- Email: [email protected]
Research on implementing evidence-based practices in community-based addiction treatment programs: Policy and program implications
Evaluation and Program Planning 34 (2011) 353–355
Contents lists available at ScienceDirect
Evaluation and Program Planning journal homepage: www.elsevier.com/locate/evalprogplan
Editorial
Research on implementing evidence-based practices in community-based addiction treatment programs: Policy and program implications
1. Why focus a special issue on the implementation of evidence-based addiction treatment practiced by community-based organizations? 1.1. The use of evidence-based practices (EBPs) for the identification and treatment of substance use disorders is increasingly mandated by government institutions and funding entities The Institute of Medicine (2001, 2006) recommends increased use of treatment supported by empirical evidence of both efficacy and effectiveness. Both federal including Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers for Disease Control (CDC) and state government funders of treatment services now have specific funding requirements mandating that organizations applying for service grants implement addiction treatment with an evidence base. Simultaneously, clinical trials increasingly document empirically valid, efficacious behavioral and pharmacological therapies for the treatment of alcohol and drug use disorders. Trials conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN) moreover, suggest that these treatments can be effective even in the chaos of realworld clinical environments and heterogeneous clinical populations (Amass et al., 2004; Carroll et al., 2006; Ling et al., 2005; Peirce et al., 2006; Petry et al., 2005). Thus, there are an increasing number of empirically supported practices appropriate for a range of clients and across substance abuse treatment settings. 1.2. Community-based organizations (CBOs) are the key implementers of government funded EBPs Treatment providers for substance use disorders include a varied group of non-profit, for-profit and governmental entities located in single-site and multisite community settings, county health departments, tribal communities, and also in some hospitals and veterans administration clinics. The largest proportion of providers includes approximately 13,000 specialty addiction treatment facilities that are small, independent outpatient and residential clinics with limited resources (SAMHSA, 2009). Around 60% of the facilities receive federal, state, county, or local government funds, but the majority of the services are paid for by cash or self-payment. Other resources for payment include private health insurance, Medicare, Medicaid, military insurance, and Access to Recovery vouchers (SAMHSA, 2009). Within these community treatment programs, there has been substantial pressure to adopt evidence-based practices (Roman & Johnson, 0149-7189/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.evalprogplan.2011.02.001
2002). In fact, many funding entities have made financial support dependent upon the implementation of evidence-based practices. The policy environment, the types of organizations and the treatment workforce all impact each agency’s ability to implement evidence-based practices (EBPs) and respond to the local and national agenda and demands of funders. For example, low pay and high job stress lead to increased rates of turnover (Knudsen, Johnson, & Roman, 2003), which also impacts the ability to train and retain qualified staff needed to implement evidence-based practices (McCarty, McConnell, & Schmidt, 2010). Further, when looking at mental health programs, the characteristics and context of the mental health agency such as affiliation with the public versus private sector (type), organizational support, implementation climate, and provider attitudes also affect which services or interventions are offered (Aarons, Sommerfeld, & Walrath-Greene, 2010). Currently, two policy changes have emerged that will likely change the financing of and service delivery for clients with substance use disorders. First, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (PL 110-343) which was enacted in 2008 has increased coverage for substance use disorders in health plans and through Medicaid coverage. In addition, the Patient Protection and Affordable Care Act (ACA) will likely increase access to services due to the requirement for coverage. These changes will shift financing from grants and contracts for specialty services to Medicaid and insurance coverage. To date, Medicaid and insurance plans have required providers with licensure and/or certification, as well as the use of empirically supported practice guidelines and specific standards of care. Substance abuse treatment providers will need to prepare for this transition in financing by supporting the professional development of their treatment workforce and increasing their use of empirically supported services. Thus, the current and future shifts toward a greater reliance on insurance are likely to result in increased pressure on community-based organizations (CBOs) to implement EBPs that are well established and reimbursable. There is, however, a notable disconnect between the real world of the community-based treatment provider and full scale implementation of the EBPs now promoted by federal and state governments. For example, with respect to residential programs, it is hard to overstate the historic influence of 12-Step Programs. For many decades, the 12-Step model has been the guiding approach in the field of substance abuse treatment, and most residential programs followed this approach. Community-based residential programs are often staffed by paraprofessionals, many of whom are in recovery themselves. Program staff have typically spent
