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SAMHSA News - Volume XI, Number 4, 2003

North Carolina Improves Evidence-Based Practices

Practice Improvement Collaboratives--Forging Partnerships logoLike most states, North Carolina has limited financial resources. Things are especially tough for those working to reduce alcohol and substance abuse in the state. Substance abuse shares a state government division with mental health and developmental disabilities, but its funding is much more limited than the other two sections. Fortunately, the state has found a way to overcome that problem.

"The way to get more out of your dollar is to improve your practices," explained Flo A. Stein, M.P.H., Chief of Community Policy and Management at the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. "In fact, our legislature has taken the lead in calling for a reformed system that pays for practices that there's evidence to support. As a result, we've been actively encouraging practice change."

Much of that support has come from SAMHSA's Center for Substance Abuse Treatment (CSAT). Since 2001, the state has been using funding from CSAT's Practice Improvement Collaboratives program (See SAMHSA News, Volume IX, Number 3) to help bridge the gap between research and practice. And now one community in North Carolina is taking the next step to integrate evidence-based practices even further, with a new CSAT grant called Strengthening Treatment Access and Retention, as well as other SAMHSA-funded efforts.

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Improving Practices

According to Ms. Stein, the umbrella under which all of the state's practice improvement activities for addiction take place is the Practice Improvement Collaboratives grant. The 3-year project is designed to help grantees set an agenda for improving addiction services and adopting evidence-based treatment practices.

Bringing researchers and practitioners together plays a key role in achieving these goals, explained project officer Susanne R. Rohrer, R.N., a public health analyst in CSAT's Division of Services Improvement. "The goal is to bring researchers and practitioners together to lay the foundation for collaborative efforts," she said. "It's a feedback loop: The researchers encourage the practitioners to adopt best practices, and then the practitioners provide feedback to the researchers."

The way to get more out of your dollar is to improve your practices.

That's just what's happening in North Carolina, where the grantee is a nonprofit organization called the Governor's Institute on Alcohol and Substance Abuse, Inc., in Research Triangle Park. According to principal investigator Wei Li Fang, Ph.D., Director for Research and Development at the Institute, the project ensures that practitioners are not only using best practices, but also using them correctly.

"We've had severe budget cuts in the last few years, so there's not as much money going to continuing education," Dr. Fang explained. "There are also problems with burn-out and staff turnover. What we're trying to do is to identify practitioners' needs and provide them with the necessary training, support, and encouragement to adopt best practices."

The project has four specific objectives:

  • Developing and implementing a statewide agenda to improve practices. Dr. Fang and her colleagues have worked with substance abuse directors and clinicians around the state to come up with a training agenda. Training priorities identified so far are relapse prevention, co-occurring substance abuse and mental health disorders, and motivational interviewing. Motivational interviewing is a counseling style designed to help clients change their behavior by exploring and resolving their ambivalence about that behavior.

    Once trained, practitioners are expected to spread the word to others. After providing scholarships to an intensive training program on co-occurring disorders, for example, the Practice Improvement Collaboratives project expects the 17 participating practitioners to make five presentations each to other clinicians and members of the community in the next year.

  • Expanding and strengthening the integration of a statewide network of researchers, substance abuse treatment providers, educators, policymakers, advocates, consumers, and others. The project has created five regional consortia to help meet its goals.
  • Conducting knowledge adoption studies. After the project trains a site in a particular skill, it will go back and study how well the site's practitioners have put that training to use. If they still have questions or have drifted away from the standard, the project will provide additional training or technical assistance.
  • Conducting evaluations. The project evaluates every training and technical assistance event it conducts.

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Strengthening Access and Retention

Now, one North Carolina community is taking the idea of practice improvement one step farther. In October, CSAT awarded a Strengthening Treatment Access and Retention grant to the state's Pitt County Mental Health, Developmental Disabilities, and Substance Abuse Center in Greenville. Building on the Practice Improvement Collaboratives' work, this project will apply lessons learned in the field of quality improvement to the provision of substance abuse treatment.

"We view this grant as the next step in the process begun by the Practice Improvement Collaboratives grant program," explained Mady Chalk, Ph.D., Director of CSAT's Division of Services Improvement. "This grant is much more focused, in this case on evidence-based practices having to do with improving access to services and retention in treatment. I'm hoping that over the next few years, the program will move on to other evidence-based practices."

In Pitt County, the 3-year project will work to ensure that alcohol and substance abusers age 17 to 25 who live in this largely rural area in the eastern part of the state get the treatment they need. To improve access to substance abuse treatment, the project plans to develop what it calls "process improvement teams." These teams will receive training and technical assistance to help them improve various aspects of treatment, such as enhancing the referral process or finding ways to reduce waiting times.

To improve retention, the project plans to train treatment providers in motivational enhancement therapy, an approach that helps clients determine their own treatment goals and protocols. "It's a best practice," explained Glenn Buck, M.S.W., Substance Abuse Program Director for the Pitt County Mental Health, Developmental Disabilities, and Substance Abuse Center in Greenville. "We're hoping that a well-trained staff using an evidence-based approach will lead to better retention."

Bringing researchers and practitioners together plays a key role in achieving these goals.

Because the grant is administered in collaboration with the Robert Wood Johnson Foundation's Paths to Recovery program, Pitt County and other CSAT grantees will participate in a "learning community" with the foundation's grantees. As part of the community, they will attend two learning community meetings a year, participate in teleconferences and Web-based educational events, and receive on-site technical assistance from a learning community expert once a year.

"The learning community will serve as a resource to the field on quality improvement," said project officer Frances Cotter, M.P.H., a team leader in CSAT's Division of Services Improvement. "Educational events, case studies, and process improvement strategies will be available from SAMHSA in the near future."

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Setting an Agenda for Improvement

That's not all Pitt County is doing to improve substance abuse services. A nonprofit organization called the Eastern Carolina Council on Substance Abuse—an offshoot of the county's substance abuse center—is working to get the entire community involved in reducing substance abuse.

Strengthening Treatment Access and Retention logoAs part of SAMHSA's National Alcohol and Drug Addiction Recovery Month in September, the council sponsored a community forum to discuss the county's substance abuse problem, develop a community plan for addressing the problem, and create a coalition that can put the plan into action. The SAMHSA-funded event brought together substance abuse counselors, the city manager, the police chief, the county sheriff, physicians, attorneys, representatives from the public school system and local university, people in recovery, and others.

"The coalition will provide a focus for improving our area's services," said Council President David Ames, M.D., Medical Director of the Pitt County Mental Health, Developmental Disabilities, and Substance Abuse Center in Greenville. "What I see the coalition doing is getting to work on all the things that SAMHSA targets, such as promoting prevention, improving access, and addressing stigma."

For Dr. Fang of the Governor's Institute, the coalition's work is just another of the multiple efforts that add up to a more effective whole. "We're all working toward the same goal," she said. "We're all working to improve addiction services for clients." End of Article

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    SAMHSA News - Volume XI, Number 4, 2003

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