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Topics to Cover

Treatment Characteristics & Quality: CHALLENGES AND EBT s Douglas Novins, M.D. University of Colorado Anschutz Medical Campus. NIDA Roundtable Meeting on Substance Use Disorders among American Indian/Alaska Natives in Urban Settings. Topics to Cover.

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Topics to Cover

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  1. Treatment Characteristics & Quality: CHALLENGES AND EBTsDouglas Novins, M.D.University of Colorado Anschutz Medical Campus NIDA Roundtable Meeting on Substance Use Disorders among American Indian/Alaska Natives in Urban Settings

  2. Topics to Cover • Challenges to Service Delivery (Qualitative) • EBT Knowledge (Qualitative) • EBT Engagement (Quantitative) • EBT Use (Quantitative) • Attitudes Towards EBTs & Perceived Cultural Appropriateness (Qualitative and Quantitative)

  3. Challenges for Service Delivery • Clinical challenges • poverty • trauma histories • Infrastructure challenges • not having enough staff • staff feeling burned out • not having enough time or resources • Service system challenges • Not having enough housing • Access to mental health treatment

  4. “There are so many survival needs that come first—housing, a job, food, things like outpatient treatment are probably last on the list.” Challenges for Service Delivery “’I grew up in an alcoholic home, I was raised in a foster home, I was in a boarding school, I may have had sexual abuse, I may have been physically abused or emotionally abused . . . .’ That’s what’s walking in your door. It’s not simple….” “…It’s not ‘I’m drinking a six-pack a day and I really get drunk on the weekends. Help me sober up.’ [W]hat’s coming to light for our communities is the trauma that has happened for so many generations to our communities and still is happening, so how do we fix that? “you have to have a certain amount of flexibility and willingness to wade through the mud and muck of peoples’ lives everyday because these people come in here when everything is falling apart.” Therefore, “at the end of your day, you feel like you just don’t have anything left because . . . it’s so intense.” “[Clients] know if they go back to their homeland there’s all the drinking and drug use going on [so they] relocate, [but] sometimes we have people staying three weeks to a month later waiting for housing because the [lack of] availability and the funding.” “It’s all good and well to have evidence-based treatment, but for who? Who does it work for? . . .[Y]ou’ve got to realize that it’s different in each community.” • Clinical challenges • poverty • trauma histories • Infrastructure challenges • not having enough staff • staff feeling burned out • not having enough time or resources • Service system challenges • not having enough housing • Access to mental health treatment

  5. Knowledge of EBTs • Asked respondents in Phase 2 qualitative interviews to define EBT. We analyzed their responses relative to Drake et. al.’s (2001) definition: “any practice that has been established as effective through scientific research…” • Majority of respondents accuratlydefined evidence-based treatments. • “effective” (80%) • “research” (71%). • Synonyms “empirical” (9%), “data” (9%), and “(it) works” (28%). “Pretty simply it’s the treatment techniques that have been researched and have proven to be effective in a population that’s been monitored.”

  6. Knowledge of EBTs • 19% were unable to define an EBT. “You know, I've heard it, I've seen it on the covers of the book. But, no, [I don’t know what it means].”

  7. Knowledge of EBTs • More detailed aspects of EBT definitions • Manual – 6% • Replication – 3% • Hierarchy of evidence– 0% “Then, someone's going to write a curriculum, manualize it, get it all nice and beautiful, and then, they're going to implement it and see if it works. And, if it works, then it'll be an evidence-based practice and maybe it'll be [listed in] NREPP…”

  8. EBT Use

  9. Psychosocial EBTs Novins et al. (in preparation) Use of Evidence-Based Treatments in Substance Abuse Treatment Programs Serving American Indian and Alaska Native Communities.

  10. Psychopharmacologic EBTs

  11. Overall EBT Engagement

  12. Factors Associated with Greater EBT Engagement - Psychosocial

  13. Factors Associated with Greater EBT Engagement - Psychopharmacologic

  14. EBT Implementation

  15. Attitudes Towards EBTs • Phase 2 results: • Concerns about cultural appropriateness – 42% • Western/Biomedical influence – 19% (negative) • External mandates – 26% • Tension between individualized care and manualized treatments – 16% • Resource drain – 13% “Evidence based just means that they have found a certain treatment approach or philosophy that helps with a certain population and it’s not true for all populations.”

  16. Perceptions of Cultural Appropriateness of EBTs: Latent Classes 28% 50% 22% CBT [CM, MM, BCT] (4/9)

  17. Perceptions of Cultural Appropriateness of EBTs: Latent Classes MI [RPT, CRFT, MST](4/9)

  18. Perceptions of Cultural Appropriateness of EBTs: Latent Classes 12-SF (1/9)

  19. Discussion • Challenges to Service Delivery (Qualitative) • EBT Knowledge (Qualitative) • EBT Engagement • EBT Use • Attitudes Towards EBTs & Perceived Cultural Appropriateness (Qualitative and Quantitative)

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