Saturday May 17, 2013 Cheryl A. Branch, MS, Community Trainer, UCLA-ISAP PSATTC

Knowledge Application Programs (KAPS)

in Faith-based Reentry Community Substance Abuse Treatment Settings

Saturday May 17, 2013

Cheryl A. Branch, MS, Community Trainer, UCLA-ISAP PSATTC 2012-2013 Faith-based Education &

Training Series

Faith-based Organizations The next generation of prison ministries is

here. In response to the call for national action to reduce alcohol & drug abuse health disparities LAM congregations developed a plan to promote EBPs in small to mid size AOD treatment and counseling providers in South LA and partnered with UCLA PSATTC. Knowledge Application Programs (KAPs) are an

opportunity for FBOs to participate and practice EBPs

Bridging The Gap

In California, publicly funded addiction services are impacted by increasingly a need to understand Prisoner Reentry

Current offense violent/serious/

sex-related

Current offense is not violent/serious/

sex-related, but prior offense(s) was

Neither current offense nor prior offense was violent/serious/sex-

related

State prison

Parole

PRCS (Post-release Community

Supervision)

County Sentence

(Local Prison Term)

(1170(h)

Jail only

Jail + Mandatory Supervision

Mandatory Supervision

only

Realignment Sentencing Created New Populations in California

The Landscape for Addressing the Alcohol and Drug Treatment and Health Care Needs of the Reentry Population Has Changed

• Recession of 2008 had a major impact on counties’ health care safety nets

????????So, how do you decide what to do?

So, how do you decide what to do?

Prison and Parole Tend to Have a Number of Chronic Health Conditions

Physical Health (Lifetime)

State Local

Prison Parole PRCSLocal

Custody

Asthma 14% 19% 11%* 13%

Diabetes 4% 2% 5% 6%

Hypertension 19% 20% 16% 16%

Hepatitis 14% 14% 13% 10%

Tuberculosis 14% 8% 7% 11%

HIV 1% 1% 0% 1%

Dental Problems Since Admission

55%^ 48%^ 39%* 41%

Any physical disability

43%^ 40%^ 34% 33%

^Indicates differences between Prison vs. Parole statistically significant at .05 level.

PRCS and Local Custody Tend to Be Physically Healthier Than Prison/Parole Populations

Physical Health (Lifetime)

State Local

Prison Parole PRCSLocal

Custody

Asthma 14% 19%* 11%* 13%

Diabetes 4% 2% 5% 6%

Hypertension 19% 20% 16% 16%

Hepatitis 14% 14% 13% 10%

Tuberculosis 14% 8% 7% 11%

HIV 1% 1% 0% 1%

Dental Problems Since Admission

55% 48%* 39%* 41%

Any physical disability

43% 40% 34% 33%

*Indicates differences between Parole vs. PRCS statistically significant. State vs. Local also significant.

There Is More Serious Mental Illness Among the Parole Population

MH Disorder/Substance Abuse

State Local

Prison Parole PRCSLocal

Custody

Ever Diagnosed with MH Disorder

30%^ 40%^ 20% 18%

. . . with Manic 11%^ 29%^ 5% 4%

. . . with Schizophrenia

8%^ 18%^ 1% 1%

. . . with Depression 22%^ 31%^ 13% 12%

. . . with Anxiety 9%^ 17%^ 7% 3%

Drug Abuse 53% 57% 64% 61%

Drug Dependence 40% 46% 53% 41%^Indicates differences between Prison vs. Parole statistically significant at .05 level.

County Clients Tend to Have More Treatment Needs with Respect to Drug Abuse/Dependence

MH Disorder/Substance Abuse

State Local

Prison Parole PRCSLocal

Custody

Ever Diagnosed with MH Disorder

30% 40%* 20%* 18%

. . . with Manic 11% 29%* 5%* 4%

. . . with Schizophrenia

8% 18%* 1%* 1%

. . . with Depression 22% 31%* 13%* 12%

. . . with Anxiety 9% 17%* 7%* 3%

Drug Abuse 53% 57% 64% 61%

Drug Dependence 40% 46% 53% 41%

*Indicates differences between Parole vs. PRCS statistically significant. All State vs. Local differences also significant.

