A PROJECT OF THE NORTH CAROLINA DIVISION OF MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES
Flo A. SteinFlo A. Stein, MPH
NC PIC Project Manager
Deputy Director
Division of MH/DD/SAS

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Evidence-based Programs and Practices

The mission for the NC PIC is to ensure that all North Carolinians will receive excellent care that is consistent with our scientific understanding of what works whenever they come into contact with the DMHDDSAS system.

To improve the lives of clients during the current era of system transformation, North Carolina must focus on the content and quality of services and supports that are offered. Research has found that even some of the most popular and well disseminated programs are not evidence based and in fact can be counterproductive. The provision of quality services and supports involve fidelity to proven intervention models.

To facilitate guidance in determining the future evidence-based services and supports that will be provided through our public system, the Director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services has developed the North Carolina Practice Improvement Collaborative (NC PIC). The NC PIC is comprised of representatives of all three disabilities and meets thrice yearly to review and discuss current and emerging best practices for adoption and implementation across the State.

NC PIC Updates

Stigma is Alive and Well

Recently, two stories have appeared in the popular press about pervasive damaging attitudes about drug addiction. Based on studies by researchers such as Kelly and Westerhoff, Huffington Post reported that the White House Office of National Drug Control Policy (ONDCP) is calling for a change in the way that people talk about drug addiction, whether they are consumers or professionals. Toward that goal, ONDCP is in the process of drafting a glossary of terms to reduce the negative imagery.

A few examples include the following:

Use: Instead of:
Abstinent Clean
Compulsive or regular substance use Drug habit
Person in recovery Former addict/alcoholic
Person with a substance use disorder Addict

Join Together reported on a national survey led by Johns Hopkins University faculty that found that Americans are significantly more likely to have a negative attitude about drug addiction than mental illness (Barry et al., 2014). For example, “22% of respondents said they would be willing to work closely on the job with a person with a drug addiction, compared with 62% who said they would be willing to work with a person with mental illness. Sixty-four percent said employers should be able to deny employment to people with a drug addiction, compared with 25% who said the same about a person with a mental illness. Forty-three percent said they opposed giving people with a drug addiction equivalent health insurance benefits to the public at large, compared with 21% who opposed giving the same benefits to people with mental illness.” Researchers stressed the need to educate the public about these treatable conditions so that they will support policy changes that will benefit people with mental illness and drug addiction.

Livingston and associates (2012) had similar results, in that stigma in individuals with substance use disorders was reduced through therapy, that it was reduced in the general public through education, and that it was reduced in professionals through education and training. Crapanzano and investigators (2014) attempted to reduce stigma in physician assistant students through education and found that it persisted after the intervention concluded. These studies call attention to the need to combat stigma and discrimination of individuals with substance use disorders and/or mental illness through a multi-pronged approach at all levels—consumers, family members, first responders, health care and behavioral health care providers, policymakers, and legislators.

References:

Barry CL, McGinty EE, Pescosolido BA, Goldman HH. Stigma, discrimination, treatment effectiveness, and policy: Public views about drug addiction and mental illness. Psychiatric Services, 2014;65(10):1269-72.

Crapanzano K, Vath RJ, Fisher D. Reducing stigma towards substance users through an educational intervention: Harder than it looks. Academy of Psychiatry, 2014;38(4):420-5.

Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and analysis. Social Science and Medicine, 2010;71(12):2150-61.

Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 2012;107(1):39-50.

McGinty EE, Goldman HH, Pescosolido B, Barry CL. Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination. Social Science and Medicine, 2015;126:73-85.

Addressing the Needs of Our Military Families in North Carolina

March 10, 2015 Practice Improvement Collaborative Conference

On March 10, the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, the Governor’s Institute on Substance Abuse, and the Southeast Addiction Technology Transfer Center sponsored an all-day Practice Improvement Collaborative conference to highlight best practices in behavioral health for military families in North Carolina. Speakers included Diane Coffill, State Family Program Director, North Carolina National Guard; Christina Wildy, Director of Psychological Health, 81st Regional Support Command, Office of the Command Surgeon, US Army Reserve; Steven L. Sayers, Ph.D., Associate Professor, University of Pennsylvania and Philadelphia VA MIRECC; Gregory L. Inman Ph.D., Team Leader, Raleigh Vet Center; and Robert M. Bray, Ph.D., Senior Researcher, and Becky Lane, Ph.D., Research Psychologist, RTI International.

One hundred twenty-six individuals, representing family members, state agencies, LME-MCOs, provider agencies, and universities attended the event. Response to the NC PIC conference was excellent. Agenda from the Meeting

NC Substance Abuse Professional Practice Board Approval Code: 15-204-S
Up to 5.5 hours SS (SAV)

 

Watch the Meeting & Download Presentations
Part 1 Video Link

Welcome from the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
Courtney Cantrell, Ph.D., Director

Background and Introduction of the Day
Flo Stein, Deputy Director, Community Policy Management, North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

Needs Assessment Survey of Guard Families in North Carolina and Services of the North Carolina National Guard Family Program
Diane Coffill, State Family Program Director, North Carolina National Guard
Introduction by Wei Li Fang, Ph.D

Presentation Slides – Needs Assessment Survey of Guard Families in North Carolina

Presentation Slides – Children & Families of the NC National Guard

Handouts – Child & Youth Program NCNG, NCNG Family Programs Office Locations, NCNG Family Programs

Part 2 Video Link

Working with Reserve Families in North Carolina
Christina Wildy, Director of Psychological Health, 81st Regional Support Command, Office of the Command Surgeon, US Army Reserve
Introduction by Wei Li Fang, Ph.D.