354
Editorial / Evaluation and Program Planning 34 (2011) 353–355
many years as active participants in AA, NA or other 12-Step fellowship groups, and thus are strong advocates for the AA principles. They often have little formal training in EBPs, and may be unreceptive to approaches that do not reflect their own path to recovery. Further, low salaries provided by treatment programs result in staffing patterns with few professionals with advanced degrees such as social workers, psychologists or rehabilitation counselors. On the other hand, these same programs also benefit from staff with a strong commitment to addiction treatment and recovery. Further, in terms of capacity, many addiction treatment CBOs are small, independent organizations with little access to hospitals, or other larger health care or research institutions with the organizational resources available to rapidly implement new treatment practices. Hence, in order to understand facilitators and barriers to successful EBP implementation in CBOs, it is critical that research studies are conducted in the real world environment of addictions services. Most studies to date have focused on EBP implementation as part of a clinical trials study and organizations participating in such clinical trials are often affiliated with research institutions and not always representative of the large range of CBOs providing addiction treatment in this country. 2. What is the specific focus of this special issue and what is the specific contribution of each of the articles? Currently, there is an emerging body of research identifying factors that facilitate and/or impede the implementation of EBPs by CBOs. There is however, a dearth of research regarding successful real world clinical, procedural or organizational and systems strategies that can be employed by policy makers, state officials, and program administrators and staff to accelerate adoption of new practices. Hence, this special issue and the articles selected describe key barriers that need to be overcome in order to increase EBP implementation and provide specific recommendations for, and examples of, how program planners, policy makers, and service providers can accelerate successful and sustained EBP implementation processes. The six articles for this special issue were selected due to the currency of their research focus and their comprehensive representation of program and policy debate regarding the future for EBPs in addiction treatment practices. Hence, these papers include: 1. A recognition that there is significant variation in attitudes about EBPs of addiction treatment providers asked to implement these practices, and efforts are needed to identify characteristics and experiences contributing to these attitudes. 2. A recognition that state and local governments need to take a more active role in overseeing and facilitating effective and efficient community-based service delivery in the addiction treatment field. 3. A recognition that a dichotomy in the field persists between traditional 12-Step oriented staff who have a strong commitment to working with addicted individuals but who may lack education and training and their peers who are more professionally trained but who may not select to work in this field due to the high stress, low pay and difficult work environment. 4. A recognition that EBPs in addiction treatment are not only social/behavioral interventions but increasingly include medication-assisted treatments such as buprenorphine, naltrexone, and other medical interventions. In addition, we selected studies which focused on highly different samples. Three articles include nationally representative samples of either directors, administrators or clinical staff from
addiction treatment organizations (Knudsen et al., this issue, Amodeo et al., this issue, and Lundgren et al., this issue). A fourth manuscript presents results from interviews with a complete national sample of all 51 state level policy makers (Rieckmann et al., this issue). Our fifth effort is a case study of a county-level collaboration initiative to promote rapid EBP implementation (Ford et al., this issue), and the final paper describes one agency’s experiences with EBP implementation (Haynes et al., this issue). Also, these papers reflect a range of methods; two quantitative papers use multivariate regression methods, two are qualitative research efforts with large samples (N = 172 and N = 51) and two are case studies. Whereas most of the papers are written by researchers, two of the papers also represent practitioner experiences with either the implementation of a specific EBP or the implementation of a collaborative local-level system to promote the use of EBPs by CBOs. The