Understanding the ‘New Normal’ in FB Reentry Community Treatment Settings

In the new ones, the infrastructure will have to include internal systems that: support performance monitoring systems assess impact of fidelity vs. adaptation on

outcomes of treatment provider use of both KAP and non-KAP products, and provide

input to the scientific community regarding new research priorities and service gaps for the substance abuse treatment field. 

Solutions

Knowledge Application Program (KAP)

SAMHSA's Knowledge Application Program (KAP) provides substance abuse treatment professionals (i.e. Faith-based Counselors, Prevention Specialists) with publications, online education, and other resources that contain information on best treatment practices.

www.kap.samhsa.gov You can access these resources online and no- cost! Some materials available for non-English speaking

populations

Knowledge Application Programs (KAPS)

The KAP approach integrates science-based health communications, social marketing, and knowledge transfer activities into an evidence-based dissemination practice which includes: Developing a culturally competent Knowledge Transfer Model

based on proven dissemination principles and practices Developing products and processes to present research

findings, best practices, and promising practices to the field

Using partnerships with organizations as an effective service practice and as a strategy in creating effective distribution channels.

LAM is practicing the KAP approach to community education and professional development for faith-based clergy and laity addiction counselors

SAMHSA Center for Mental Health Services - Knowledge Application

Program (CMHS/KAP)

- Dedicated to supporting product development and dissemination through providing innovative use of media and marketing that will advance the adoption of evidenced -based and promising practices in servicing persons with mental illnesses and/or substance use disorders.

Different Types of KAPs

SAMHSA Protocol (TIP) Series SAMHSA Technical Assistance

Publications (TAPs) Periodicals ATTC’s Local quarterly LAC SAPC training Local ONTRACK Program Resources

(state)

How Are Evidence-Based Practices Documented?

Gold Standard Multiple randomized clinical trials

Second Tier Consensus reviews of available science

Third Tier Expert opinion based on clinical observation

Process Benchmarking In Action

• How do they do it?

• The identification

of “best practices?”

In Plain Terms, Please

It’s about: Critical Thinking, Standardized Approaches Collective Work Teams Lots of Reading and Writing Disciplined Procedures & Systems Follow the Plan—all the time Balancing idea each client is different and the same

It is not your program’s daily schedule

Evidence-Based Practices for Alcohol Treatment

Brief intervention Social skills training Motivational enhancement Community reinforcement Behavioral contracting

Scientifically-Based Approaches to Addiction Treatment

Cognitive–behavioral interventions Community reinforcement Motivational enhancement therapy 12-step facilitation Contingency management Pharmacological therapies Systems treatment

What Does All This Mean?

We have an opportunity to improve treatment services.

There are effective and cost-efficient treatments available for alcohol and drug dependence.

Need solutions for Changing Environment in local agencies (i.e. SAPC, DMH, DPSS, Probation, LAUSD, Courts)

In SummaryIn Summary

Summary

Defined evidence-based practice Considered barriers to adoption Noted counselor endorsements and

recommendations for manuals Described an evidence-based practice model Discussed how manuals fit within that model

Sources of Evidence-Based Information on the Web

Managed Care samhsa.gov/mcnew

Dual Disorders dartmouth.edu/~psychrc

Stimulant Treatment matrixcenter.com

Drug Abuse Treatment ibr.tcu.edu

Sources of Evidence-Based Information on the Web

Drug Abuse Treatment nida.nih.gov

Alcoholism Treatment niaaa.nih.gov

Addiction Medicine asam.org

HIV/AIDS cdc.gov/idu/

Sources of Evidence-Based Information on the Web

Prevention unr.edu/westcapt

Technology Transfer nattc.org

Addiction Science utexas.edu/research/asrec http://gainscenter.samhsa.gov/topical_resources/e

bps.asp http://www.nrepp.samhsa.gov/Learnlanding.aspx http://store.samhsa.gov/list/series?

name=Evidence-Based-Practices-KITs

An Evidence-Based Treatment Model for Improving Practice1

Core Components of Comprehensive Services

MedicalMental Health

Vocational

Educational

LegalAIDS / HIV

Risks

Financial

Housing & Transportation

Child Care

Family

Continuing Care

Case Manageme

nt

Urine Monitoring

Self-Help(AA/NA)

Pharmaco-therapy

Group/Individual Counseling

AbstinenceBasedIntake

Assessment

Treatment Plans

CoreTreatment

Elements of a Treatment Process Model

SufficientRetentionSufficientRetention?