Presentation Slides – Working With Army Reserve Families

Part 3 Video Link

Challenges Faced by Military Families During and Post Deployment
Steven L. Sayers, Ph.D., Associate Professor, University of Pennsylvania and Philadelphia VA MIRECC
Introduction by Flo Stein

Presentation Slides – Challenges Faced by Military Families During and Post Deployment

Handout – Resource List

Part 4 Video Link

Integrative Behavioral Couples Therapy
Gregory L. Inman, Ph.D., Team Leader, Raleigh Vet Center
Introduction by Vince Newton, Transitions to Community Living, North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

Presentation Slides – Integrative Behavioral Couple Therapy with Combat Veterans

Part 5 Video Link

Strengthening Families through Community-based Programs
Robert M. Bray, Ph.D., Senior Researcher, and Marian (Becky) Lane, Ph.D., Research Psychologist, RTI International
Introduction by Kimberly Lesane Ratliff,M.A., Community Wellness, Prevention and Health Integration, North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

Presentation Slides – Strengthening Families Through Community-based Programs: Background and Plans for a Research Study

Part 6 Video Link

Panel of Speakers and Military Family Members
Alice Dean, NC National Guard Lead Child & Youth Coordinator; Ms. Wildy, Dr. Sayers, Dr. Inman, Dr. Bray, and Dr. Lane
Moderated by Diane Coffill

Download North Carolina Support Networks for Military Families Infographic

Coalition for Evidence-Based Policy Issue Briefs

The nonprofit Coalition for Evidence-based Policy has issued two issue briefs on study designs:

Which Study Designs are Capable of Producing Valid Evidence of Effectiveness in October 2014: Randomized control trials are recommended when possible. Quasi-experimental designs are the next best choice. Additional reading materials are recommended. View the Brief

Validity of Comparison Group Designs, January 2014: This publication stated that the comparison group designs most likely to produce valid results contained the following: (1) program and comparison groups are similar in pre-program characteristics such as demographics, pre-program measures of the outcome that the program is trying to improve, and geographic location; (2) outcome data are collected in the same way for both groups; (3) motivation of program and comparison group members is similar; and (4) statistical methods are used to adjust for minor pre-program differences between the two groups. View the Brief

In addition, the website includes what they consider to be top tier programs, some of which are offered in North Carolina and other resources. A publication list can be found here.

Issue Briefs on Effective Implementation and Evaluation of Evidence-based Programs

In September 2014, the Office of the Assistant Secretary for Planning and Evaluation (ASPE), US Department of Health and Human Services published three issue briefs on elements to consider in implementing and evaluating evidence-based programs and practices.

Each issue brief is briefly outlined below:

Willing, Able –> Ready: Basics and Policy Implications of Readiness as a Key Component for Implementation of Evidence-Based Interventions:

Readiness of an organization to implement an evidence-based intervention (EBI) is considered to be essential to its successful adoption. Three components—motivation of staff, general organizational capacities, and intervention-specific capacities—are defined as R=MC2. The brief recommends that provider agencies examine their organizational readiness to determine their technical assistance needs prior to implementation and as a part of continuous program improvement.

The Importance of Contextual Fit when Implementing Evidence-Based Interventions:

Contextual fit is defined as the match between the strategies, procedures, or elements of an intervention and the values, needs, skills, and resources available in a setting. Eight elements are identified as determining the contextual fit: need, precision, an evidence base, efficiency, skills/competencies, cultural relevance, resources, and administrative and organizational support. The brief contends that contextual fit is undervalued and that technical assistance should focus on building strong contextual fit before investing in direct implementation efforts.

Using Evidence-Based Constructs to Assess the Extent of Implementation of Evidence-Based Interventions:

Five constructs are summarized in measuring implementation milestones: fidelity of implementation, competence in use, feeling and perceptions, context of the organization and community, and supporting implementation. The brief encourages organizations to evaluate the implementation process from multiple perspectives in order to identify barriers to implementation as well as their solutions. A sample monitoring plan is provided.

 

The issue briefs not only lay out elements to consider in implementing and evaluating EBIs, but they also outline what many federal and state funding agencies are already mandating in grant applications. Policymakers look at organizational readiness, contextual fit, and implementation and evaluation results to determine the viability and sustainability of supported interventions that applicants are proposing.

Infographics

Funded by the US Substance Abuse and Mental Health Services Administration, the Service Members, Veterans, and their Families (SMVF) Technical Assistance Center has assisted members of the Governor’s Working Group on Veterans, Service Members, and their Families in developing infographics on specific topics.

Currently, two have been developed—one for Student Veterans and one for Military Families and the professionals who help them. The infographics are useful in identifying strategies and resources. An infographic on employment is currently in progress with one planned for women veterans in the future.

If you use either or both infographics, please email Dr. Fang (wei.li.fang@governorsinstitute.org) as to how you are using them. We would love to know if they are helpful and/or how they can be improved or disseminated.

Download North Carolina Support Networks for Student Veterans Infographic

Download North Carolina Support Networks for Military Families Infographic

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