papers were organized by the scope of their research effort. The first two papers are the broadest in range, with the remaining papers becoming increasingly narrower in focus. Specifically, the first paper describes attitudes about the usefulness of sciencebased addiction treatment in a national sample of CBO directors (n = 296) and front line staff (n = 518) (Lundgren et al.). The second paper describes for 51 states, the variance in existing state-level policies developed to promote CBO implementation of EBPs (Rieckmann et al.). The third paper, using a national representative sample of CBO administrators (N = 250), compares the importance of administrator attitudes versus organizational linkages to medical institutions as factors facilitating implementation of a specific EBP: Medication-Assisted Treatment (MAT) (Knudsen et al.). The fourth paper, a national sample of 172 clinical staff, compares four specific EBPs and differing staff experiences and types of barriers experienced when implementing each of the specific EBPs (Amodeo et al.). The fifth paper is a case study of a county collaborative effort organized to promote rapid implementation of EBPs by community providers. The local learning collaborative used the rapid cycle change model as adapted for the NIAtx initiative (www.niatx.net) to aid service providers in implementing various targeted EBPs (Ford et al.). The final paper is an organizational case study of the experiences of one agency implementing one specific EBP: HIV rapid testing and counseling (Haynes et al.). 3. Summary policy and program implications The papers presented here reflect the next steps in the research on implementation of evidence-based practices in the addiction treatment field. An underlying theme is the importance of both organizational resources and a supportive government policy environment facilitating implementation of EBPs in CBOs. Specifically, one of the national studies identified that having access to medical personnel and having public insurance pay for addiction treatment were key factors in whether or not MATs were implemented by CBOs (Knudson et al.). In an article examining state-level policy supporting EBP implementation, Rieckmann et al. identified significant variation in states’ level of supportiveness and resources for implementation of EBPs in community-based treatment settings. Another national study of staff attitudes found that staff with higher levels of education (professional degrees) had more positive attitudes about EBPs (Lundgren et al.). Also, staff working in organizations with greater access to technology resources, and with an affiliation with research institutions, also had more positive opinions about the usefulness of science-based treatment. A qualitative study (Amodeo et al.) indicated that clinical staff identified key barriers for implementing specific EBPs: organizational resources including space, staff shortage and community resources such as transportation or housing. The Ford et al., case
Editorial / Evaluation and Program Planning 34 (2011) 353–355
study suggests that government efforts to support EBP implementation by community providers may be more successful if starting with the implementation of less rigorous evidence-based practices. This article, as well as the Amodeo et al. article, both found specific staffing barriers and the organizational capacity of the CBO as critical when seeking to implement Motivational Interviewing, one of the most prevalent EBPs. To date, the majority of current policy efforts aimed at improving EBP implementation have focused on work force development and training. Even though it is critical that more professionally trained clinicians enter the addiction treatment field, and that the existing workforce receive training and become licensed counselors, additional implications of the studies presented in this special issue include the need to promote new government policies and programs that: (1) link addiction treatment CBOs with research and medical institutions; (2) promote collaboration between existing staff and new professionally trained staff; (3) reduce variations between states with respect to financing and program support for EBP implementation at the community level, and that; (4) if governments continue to mandate the implementation of EBPs, these mandates need to acknowledge the range of organizational capacity of CBOs. Overall, government stakeholders and funding entities may employ specific policy levers including regulations, critical technical assistance and training support, and resource allocation that bolsters the ability of each CBO seeking to increase their use of EBPs. Acknowledgements The editorial assistance of Steven Garte-Wolf and Ivy Krull is gratefully acknowledged. We also thank the reviewers for all their work. References Aarons, G. A., Sommerfeld, D. H., & Walrath-Greene, C. M. (2010). Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice. Implementation Science 4(83), doi:10.1186/1748-5908-4-83. Amass, L., Ling, W., Freese, T., Reiber, C., Annon, J., Cohen, A., et al. (2004). Bringing buprenorphine–naloxone detoxification to community treatment providers: The NIDA clinical trials network field experience. The American Journal of Addictions, 13(1), 542–566.
