are measured to determine the effectiveness of the Opinion Leader model

Training & Consultation Activities: GST

1. Foundations training – 4 hours for Opinion Leaders and program counselors

2. Opinion Leader training – 1.5 days

3. Treatment counselor training conducted by Opinion Leaders– How to implement treatment protocol– For GST, up to four 2-hour sessions to cover all 25

topics

4. Group /Individual supervision – once a week– Conducted by Opinion Leaders for treatment

counselors

5. Ongoing supervision provided to Opinion Leaders– Conducted by Site Coordinators / Project staff– GST: Brown Bag Luncheons

TrainedCounselors

N=30

Study Design: GST

Experimental GroupTampa N=42 Comparison Group

Orlando N=55

Opinion Leaders

N=9

CounselorsN=33

CounselorsN=55

Model Interventions

Seeking Safety (Najavits, 2001) Concurrent Treatment of PTSD and

Cocaine Dependence (Brady et al., 2001)

Substance Dependence PTSD Therapy (Triffleman et al., 1999)

Triad Women’s Project (C. Clark, PI) Trauma Recovery and Empowerment

(TREM) (Harris, 1998)

Seeking Safety (Najavits, 2002)

Structured interventions in manual format Organized around 25 trauma-related topics Integrates trauma & substance abuse For more information: Seeking Safety: A

Treatment Manual for PTSD and Substance Abuse (Guilford Press, 2002)

www.seekingsafety.org

Where would you go for information about treating a female client with a history of trauma and substance abuse? How Helpful? (1) Not at all to (10) Extremely

0 1 2 3 4 5 6 7 8

Co-workers in Program

Books

Training Materials

C-workers w/in Agency

Conference Materials

Websites

Co-workers outside ofAgency

Tips

Consultants

Where would you go for information about treating a female client with a history of trauma and substance abuse problems? How Often? (1) Never (2) Monthly (3) Weekly (4) Daily

0

0.5

1

1.5

2

2.5

3

3.5

Co

-wo

rker

sin

Pro

gra

m

Tra

inin

gM

ater

ials

Co

nfe

ren

ceM

ater

ials

Co

-wo

rker

so

uts

ide

of

Co

nsu

ltan

ts

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

# Clients in Group

# G

rou

ps

Number of Clients in Seeking Safety Groups (405 Total Groups)

Average = 7.25 Clients per Group

0 0 1 1

20 20

87 87 83 84

0102030405060708090

# O

L R

ati

ng

s

Reception of Manual

By Counselors

By Clients

Opinion Leaders’ Impressions of How Well the Modules Were Received?

GST Counselor (N=38) Feedback on OL Process at Post

0

2

4

6

8

10

12

14

16

18

20

# C

oun

selo

rs

StronglyDisagree

Disagree Neutral Agree StronglyAgree

Using OL's is an Effective Way toTransfer Knowledge

I Would Recommend Using OL's as aRoutine Knowledge Transfer Strategyin my Organization

Counselor (N=38) Difficulties with Implementing the Seeking Safety Groups

% N

Changing the Daily Schedule 40% 15

Preparing for the Groups 29% 11

Removing other Clinical Material from the Schedule

26% 10

Participating in Training 11% 4

Participating in Supervision 11% 4

GST: Did Change Occur?

Post 6 Mo. follow-up

TPA Orlando TPA Orlando

Have you used the manual “Seeking Safety” in the past 6 months?

95% 41% 85% 41%

Will you be using the manual in the future 6 months

97% 82% 100% 93%

N 38 46 27 29

GST: What Parts of the Manual will you be Using?

Percent saying "yes"

0

20

40

60

80

100

All of theManual

Some of theManual

InformationOnly

Post Tampa 6 mo Tampa Post Orlando 6 mo Orlando

**

Tampa vs. Orlando at post .001 signif

Tampa vs. Orlando at post .001 signif

GST Post 6 mo % Opinion Leaders Remaining

100% 75%

% Counselors Remaining 72% 76%

Staff Attrition from Post Implementation to Follow Up