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The appalachian tri-state node experiences

opioid dependent clients. The CTN training on dissemination supported this effort.

Center for Psychiatric and Chemical Dependency Services (CPCDS, Pittsburgh, Pennsylvania)

The CPCDS staff has participated in several clinical trials

and numerous training events, which provided the opportu- nity for many clinicians to receive training in EBPs. Specific clinical training has been provided on motivational interview- ing, motivational incentives, cognitive-behavioral therapy, twelve-step facilitation therapy, family treatment, group drug counseling, smoking cessation, HIV counseling, and co-occurring disorders treatment. This has led to a significant increase in clinician and supervisor focus on EBPs. One example is our use of a contingency management (CM) program used to provide incentives to patients attending our partial hospital program. Attendance at this program in- creased by 60% as a result of using incentives. In addition, patients reported more time abstinent from substances, reduced mood and anxiety symptoms, reduced stress, and increased coping ability.25 Based on these findings, several of our other programs are planning to use incentives to increase patient adherence.

One of the clinicians at CPCDS who served as a therapist or supervisor on two trials reported the following gains from his participation in the CTN: (a) increase of CBT skills from learning to work within a manualized CBT framework, (b) a deeper appreciation for motivational interviewing (MI) and how to use MI across treatment settings with diverse clinical populations, and (c) an increase in use of HIV risk reduction counseling in nonresearch practice. This clinician also stated ‘‘one of the most positive aspects of my participation in the research projects has been the departure for the normal routine of addiction counseling that it has afforded me. I enjoyed working with clients on issues that may not typically be an area of focus in ‘treatment-as-usual.’ My experience with research has helped me to keep counseling and treatment fresh and exciting.’’

House of Crossroads (HOC, Pittsburgh, Pennsylvania)

What makes the CTN effective is the true bidirectional structure in which those of us in community programs are included in all research and training projects. As a member of the CTN, I have had the opportunity to take a leadership role representing the community programs of the ATS Node by participating in CTN and Node committees and contributing to dissemination activities nationally, regionally, and locally. For HOC, the CTN collaborative process has influenced a cultural shift toward evidence-based care and demonstrated that rigorous and relevant clinical research can be carried out directly in CTPs addressing a broad range of addictive disorders. This framework has also provided for the success- ful dissemination of current effective treatments to the front lines of CTPs and opportunity for HOC staff to learn more about how treatment works, when, and for whom, with the goal of enhancing its effectiveness. 59

Dissemination Activities and Adoption of Evidence- Based Practices

The CTN and individual Nodes disseminate information through national, regional, and local conferences; Node sponsored clinical workshops; presentations at scientific, research, or clinical meetings or conferences; grand rounds; and other lectures for professionals or individuals with substance problems. In addition, at the twice yearly Steering Committee meetings of the CTN, the Research Utilization Committee organizes presentations of diverse community agencies’ adoption of specific EBPs. These presentations present opportunities for treatment providers to share their experiences, both in terms of barriers and successes in adopting and sustaining the use of specific EBPs. Further- more, all CTPs are encouraged to provide presentations to other providers in their local communities at agencies, conferences, or workshops. The CTPs have thus been able to disseminate information to other non-CTP providers about CTN trials and EBPs.

During our first 4 years in the CTN, our ATS Node provided

hundreds of educational programs reaching over 10 000 participants including presentations at scientific or research meetings; national, state, or regional conferences (15 days); one-half, full-day, and 2-day clinical workshops; and lectures or grand rounds at universities or treatment programs. While not all of these focused on the work of the CTN, most were on evidence-based behavioral treatments (motivational interview- ing, motivational incentives, group drug counseling, family treatment); medication-assisted treatments for opioid, alcohol, or nicotine dependence; or treatment of special populations (eg, adolescents, clients with co-occurring psychiatric illness).

Our Node also provided clinical rotations or educational

programs for more than 300 medical students, 100 psychia- tric residents, and 15 pre- or post-docs or fellows. One of our CTPs in West Virginia provided an annual 5-day state conference on EBPs, and recently provided six 1-day, on-site specialty training programs throughout the state to physi- cians and other caregivers on the use of buprenorphine with opioid dependent individuals. Ratings by participants from 46 clinical workshops averaged 3.9 on a scale of 4.0, indicating that clinicians find these programs very informa- tive and helpful in their clinical work. The breadth and number of programs provide evidence our Node’s commit- ment to dissemination and the excellent ratings and com- ments by participants show that we are influencing the treatment community leading to the increased use of EBPs.

Dissemination of CTN findings at the national and interna- tional levels is accomplished through presentations at profes- sional and research society meetings and publications in professional journals and other publications. The CTN Pub- lications Committee (PC) provides the infrastructure for disseminating the EBPs developed or validated in CTN studies. Using the bidirectional process, the PC determines the topics for journal articles and other modes of dissemination.

Many researchers and community providers contributed to the NIDA or Substance Abuse and Mental Health Services

M&B 2011; 2:(1). July 2011

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