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Training and exposure to evidence-based practices: Changing attitudes among the addiction treatment workforce J. Training and exposure to evidence-based practices: Changing attitudes among the addiction treatment workforce J. Aaron Johnson, Ph. D. Meredith Huey Dye, MA The University of Georgia With research grant support from the National Institute on Drug Abuse (R 01 DA 14976 and R 01 DA 14482) The University of Georgia

Background • Significant efforts devoted to moving evidence -based treatment from research settings into Background • Significant efforts devoted to moving evidence -based treatment from research settings into community-based treatment programs – Development of treatment techniques, including medications and psycho-social approaches – Testing and disseminating these EBPs – NIDA CTN, SAMHSA ATTC’s, RWJF initiatives – Our research – devoted to identifying barriers as well as factors facilitating adoption/implementation The University of Georgia

Background (cont. ) • Research in other organizations - attitudes of members critical to Background (cont. ) • Research in other organizations - attitudes of members critical to successful implementation of new innovation • Previous research on innovation adoption in addiction treatment: – “Exposure” to buprenorphine through specific training or use by program led to more positive attitudes among counselors (Knudsen et al. , 2005) – Counselor computer access relatively high, use of internet to learn about new techniques low = possible “technology gap” in diffusion of EBPs (Ducharme et al, 2005) The University of Georgia

Research Questions • What is the impact of training and exposure to EBPs on Research Questions • What is the impact of training and exposure to EBPs on counselor attitudes toward pharmaceutical and behavioral interventions? • What are the implications of these findings on current efforts to disseminate EBPs into community-based treatment programs? The University of Georgia

The National Treatment Center Study • Monitoring the organization, management, delivery, and content of The National Treatment Center Study • Monitoring the organization, management, delivery, and content of addiction treatment in the U. S. • Includes Nationally Representative Samples of: – Privately-funded treatment programs (N=401) – Publicly-funded treatment programs (N=362) • Programs must offer a level of care for addiction treatment at least equivalent to structured outpatient as defined by ASAM – Excludes: methadone maintenance-only facilities, clinicians in private practice, DUI-only programs, halfway houses The University of Georgia

NTCS Instrument Design • Multiple data collection methods used: – Detailed on-site interviews with NTCS Instrument Design • Multiple data collection methods used: – Detailed on-site interviews with program administrator § Focus - organizational characteristics, services offered, use of innovations – Mail questionnaire from program administrator § Focus - leadership and management practices – Mail questionnaire from counselors § Focus - services received by clients, attitudes toward innovations – Brief telephone follow-ups w/ program administrator at six month intervals § Focus - major program changes • Today’s presentation: data from counselor questionnaires collected between November 2004 and July 2006 (N=880) The University of Georgia

Counselor Demographics Female 64. 5% Race/Ethnicity Caucasian 63. 6% African American 25. 1% Hispanic Counselor Demographics Female 64. 5% Race/Ethnicity Caucasian 63. 6% African American 25. 1% Hispanic 6. 7% Master’s degree or higher 41. 3% In Recovery 46. 1% Mean age (in years) 45. 5 Mean yrs in field 9. 4 Mean yrs at program 5. 4 The University of Georgia

Counselor Training and Access to Computers w/ Internet Formal “in-house” training (hrs) 29. 0 Counselor Training and Access to Computers w/ Internet Formal “in-house” training (hrs) 29. 0 Cont. Ed. Outside Program (hrs) 32. 1 Computer/Internet Access No Computer/Internet 26. 5% Shared Computer/Internet 19. 4% Own Computer/Internet 54. 1% The University of Georgia

Prevalence of “Exposure” to EBPs Buprenorphine Acamprosate (October 2002) (July 2004) MET Used in Prevalence of “Exposure” to EBPs Buprenorphine Acamprosate (October 2002) (July 2004) MET Used in Program (1=yes) 15. 3% 9. 8% 80. 1% 34. 4% Specific Training (1 -7) 2. 04 1. 58 3. 95 2. 39 How Acceptable (1 -7) 4. 28 4. 07 5. 97 4. 76 The University of Georgia Vouchers

Counselor “Exposure” and Attitudes toward EBPs Buprenorphine Used in Program Acamprosate MET Vouchers 5. Counselor “Exposure” and Attitudes toward EBPs Buprenorphine Used in Program Acamprosate MET Vouchers 5. 88** 5. 76** 6. 34** 5. 54** 3. 76 5. 45 4. 74 Not Used 4. 14 in Program • In each case counselors report significantly more positive attitudes toward EBPs when exposed to those practices. The University of Georgia

Computer Access & Attitudes toward EBPs Buprenorphine Acamprosate MET Vouchers No Computer 4. 31 Computer Access & Attitudes toward EBPs Buprenorphine Acamprosate MET Vouchers No Computer 4. 31 4. 17 6. 04 4. 93 Shared Computer 4. 17 3. 80 5. 99 4. 84 Own Computer 4. 96** 4. 69** 6. 38* 5. 17 • Counselors report significantly more positive attitudes toward EBPs when provided with their own computer/internet access The University of Georgia

Regression Models Buprenorphine Acamprosate MET Vouchers - - + Gender (1=male) + + + Regression Models Buprenorphine Acamprosate MET Vouchers - - + Gender (1=male) + + + Age Educ (Masters +) In Recovery + Cont. Ed. Hrs Specific Training Used in Program + + Comp. /w internet The University of Georgia + +

Discussion • Regardless of whether pharmacological or psychosocial, “Exposure” to specific EBPs has significant Discussion • Regardless of whether pharmacological or psychosocial, “Exposure” to specific EBPs has significant impact on counselors’ attitudes toward those practices • Only attitudes toward psychosocial therapies impacted by counselor education • Having access to computer w/ internet has limited impact on attitudes • Males have significantly more negative attitudes toward use of MET and vouchers than females? The University of Georgia

Conclusion/Implications • On-site training and testing of EBPs will likely have significant positive impact Conclusion/Implications • On-site training and testing of EBPs will likely have significant positive impact on counselor attitudes • Dissemination of information via computer (CD-ROM, website, etc. ) will likely have little impact (limited access, limited time) • For Psychosocial EBPs, might consider tailoring training to specific genders The University of Georgia

For more information… • Visit us at www. uga. edu/ntcs • Data summaries • For more information… • Visit us at www. uga. edu/ntcs • Data summaries • Recent and upcoming presentations • Publication abstracts The University of Georgia