nida interests: focus on addiction health services tisha wiley, ph.d. service research branch...

NIDA Interests: Focus on Addiction Health

Services

Tisha Wiley, Ph.D. Service Research Branch

Division of Epidemiology, Services, and Prevention ResearchNational Institute on Drug Abuse

August 14, 2012CALDAR Early Career Track

SERVICES RESEARCH BRANCHPREVENTION RESEARCH BRANCH

EPIDEMIOLOGY RESEARCH BRANCH

Division of Epidemiology, Services and Prevention Research (DESPR):

NIDA’s Public Health Division

DESPR promotes epidemiology, services &prevention research to

understand and address the range of problems

related to drug abuse, in order to improve public health.

Service Research Branch Mission

Support rigorous research to improve the quality of addiction treatment and recovery support services SERVICES: Drug, alcohol, nicotine disorder services & HIV/HCV

services for drug-involved individuals DELIVERY SYSTEMS: Specialty treatment programs, general

health care settings, criminal justice settings, social service agencies, etc.

QUALITY: effective services for all who need them at reasonable a cost• Availability, access, appropriateness, effectiveness, safety,

efficiency, cost

Our Research Vision

NIDA’s Services Research Branch supports science that leads

addiction treatment services toward the highest possible levels of quality, efficiency, & economy.

About NIDA’s Service Research Branch

238 Active Grants (as of August 2012)

$75m in Direct Costs 83% of funding goes to

Research Project Grants R01, R21, R03s, etc.

Defining service needs

Refining practices for real-

world use

Testing service delivery models

Pre-implementation

research

Implementation Trials

Systems Overlap (e.g., child welfare)

Use of technology in treatment

Co- & Multi-morbidity

CJ services

EBP uptake

Seek, Test, Treat, Retain

Justice Involved Adolescents (U01)

CJDATS (U01)

Workforce

SBIRT

Primary Care

Other D&I TrialsTx engagement/retention

Drug use trajectories

Health disparities

Alternative service models

PIPE

LIN

ESR

B G

RAN

T T

OPI

CS

Services Research Continuum

Measures/methods

Selected SRB Areas of Interest

Technology & Methodology

Implementation, Sustainability & Outcomes of EBP’s

Special Settings: Criminal Justice, Juvenile Justice, Child Welfare

Healthcare Reform Impact

Methodology & Technology

Relevant Funding Announcements SRB Flagship PA’s

• PA-12-127 (R01) – 5 years, unlimited*• PA-12-128 (R21) – 2 years, $275k direct total• PA-12-129 (R03) – 2 years, $100k direct total• PA-12-134 (R34) – 3 years, $435 direct total

Technology/HIV PA’s• PA-12-117 (R01)• PA-12-118 (R34)


Our “Flagship” PA’s PA-12-127 (R01)

Supports “developing, refining, and validating new approaches for conducting treatment and prevention services research” Study Designs Measurement Tools Simulation Modeling Quality/Performance Measures Statistical Models

Health Services and Economic Research on the Prevention and Treatment of Drug, Alcohol, and Tobacco Abuse (R01, R21, & R03)

PA-12-128 (R21) PA-12-129 (R03)


Use of technology to directly improve patient-level outcomes (i.e., adherence)

Capacity of HIV treatment providers and related service delivery organizations to adopt and integrate such technologies to promote HIV treatment outcomes;

Use of technology to improve the organization and delivery of HIV treatment and services.

Technology-Based Interventions to Promote Engagement in Care and Treatment Adherence for Substance Abusing Populations with HIV (R01, R34)

Implementation Science

Relevant Funding Announcements SRB Flagship PA’s, especially R34 RFA-DA-13-001 (R21/R33)

• (August 22 Deadline)


Organizational and/or systems-level interventions that may optimize access, utilization, delivery, quality, and/or cost of treatment services through the use of EPBs

Organizational and/or systems-specific adaptations to existing EBPs

Novel service delivery models to be pilot tested in preparation for larger-scale effectiveness trials

PA-12-130 (R34): Building System Capacity for Implementing EBPs


Hypothesis-driven research that:• Addresses systems-level implementation research questions• Builds provider/funder capacity for conducting research beyond life of

the grant

Designed to implement (not develop) evidence-based drug treatment or prevention practices

Ideally, projects will involve:• One or more treatment or prevention settings• An external agency that impacts their services (e.g., SSA, SMA)• An academic partner experienced in doing NIH research

PA-12-130 (R34): Building System Capacity for Implementing EBPs

Implementation science is not intended to test interventions,

but to study how to get evidence-based interventions

adopted, adapted, & sustained.


Implementation Research:Studying the Technology Transfer Process

How do we move EBP’s into everyday use? How do we organize treatment to support EBPs? How do we train and supervise staff to use EBPs? How do we change business practices to value EBPs?

Client-level outcomes are NOT the focal outcome. Research questions are about finding effective implementation

strategies.

What are implementation strategies?

