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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 Realignment Sentencing Created New Populations in California Current offense violent/serious/ sex-related Current offense is not violent/serious/ sex-related, but prior offense(s) was Parole State prison PRCS (Post-release Community Supervision) Jail only Neither current offense nor prior offense was violent/serious/sexrelated County Sentence (Local Prison Term) (1170(h) Jail + Mandatory Supervision Mandatory Supervision only 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? Prison and Parole Tend to Have a Number of Chronic Health Conditions State Physical Health (Lifetime) Local Prison Parole PRCS Local 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% 1% 1% 0% 1% Dental Problems Since Admission 55%^ 48%^ 39%* 41% Any physical disability 43%^ 40%^ 34% 33% HIV ^Indicates differences between Prison vs. Parole statistically significant at .05 level. PRCS and Local Custody Tend to Be Physically Healthier Than Prison/Parole Populations State Physical Health (Lifetime) Local Prison Parole PRCS Local 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% 1% 1% 0% 1% Dental Problems Since Admission 55% 48%* 39%* 41% Any physical disability 43% 40% 34% 33% HIV *Indicates differences between Parole vs. PRCS statistically significant. State vs. Local also significant. There Is More Serious Mental Illness Among the Parole Population State MH Disorder/ Substance Abuse Local Prison Parole PRCS Local Custody Ever Diagnosed with MH Disorder 30%^ 40%^ 20% 18% . . . with Manic 11%^ 29%^ 5% 4% . . . with Schizophrenia 8%^ 18%^ 1% 1% 22%^ 31%^ 13% 12% . . . with Anxiety 9%^ 17%^ 7% 3% Drug Abuse 53% 57% 64% 61% Drug Dependence 40% 46% 53% 41% . . . with Depression ^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 State MH Disorder/ Substance Abuse Local Prison Parole PRCS Local Custody Ever Diagnosed with MH Disorder 30% 40%* 20%* 18% . . . with Manic 11% 29%* 5%* 4% . . . with Schizophrenia 8% 18%* 1%* 1% 22% 31%* 13%* 12% 9% 17%* 7%* 3% Drug Abuse 53% 57% 64% 61% Drug Dependence 40% 46% 53% 41% . . . with Depression . . . with Anxiety *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 Consensus reviews of available science Expert opinion based on clinical observation Second Tier Third Tier 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 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 Dual Disorders dartmouth.edu/~psychrc Stimulant Treatment samhsa.gov/mcnew matrixcenter.com Drug Abuse Treatment ibr.tcu.edu Sources of Evidence-Based Information on the Web Drug Abuse Treatment Alcoholism Treatment niaaa.nih.gov Addiction Medicine nida.nih.gov asam.org HIV/AIDS cdc.gov/idu/ Sources of Evidence-Based Information on the Web Prevention Technology Transfer unr.edu/westcapt nattc.org Addiction Science utexas.edu/research/asrec http://gainscenter.samhsa.gov/topical_resources/ ebps.asp http://www.nrepp.samhsa.gov/Learnlanding.aspx http://store.samhsa.gov/list/series?name=Eviden ce-Based-Practices-KITs An Evidence-Based Treatment Model for Improving Practice 1 Core Components of Comprehensive Services Medical Financial Core Housing & Treatment Transportation Intake Assessmen t Child Care Treatment Plans Group/Individ ual Counseling Abstinence Based Pharmacotherapy Mental Health Urine Monitoring Case Manageme nt Continuing Care Self-Help (AA/NA) Family AIDS / HIV Risks Vocational Legal Educational Elements of a Treatment Process Model Patient Factors Detox Psychological Functioning, OP-DF Motivation, TC/Res & Problem Severity OP-MM ? Sufficient Retention Drug Use Crime Social Relations Post-treatment Cognitive and behavioral components with therapeutic impact TCU Treatment Process Model Motiv Patient Attributes at Intake Early Engageme nt Early Recover y Program Behavioral Participation Change Sufficient Retention Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Engagement Simpson, 2001 (Addiction) “Sequence” of Recovery Stages Patient Readiness for Tx Program Participation Behavioral Change Adequate Stay in Tx Therapeutic Relationship Cognitive Change Drug Use Crime Social Relations Posttreatment Targeted Interventions Get Focused!! Interventions Should Maintain This Process Motiv Patient Attributes at Intake Early Engageme nt Early Recover y Program Behavioral Participation Change Sufficient Retention Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Induction to Treatment (Motivational Enhancement) Motiv Patient Attributes at Intake Early Engagemen t Early Recovery Program Participation Behavioral Change Sufficient Retention Problem Recognition Desire for Help Readiness for Treatment Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Counseling Enhancements (Cognitive “Mapping”) Motiv Patient Attributes at Intake Early Engagemen t Early Recovery Program Participation Behavioral Change Sufficient Retention Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Contingency Management (Token Rewards) Motiv Patient Attributes at Intake Early Engagemen t Early Recovery Program Participation Behavioral Change Sufficient Retention Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Specialized Interventions (Skills-Based Counseling Manuals) Motiv Patient Attributes at Intake Early Engagemen t Early Recovery Program Participation Behavioral Change Supportive Networks Sufficient Retention Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Evidence-Based Treatment Model Induction Motiv Patient Attributes at Intake Staff Attributes & Skills Program Characteristics Behavioral Strategies Early Engageme nt Family & Friends Personal Health Services Early Recover y Supportive Networks Program Behavioral Participation Change Sufficient Retention Therapeutic Psycho-Social Relationship Change Drug Use Crime Social Relations Posttreatment Enhanced Counseling Social Skills Training Social Support Services 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