355
Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., et al. (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and Alcohol Dependence, 81(3), 301–312. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Institute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academies Press. Knudsen, H. K., Johnson, J. A., & Roman, P. M. (2003). Retaining counseling staff at substance abuse treatment centers: Effects of management practices. Journal of Substance Abuse Treatment, 24(2), 129–135. Ling, W., Amass, L., Shoptaw, S., Annon, J. J., Hillhouse, M., Babcock, D., et al. (2005). A multi-center randomized trial of buprenorphine–naloxone versus clonidine for opioid detoxification: Findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction, 100(8), 1090–1100. McCarty, D., McConnell, K. J., & Schmidt, L. A. (2010). Priorities for policy research on treatments for alcohol and drug use disorders. Journal of Substance Abuse Treatment, 39(2), 87–95. Peirce, J. M., Petry, N. M., Stitzer, M. L., Blaine, J., Kellogg, S., Satterfield, F., et al. (2006). Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment. Archives of General Psychiatry, 63(2), 201–208. Petry, N. M., Peirce, J. M., Stitzer, M. L., Blaine, J., Roll, J. M., Cohen, A., et al. (2005). Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs. Archives of General Psychiatry, 62(10), 1148– 1156. Roman, P. M., & Johnson, J. A. (2002). Adoption and implementation of new technologies in substance abuse treatment. Journal of Substance Abuse Treatment, 22, 211– 218. Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National findings. Rockville, MD: Office of Applied Studies NSDUH Series H-36 HHS Publication No SMA 09-4434.
Lena M. Lundgren* Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States Traci Rieckmann Department of Public Health & Preventive Medicine, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, United States *Corresponding author. Tel.: +1 617 353 1634; fax: +1 617 353 5612 E-mail addresses: [email protected] (T. Rieckmann) [email protected] (L.M. Lundgren). Available online 21 March 2011
Contents lists available at ScienceDirect
Evaluation and Program Planning journal homepage: www.elsevier.com/locate/evalprogplan
Editorial
Research on implementing evidence-based practices in community-based addiction treatment programs: Policy and program implications
1. Why focus a special issue on the implementation of evidence-based addiction treatment practiced by community-based organizations? 1.1. The use of evidence-based practices (EBPs) for the identification and treatment of substance use disorders is increasingly mandated by government institutions and funding entities The Institute of Medicine (2001, 2006) recommends increased use of treatment supported by empirical evidence of both efficacy and effectiveness. Both federal including Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers for Disease Control (CDC) and state government funders of treatment services now have specific funding requirements mandating that organizations applying for service grants implement addiction treatment with an evidence base. Simultaneously, clinical trials increasingly document empirically valid, efficacious behavioral and pharmacological therapies for the treatment of alcohol and drug use disorders. Trials conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN) moreover, suggest that these treatments can be effective even in the chaos of realworld clinical environments and heterogeneous clinical populations (Amass et al., 2004; Carroll et al., 2006; Ling et al., 2005; Peirce et al., 2006; Petry et al., 2005). Thus, there are an increasing number of empirically supported practices appropriate for a range of clients and across substance abuse treatment settings. 1.2. Community-based organizations (CBOs) are the key implementers of government funded EBPs Treatment providers for substance use disorders include a varied group of non-profit, for-profit and governmental entities located in single-site and multisite community settings, county health departments, tribal communities, and also in some hospitals and veterans administration clinics. The largest proportion of providers includes approximately 13,000 specialty addiction treatment facilities that are small, independent outpatient and residential clinics with limited resources (SAMHSA, 2009). Around 60% of the facilities receive federal, state, county, or local government funds, but the majority of the services are paid for by cash or self-payment. Other resources for payment include private health insurance, Medicare, Medicaid, military insurance, and Access to Recovery vouchers (SAMHSA, 2009). Within these community treatment programs, there has been substantial pressure to adopt evidence-based practices (Roman & Johnson, 0149-7189/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.evalprogplan.2011.02.001