Determining organization’s needs and alternative solutions STRATEGIC PLANNING

Determining organization’s readiness for change READINESS ASSESSMENT

Monitoring and modifying organizational processes and procedures to implement and sustain new practices (e.g., NIATx)PROCESS

IMPROVEMENTWho is trained (e.g., clinical staff, correctional staff, administrative staff), on what, and required resources? TRAINING AND

SUPERVISIONModifying what information is collected, how it is accessed and used to support decision-making.INFORMATION

SYSTEMSHow can organizational culture be changed to support the infrastructure needed to maintain new services?ORGANIZATIONAL

CULTURE

Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare

Relevant Funding Announcements Flagship PA TRIALS (RFA-DA-13-009)

• Deadline: November 28, 2012 Relevant Funded Projects

CJ-DATS (U01, 10 Research Centers) Seek, Test & Treat: Addressing HIV in the Criminal Justice

System (R01s, 13 awards)• Data Harmonization


Purpose Test implementation strategies and associated measures to

improve the continuum of substance abuse prevention and treatment services delivered to youth under juvenile justice supervision

Structure Multisite collaborative Agreement

Two Types of Applications Coordinating Center Research Center

RFA-DA-13-009 (U01): Translational Research on Interventions for Adolescents in the Legal System: TRIALS


Need Youth and adolescents in juvenile justice system at high risk and need

effective drug use prevention and treatment services Most juvenile justice systems do not provide adequate services

Opportunity We have effective, evidence-based prevention and treatment interventions

for adolescents Involvement in the juvenile justice system provides window to intervene with

drug abuse & HIV Researchers can partner with juvenile justice agencies:

• Adolescent drug courts; truancy, teen, family courts• Juvenile detention• Juvenile probation

RFA-DA-13-009 (U01): Translational Research on Interventions for Adolescents in the Legal System: TRIALS


Focus on implementation research Transfer of evidence-based practices

Criminal justice re-entry-systems improvement Correctional Facilities, Probation, & Parole

Test of different implementation & quality improvement strategies

Key Features of CJ-DATS-2 (2008-2013)


3 Research Protocols 10 Research Centers 62 Correctional Facilities 11 States 2 NIDA FTEs $26.8 million over 5 years

$2.7 million from CSAT and DOJ co-funders



MAT Does strategic planning intervention + staff training improve

MAT utilization? HIV

Does a local change team improve utilization of HIV services along the continuum of care?

Assessment Does a local change team improve the case planning process?


Criminal Justice System:Key Participants and Intervention Opportunities

Crime victimPoliceFBI

Crime victimPoliceFBIJudge

Key Participants/Stakeholders

Screening/Referral

ProsecutorDefense AttorneyDefendantJuryJudge

JudgeJury

Probation Officers

Correctional Personnel

Probation/ Parole Officers

FamilyCommunity-based providers

Diversion Programs

Drug CourtsCommunity

TreatmentTASC

Drug CourtTerms of

IncarcerationRelease

Conditions

Drug Treatment Drug TreatmentAftercareHousingEmploymentMental HealthHalf-way HouseTASC

N/A

SENTENCING(Fines, Community Supervision, Incarceration)

ADJUDICATION(Trial)

PROSECUTION(Court, Pre-Trial Release, Jail)

ENTRY(Arrest)

CORRECTIONS(Probation, Jail, Prison)

COMMUNITY REENTRY(Probation, Parole, Release)

Intervention Opportunities


Relevant ACA Provisions & Environment: Expands coverage to more than 30

million individuals, many at high risk for drug abuse

Fundamentally changes the way many drug abuse prevention and treatment services are financed

Emphasizes central role of primary care settings

Focuses on screening and prevention Promotes use of electronic health

records


Relevant RFA: RFA-DA-13-001 (R21/R33) Closes August 22, but still an area of interest

Research Topic Examples: Uptake rate for insurance among those with drug use

disorders and related conditions and how this is affected by outreach and types of offered coverage

Responsiveness of demand for services among the newly covered• Effect on types and quantity of services sought and responses by

payers Effect on financing and cost of treatment

Other FOAs

Time-Sensitive Drug Abuse Research (R01) PAR-10-072

“Rapidly evolving areas where opportunities for empirical study are, by their very nature, only available through expedited review and award of support.”

3 Criteria scientific value and feasibility are clear, rapid review and funding are required knowledge gained from the study is time-sensitive –regular

review cycle = missed opportunity

Other FOAs

Last receipt date: October 2012 2 years, $50k in direct costs Supports research on:

Epidemiology Prevention Services Women and Sex/Gender Differences

Drug Abuse Dissertation Research (R36) PAR-10-020

Other Areas of Interest

Adaptive service delivery strategies to adjust level, dosage, and type of intervention in response to changing needs Continuity of care within and across settings Integrated addiction and other medical treatment Performance measurement and management Impact of IT systems and system changes

Clinical Quality Improvement


Service delivery models (e.g. collaboration, co-location) Management and human resources (e.g. recruitment,

training, retention) Business practices

Services Organization and Management


Financing, e.g. Effect of health insurance on demand for treatment Effect of reimbursement mechanisms on supply of treatment

Economic incentives for quality improvement Economic evaluation (CEA, CUA, CBA) Economic efficiency

Economics

SRB: We are here to help! Contact Us: (301) 443-6504

• Branch ChiefRedonna Chandler, Ph.D.

• Medication-assisted treatment, SBIRT, NIDA-MEDRichard Denisco, M.D.

• Organization & management, implementation scienceLori Ducharme, Ph.D.

• Economics research, performance measurementSarah Duffy, Ph.D.

• HIV, vulnerable populationsDionne Jones, Ph.D.

• HIV prevention & adherence, child & adolescent drug treatmentShoshana Kahana, Ph.D.

• Science Officer for CJDATS; criminal justice research, methodologyTisha Wiley, Ph.D. ([email protected])

nida interests: focus on addiction health services tisha wiley, ph.d. service research branch...

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