NIDA Interests: Focus on Addiction Health Services

1. NIDA Interests: Focus on Addiction Health Services Tisha Wiley, Ph.D. Service Research Branch Division of Epidemiology, Services, and Prevention Research National Institute on Drug Abuse August 14, 2012 CALDAR Early Career Track

2. SERVICES RESEARCH BRANCH PREVENTION RESEARCH BRANCH EPIDEMIOLOGY RESEARCH BRANCH Division of Epidemiology, Services and Prevention Research (DESPR): NIDA’s Public Health Division DESPR promotes epidemiology,services & prevention research to understand and address the range of problems related to drug abuse, in order to improve public health.

3. SERVICES RESEARCH BRANCH PREVENTION RESEARCH BRANCH EPIDEMIOLOGY RESEARCH BRANCH Division of Epidemiology, Services and Prevention Research (DESPR): NIDA’s Public Health Division DESPR promotes epidemiology,services & prevention research to understand and address the range of problems related to drug abuse, in order to improve public health.

4. Service Research Branch Mission • Support rigorous research to improve the quality of addiction treatment and recovery support services • SERVICES: Drug, alcohol, nicotine disorder services & HIV/HCV services for drug-involved individuals • DELIVERY SYSTEMS: Specialty treatment programs, general health care settings, criminal justice settings, social service agencies, etc. • QUALITY: effective services for all who need them at reasonable a cost • Availability, access, appropriateness, effectiveness, safety, efficiency, cost

5. Our Research Vision NIDA’s Services Research Branch supports science that leads addiction treatment services toward the highest possible levels of quality, efficiency, & economy.

6. About NIDA’s Service Research Branch • 238 Active Grants (as of August 2012) • $75m in Direct Costs • 83% of funding goes to Research Project Grants • R01, R21, R03s, etc.

7. Services Research Continuum Defining service needs Refining practices for real-world use Testing service delivery models Pre-implementation research Implementation Trials PIPELINE Measures/methods Seek, Test, Treat, Retain CJDATS (U01) SRB GRANT TOPICS Alternative service models Co- & Multi-morbidity Justice Involved Adolescents (U01) Drug use trajectories Primary Care CJ services Other D&I Trials Tx engagement/retention SBIRT EBP uptake Health disparities Workforce Use of technology in treatment Systems Overlap (e.g., child welfare)

8. Selected SRB Areas of Interest

9. Methodology & Technology • Relevant Funding Announcements • SRB Flagship PA’s • PA-12-127 (R01) – 5 years, unlimited* • PA-12-128 (R21) – 2 years, $275k direct total • PA-12-129 (R03) – 2 years, $100k direct total • PA-12-134 (R34) – 3 years, $435 direct total • Technology/HIV PA’s • PA-12-117 (R01) • PA-12-118 (R34)

10. Methodology & Technology Health Services and Economic Research on the Prevention and Treatment of Drug, Alcohol, and Tobacco Abuse (R01, R21, & R03) • Our “Flagship” PA’s • PA-12-127 (R01) • Supports “developing, refining, and validating new approaches for conducting treatment and prevention services research” • Study Designs • Measurement Tools • Simulation Modeling • Quality/Performance Measures • Statistical Models • PA-12-128 (R21) • PA-12-129 (R03)

11. Methodology & Technology Technology-Based Interventions to Promote Engagement in Care and Treatment Adherence for Substance Abusing Populations with HIV (R01, R34) • Use of technology to directly improve patient-level outcomes (i.e., adherence) • Capacity of HIV treatment providers and related service delivery organizations to adopt and integrate such technologies to promote HIV treatment outcomes; • Use of technology to improve the organization and delivery of HIV treatment and services.

12. Implementation Science • Relevant Funding Announcements • SRB Flagship PA’s, especially R34 • RFA-DA-13-001 (R21/R33) • (August 22 Deadline)

13. Implementation Science PA-12-130 (R34): Building System Capacity for Implementing EBPs • Organizational and/or systems-level interventions that may optimize access, utilization, delivery, quality, and/or cost of treatment services through the use of EPBs • Organizational and/or systems-specific adaptations to existing EBPs • Novel service delivery models to be pilot tested in preparation for larger-scale effectiveness trials

14. Implementation Science PA-12-130 (R34): Building System Capacity for Implementing EBPs • Hypothesis-driven research that: • Addresses systems-level implementation research questions • Builds provider/funder capacity for conducting research beyond life of the grant • Designed to implement (not develop) evidence-based drug treatment or prevention practices • Ideally, projects will involve: • One or more treatment or prevention settings • An external agency that impacts their services (e.g., SSA, SMA) • An academic partner experienced in doing NIH research

15. Implementation Science Implementation science is not intended to test interventions, but to study how to get evidence-based interventions adopted,adapted, & sustained.

16. Implementation Research:Studying the Technology Transfer Process • How do we move EBP’s into everyday use? • How do we organize treatment to support EBPs? • How do we train and supervise staff to use EBPs? • How do we change business practices to value EBPs? • Client-level outcomes are NOT the focal outcome. • Research questions are about finding effective implementation strategies.