2002). In fact, many funding entities have made financial support dependent upon the implementation of evidence-based practices. The policy environment, the types of organizations and the treatment workforce all impact each agency’s ability to implement evidence-based practices (EBPs) and respond to the local and national agenda and demands of funders. For example, low pay and high job stress lead to increased rates of turnover (Knudsen, Johnson, & Roman, 2003), which also impacts the ability to train and retain qualified staff needed to implement evidence-based practices (McCarty, McConnell, & Schmidt, 2010). Further, when looking at mental health programs, the characteristics and context of the mental health agency such as affiliation with the public versus private sector (type), organizational support, implementation climate, and provider attitudes also affect which services or interventions are offered (Aarons, Sommerfeld, & Walrath-Greene, 2010). Currently, two policy changes have emerged that will likely change the financing of and service delivery for clients with substance use disorders. First, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (PL 110-343) which was enacted in 2008 has increased coverage for substance use disorders in health plans and through Medicaid coverage. In addition, the Patient Protection and Affordable Care Act (ACA) will likely increase access to services due to the requirement for coverage. These changes will shift financing from grants and contracts for specialty services to Medicaid and insurance coverage. To date, Medicaid and insurance plans have required providers with licensure and/or certification, as well as the use of empirically supported practice guidelines and specific standards of care. Substance abuse treatment providers will need to prepare for this transition in financing by supporting the professional development of their treatment workforce and increasing their use of empirically supported services. Thus, the current and future shifts toward a greater reliance on insurance are likely to result in increased pressure on community-based organizations (CBOs) to implement EBPs that are well established and reimbursable. There is, however, a notable disconnect between the real world of the community-based treatment provider and full scale implementation of the EBPs now promoted by federal and state governments. For example, with respect to residential programs, it is hard to overstate the historic influence of 12-Step Programs. For many decades, the 12-Step model has been the guiding approach in the field of substance abuse treatment, and most residential programs followed this approach. Community-based residential programs are often staffed by paraprofessionals, many of whom are in recovery themselves. Program staff have typically spent
354
Editorial / Evaluation and Program Planning 34 (2011) 353–355
many years as active participants in AA, NA or other 12-Step fellowship groups, and thus are strong advocates for the AA principles. They often have little formal training in EBPs, and may be unreceptive to approaches that do not reflect their own path to recovery. Further, low salaries provided by treatment programs result in staffing patterns with few professionals with advanced degrees such as social workers, psychologists or rehabilitation counselors. On the other hand, these same programs also benefit from staff with a strong commitment to addiction treatment and recovery. Further, in terms of capacity, many addiction treatment CBOs are small, independent organizations with little access to hospitals, or other larger health care or research institutions with the organizational resources available to rapidly implement new treatment practices. Hence, in order to understand facilitators and barriers to successful EBP implementation in CBOs, it is critical that research studies are conducted in the real world environment of addictions services. Most studies to date have focused on EBP implementation as part of a clinical trials study and organizations participating in such clinical trials are often affiliated with research institutions and not always representative of the large range of CBOs providing addiction treatment in this country. 2. What is the specific focus of this special issue and what is the specific contribution of each of the articles? Currently, there is an emerging body of research identifying factors that facilitate and/or impede the implementation of EBPs by CBOs. There is however, a dearth of research regarding successful real world clinical, procedural or organizational and systems strategies that can be employed by policy makers, state officials, and program administrators and staff to accelerate adoption of new practices. Hence, this special issue and the articles selected describe key barriers that need to be overcome in order to increase EBP implementation and provide specific recommendations for, and examples of, how program planners, policy makers, and service providers can accelerate successful and sustained EBP implementation processes. The six articles for this special issue were selected due to the currency of their research focus and their comprehensive representation of program and policy debate regarding the future for EBPs in addiction treatment practices. Hence, these papers include: 1. A recognition that there is significant variation in attitudes about EBPs of addiction treatment providers asked to implement these practices, and efforts are needed to identify characteristics and experiences contributing to these attitudes. 