PatientFactorsPatientFactors

PsychologicalFunctioning,

Motivation,

& ProblemSeverity

Cognitive and behavioralcomponents with therapeutic impact

Post-treatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations

Detox

OP-DF

TC/Res

OP-MM

TCU Treatment Process Model

SufficientRetentionSufficientRetention

Posttreatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations

PatientAttributesat Intake

PatientAttributesat Intake

Motiv

Simpson, 2001 (Addiction)

Early Engageme

nt

Early Recover

y

ProgramParticipation

ProgramParticipation

TherapeuticRelationship

TherapeuticRelationship

BehavioralChange

BehavioralChange

Psycho-SocialChange

Psycho-SocialChange

Engagement

AdequateStay in Tx

Posttreatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations

ProgramParticipation

TherapeuticRelationship

BehavioralChange

CognitiveChange

PatientReadiness

for Tx

“Sequence” of Recovery Stages

Targeted InterventionsGet Focused!!

SufficientRetentionSufficientRetention

Early Engageme

nt

Early Recover

y

Posttreatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations

ProgramParticipation

ProgramParticipation

TherapeuticRelationship

TherapeuticRelationship

BehavioralChange

BehavioralChange

Psycho-SocialChange

Psycho-SocialChange

PatientAttributesat Intake

PatientAttributesat Intake

Motiv

Interventions Should Maintain This Process

SufficientRetention

Early Engagemen

t

Early Recovery

Posttreatment

DrugUse

Crime

SocialRelations

ProgramParticipation

TherapeuticRelationship

BehavioralChange

Psycho-SocialChange

PatientAttributesat Intake

Motiv

Induction to Treatment(Motivational Enhancement)

ProblemRecognition

Desirefor Help

Readinessfor Treatment

SufficientRetention

Early Engagemen

t

Early Recovery

Posttreatment

DrugUse

Crime

SocialRelations

ProgramParticipation

TherapeuticRelationship

BehavioralChange

Psycho-SocialChange

PatientAttributesat Intake

Motiv

Counseling Enhancements

(Cognitive “Mapping”)

SufficientRetention

Early Engagemen

t

Early Recovery

Posttreatment

DrugUse

Crime

SocialRelations

ProgramParticipation

TherapeuticRelationship

BehavioralChange

Psycho-SocialChange

PatientAttributesat Intake

Motiv

Contingency Management(Token Rewards)

SufficientRetention

Early Engagemen

t

Early Recovery

Posttreatment

DrugUse

Crime

SocialRelations

ProgramParticipation

TherapeuticRelationship

BehavioralChange

Psycho-SocialChange

PatientAttributesat Intake

Motiv

Specialized Interventions (Skills-Based Counseling Manuals)

SupportiveNetworks

SufficientRetentionSufficientRetention

Early Engageme

nt

Early Recover

y

Posttreatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations

ProgramParticipation

ProgramParticipation

TherapeuticRelationship

TherapeuticRelationship

BehavioralChange

BehavioralChange

Psycho-SocialChange

Psycho-SocialChange

PatientAttributesat Intake

PatientAttributesat Intake

Motiv

Evidence-Based Treatment Model

EnhancedCounseling

BehavioralStrategies

Social SkillsTraining

Family &Friends

SupportiveNetworks

SupportiveNetworks

Induction Personal Health Services

Social Support Services

ProgramCharacteristics

ProgramCharacteristics

StaffAttributes

& Skills

StaffAttributes

& Skills

Simpson, 2001 (Addiction)

How to Order KAPs

To order publications, contact SAMHSA at

http://store.samhsa.gov or 1-877-SAMHSA-7

(1-877-726-4727) (English and Español) or call 800-487-4889

(TDD hearing impaired) and ask for an information specialist