17. What are implementation strategies?

18. Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare • Relevant Funding Announcements • Flagship PA • TRIALS (RFA-DA-13-009) • Deadline: November 28, 2012 • Relevant Funded Projects • CJ-DATS (U01, 10 Research Centers) • Seek, Test & Treat: Addressing HIV in the Criminal Justice System (R01s, 13 awards) • Data Harmonization

19. Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare RFA-DA-13-009 (U01): Translational Research on Interventions for Adolescents in the Legal System: TRIALS • Purpose • Test implementation strategies and associated measures to improve the continuum of substance abuse prevention and treatment services delivered to youth under juvenile justice supervision • Structure • Multisite collaborative Agreement • Two Types of Applications • Coordinating Center • Research Center

20. Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare RFA-DA-13-009 (U01): Translational Research on Interventions for Adolescents in the Legal System: TRIALS • Need • Youth and adolescents in juvenile justice system at high risk and need effective drug use prevention and treatment services • Most juvenile justice systems do not provide adequate services • Opportunity • We have effective, evidence-based prevention and treatment interventions for adolescents • Involvement in the juvenile justice system provides window to intervene with drug abuse & HIV • Researchers can partner with juvenile justice agencies: • Adolescent drug courts; truancy, teen, family courts • Juvenile detention • Juvenile probation

21. Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare Key Features of CJ-DATS-2 (2008-2013) • Focus on implementation research • Transfer of evidence-based practices • Criminal justice re-entry-systems improvement • Correctional Facilities, Probation, & Parole • Test of different implementation & quality improvement strategies

22. Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare Key Features of CJ-DATS-2 (2008-2013) • 3 Research Protocols • 10 Research Centers • 62 Correctional Facilities • 11 States • 2 NIDA FTEs • $26.8 million over 5 years • $2.7 million from CSAT and DOJ co-funders

23. Special Settings: Criminal Justice, Juvenile Justice, & Child Welfare Key Features of CJ-DATS-2 (2008-2013) • MAT • Does strategic planning intervention + staff training improve MAT utilization? • HIV • Does a local change team improve utilization of HIV services along the continuum of care? • Assessment • Does a local change team improve the case planning process?

24. ADJUDICATION(Trial) ENTRY(Arrest) PROSECUTION(Court, Pre-Trial Release, Jail) SENTENCING(Fines, Community Supervision, Incarceration) CORRECTIONS(Probation, Jail, Prison) COMMUNITY REENTRY(Probation, Parole, Release) Key Participants/Stakeholders Crime victim Police FBI Crime victim Police FBI Judge Prosecutor Defense Attorney Defendant Jury Judge Judge Jury Probation Officers Correctional Personnel Probation/ Parole Officers Family Community-based providers Intervention Opportunities N/A Drug Court Terms of Incarceration Release Conditions Drug Treatment Drug Treatment Aftercare Housing Employment Mental Health Half-way House TASC Diversion Programs Drug Courts Community Treatment TASC Screening/Referral Criminal Justice System:Key Participants and Intervention Opportunities

25. Healthcare Reform Impact • Relevant ACA Provisions & Environment: • Expands coverage to more than 30 million individuals, many at high risk for drug abuse • Fundamentally changes the way many drug abuse prevention and treatment services are financed • Emphasizes central role of primary care settings • Focuses on screening and prevention • Promotes use of electronic health records

26. Healthcare Reform Impact • Relevant RFA: RFA-DA-13-001 (R21/R33) • Closes August 22, but still an area of interest • Research Topic Examples: • Uptake rate for insurance among those with drug use disorders and related conditions and how this is affected by outreach and types of offered coverage • Responsiveness of demand for services among the newly covered • Effect on types and quantity of services sought and responses by payers • Effect on financing and cost of treatment

27. Other FOAs Time-Sensitive Drug Abuse Research (R01) PAR-10-072 • “Rapidly evolving areas where opportunities for empirical study are, by their very nature, only available through expedited review and award of support.” • 3 Criteria • scientific value and feasibility are clear, • rapid review and funding are required • knowledge gained from the study is time-sensitive –regular review cycle = missed opportunity

28. Other FOAs Drug Abuse Dissertation Research (R36) PAR-10-020 • Last receipt date: October 2012 • 2 years, $50k in direct costs • Supports research on: • Epidemiology • Prevention • Services • Women and Sex/Gender Differences

29. Other Areas of Interest Clinical Quality Improvement • Adaptive service delivery strategies to adjust level, dosage, and type of intervention in response to changing needs • Continuity of care within and across settings • Integrated addiction and other medical treatment • Performance measurement and management • Impact of IT systems and system changes

30. Other Areas of Interest Services Organization and Management • Service delivery models (e.g. collaboration, co-location) • Management and human resources (e.g. recruitment, training, retention) • Business practices

31. Other Areas of Interest Economics • Financing, e.g. • Effect of health insurance on demand for treatment • Effect of reimbursement mechanisms on supply of treatment • Economic incentives for quality improvement • Economic evaluation (CEA, CUA, CBA) • Economic efficiency

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