2. A recognition that state and local governments need to take a more active role in overseeing and facilitating effective and efficient community-based service delivery in the addiction treatment field. 3. A recognition that a dichotomy in the field persists between traditional 12-Step oriented staff who have a strong commitment to working with addicted individuals but who may lack education and training and their peers who are more professionally trained but who may not select to work in this field due to the high stress, low pay and difficult work environment. 4. A recognition that EBPs in addiction treatment are not only social/behavioral interventions but increasingly include medication-assisted treatments such as buprenorphine, naltrexone, and other medical interventions. In addition, we selected studies which focused on highly different samples. Three articles include nationally representative samples of either directors, administrators or clinical staff from
addiction treatment organizations (Knudsen et al., this issue, Amodeo et al., this issue, and Lundgren et al., this issue). A fourth manuscript presents results from interviews with a complete national sample of all 51 state level policy makers (Rieckmann et al., this issue). Our fifth effort is a case study of a county-level collaboration initiative to promote rapid EBP implementation (Ford et al., this issue), and the final paper describes one agency’s experiences with EBP implementation (Haynes et al., this issue). Also, these papers reflect a range of methods; two quantitative papers use multivariate regression methods, two are qualitative research efforts with large samples (N = 172 and N = 51) and two are case studies. Whereas most of the papers are written by researchers, two of the papers also represent practitioner experiences with either the implementation of a specific EBP or the implementation of a collaborative local-level system to promote the use of EBPs by CBOs. The papers were organized by the scope of their research effort. The first two papers are the broadest in range, with the remaining papers becoming increasingly narrower in focus. Specifically, the first paper describes attitudes about the usefulness of sciencebased addiction treatment in a national sample of CBO directors (n = 296) and front line staff (n = 518) (Lundgren et al.). The second paper describes for 51 states, the variance in existing state-level policies developed to promote CBO implementation of EBPs (Rieckmann et al.). The third paper, using a national representative sample of CBO administrators (N = 250), compares the importance of administrator attitudes versus organizational linkages to medical institutions as factors facilitating implementation of a specific EBP: Medication-Assisted Treatment (MAT) (Knudsen et al.). The fourth paper, a national sample of 172 clinical staff, compares four specific EBPs and differing staff experiences and types of barriers experienced when implementing each of the specific EBPs (Amodeo et al.). The fifth paper is a case study of a county collaborative effort organized to promote rapid implementation of EBPs by community providers. The local learning collaborative used the rapid cycle change model as adapted for the NIAtx initiative (www.niatx.net) to aid service providers in implementing various targeted EBPs (Ford et al.). The final paper is an organizational case study of the experiences of one agency implementing one specific EBP: HIV rapid testing and counseling (Haynes et al.). 3. Summary policy and program implications The papers presented here reflect the next steps in the research on implementation of evidence-based practices in the addiction treatment field. An underlying theme is the importance of both organizational resources and a supportive government policy environment facilitating implementation of EBPs in CBOs. Specifically, one of the national studies identified that having access to medical personnel and having public insurance pay for addiction treatment were key factors in whether or not MATs were implemented by CBOs (Knudson et al.). In an article examining state-level policy supporting EBP implementation, Rieckmann et al. identified significant variation in states’ level of supportiveness and resources for implementation of EBPs in community-based treatment settings. Another national study of staff attitudes found that staff with higher levels of education (professional degrees) had more positive attitudes about EBPs (Lundgren et al.). Also, staff working in organizations with greater access to technology resources, and with an affiliation with research institutions, also had more positive opinions about the usefulness of science-based treatment. A qualitative study (Amodeo et al.) indicated that clinical staff identified key barriers for implementing specific EBPs: organizational resources including space, staff shortage and community resources such as transportation or housing. The Ford et al., case
Editorial / Evaluation and Program Planning 34 (2011) 353–355
study suggests that government efforts to support EBP implementation by community providers may be more successful if starting with the implementation of less rigorous evidence-based practices. This article, as well as the Amodeo et al. article, both found specific staffing barriers and the organizational capacity of the CBO as critical when seeking to implement Motivational Interviewing, one of the most prevalent EBPs. To date, the majority of current policy efforts aimed at improving EBP implementation have focused on work force development and training. Even though it is critical that more professionally trained clinicians enter the addiction treatment field, and that the existing workforce receive training and become licensed counselors, additional implications of the studies presented in this special issue include the need to promote new government policies and programs that: (1) link addiction treatment CBOs with research and medical institutions; (2) promote collaboration between existing staff and new professionally trained staff; (3) reduce variations between states with respect to financing and program support for EBP implementation at the community level, and that; (4) if governments continue to mandate the implementation of EBPs, these mandates need to acknowledge the range of organizational capacity of CBOs. Overall, government stakeholders and funding entities may employ specific policy levers including regulations, critical technical assistance and training support, and resource allocation that bolsters the ability of each CBO seeking to increase their use of EBPs. Acknowledgements The editorial assistance of Steven Garte-Wolf and Ivy Krull is gratefully acknowledged. We also thank the reviewers for all their work. References Aarons, G. A., Sommerfeld, D. H., & Walrath-Greene, C. M. (2010). Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice. Implementation Science 4(83), doi:10.1186/1748-5908-4-83. Amass, L., Ling, W., Freese, T., Reiber, C., Annon, J., Cohen, A., et al. (2004). Bringing buprenorphine–naloxone detoxification to community treatment providers: The NIDA clinical trials network field experience. The American Journal of Addictions, 13(1), 542–566.
355
Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., et al. (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and Alcohol Dependence, 81(3), 301–312. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Institute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academies Press. Knudsen, H. K., Johnson, J. A., & Roman, P. M. (2003). Retaining counseling staff at substance abuse treatment centers: Effects of management practices. Journal of Substance Abuse Treatment, 24(2), 129–135. Ling, W., Amass, L., Shoptaw, S., Annon, J. J., Hillhouse, M., Babcock, D., et al. (2005). A multi-center randomized trial of buprenorphine–naloxone versus clonidine for opioid detoxification: Findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction, 100(8), 1090–1100. McCarty, D., McConnell, K. J., & Schmidt, L. A. (2010). Priorities for policy research on treatments for alcohol and drug use disorders. Journal of Substance Abuse Treatment, 39(2), 87–95. Peirce, J. M., Petry, N. M., Stitzer, M. L., Blaine, J., Kellogg, S., Satterfield, F., et al. (2006). Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment. Archives of General Psychiatry, 63(2), 201–208. Petry, N. M., Peirce, J. M., Stitzer, M. L., Blaine, J., Roll, J. M., Cohen, A., et al. (2005). Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs. Archives of General Psychiatry, 62(10), 1148– 1156. Roman, P. M., & Johnson, J. A. (2002). Adoption and implementation of new technologies in substance abuse treatment. Journal of Substance Abuse Treatment, 22, 211– 218. Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National findings. Rockville, MD: Office of Applied Studies NSDUH Series H-36 HHS Publication No SMA 09-4434.
Lena M. Lundgren* Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States Traci Rieckmann Department of Public Health & Preventive Medicine, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, United States *Corresponding author. Tel.: +1 617 353 1634; fax: +1 617 353 5612 E-mail addresses: [email protected] (T. Rieckmann) [email protected] (L.M. Lundgren). Available online 21 March 2011