Deborah Chassler

Boston University, Boston, Massachusetts, United States

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Publications (36)30.67 Total impact

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    ABSTRACT: Background: The Tapestry Health SAMHSA-funded HIV prevention effort targets at-risk Latinas in Springfield, MA. Outreach workers travel the city knocking on doors, educating about HIV rapid testing services, and gathering data on at-risk Latina community members. The breadth of canvassing is limited by time, personnel numbers, and the geographic extent of the city. Managers and outreach workers need a tool to develop a method for their door-knocking campaign location choices. Description: Using GoogleMaps Engine Lite, a free mapping tool, researchers will work with grant project managers and outreach workers to modify a map of Springfield using Census and Massachusetts Department of Public Health data on demographics, drug overdoses, and HIV rates. The project incorporates user-friendly nonprofessional GIS instruments to create an interactive map that workers can use on iPads in the field and update as suggestions and changes are made. Lessons Learned: Current findings include feedback about the helpfulness of the health information displayed and suggestions for including domestic violence information in newer versions. Further feedback transforming the map to more effectively indicate neighborhoods to target in canvassing, leading to a broader knowledge base on application of mapping technology to community outreach work is expected. Recommendations: Free and low cost beta technology is a resource to be explored. The ranges of possible benefits are currently unknown but greatly promising. Seeking out accessible technology to create innovative outreach work in public health human service delivery and research is vital and advantageous to the field.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Purpose: Instances of opioid overdoses are increasing across the country. As an evidence-based practice (EBP), Naloxone, an opioid antagonist, has been proven effective in reversing overdoses when administered intra-nasally. Utilizing Simpson and Flynn’s Organizational Readiness for Change (TCU-ORC) model, this study explores the decision-making processes guiding the implementation and integration of a naloxone-based opioid overdose response protocol (NBOORP) in organizations providing services to heroin and other opioid users in Western Massachusetts. Methods: Qualitative interviews were conducted with 75 program directors and staff from organizations which received naloxone responder training. Participants were asked (1) to describe the decision-making process that led to the implementation of their NBOORP, (2) how, if at all, the NBOORP was integrated into the organization’s service model, and, (3) if integrated, whether a NBOORP was currently and routinely used to reverse overdoses. Participants completed a modified version of the TCU-ORC measures focusing on program needs, workplace stress, and staff’s perceived organizational influence. Results: Preliminary analysis shows a significant barrier to implementation is administrative concerns around organizational liability, especially in for-profit organizations. Most organizations implemented a NBOORP immediately after training and prior to developing a written policy. Additionally, the quantitative measures will assess the impact of perceived barriers and the organization’s readiness for change on its ability to implement a NBOORP. Discussion: The identification of characteristics linked to the successful implementation of a NBOORP will increase understanding of a model for rapid infusion of an EBP, Naloxone, for service providers offering a range of services to opioid users.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Introduction: Health risk assessments of racial and ethnic minority lesbian, gay, bisexual, transgender (LGBT) sub-populations are lacking. Federally-funded substance use treatment programs are not required to collect data about sexual orientation. This project uses data from a SAMHSA-funded grant to analyze the variation between primarily Latino, heterosexual and sexual minority (LGB) clients at a residential treatment organization in Boston, MA. Methods: We developed a sexual orientation question for the client questionnaires at baseline and 6 month follow up. This study compares heterosexual (n=305) and sexual minority (n=38) clients on risk factors related to mental health and sexual behavior using chi-square tests. Further analyses of the baseline and 6 month follow-up questionnaires will determine whether sexual minority status is an indicator of differential treatment response. Results: Preliminary bivariate analyses reveal significant differences (p<.05) between Latino sexual minority and heterosexual clients on mental health indicators, including thoughts and attempts of suicide, hallucinations, obsessive thoughts, panic attacks, and strong fears. Our findings provide evidence that sexual minority clients were significantly (p<.01) more likely to engage in high-risk behaviors, including trading sex for money, drugs, or housing. Discussion: Few studies focus on the intersection between ethnic minority status and sexual orientation in addictions treatment. This exploratory study illustrates the need to collect LGB demographic information. It is important to determine whether LGB populations are being adequately served by mainstream programs. Findings from this research indicate that there may be important differences in risk factors and behaviors of LGB clients and in their treatment needs.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Robert Grahn, Deborah Chassler, Lena Lundgren
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    ABSTRACT: Sweden has a free, universal addiction treatment system, yet few studies exist examining utilization of treatment in this country. This study identified predisposing, enabling, and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that predisposing factors such as older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the number of treatment episodes by education or immigrant status. Implications: (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories, Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.
    Substance Use &amp Misuse 06/2014; · 1.11 Impact Factor
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    ABSTRACT: Background: Numerous studies point to the relationship between addiction, mental health, and suicide. However, few studies describe the relationship between suicidality in substance-using Latinos and the presence of severe mental health symptoms. Our exploratory study examines the prevalence of suicidal ideation and suicide attempts and the relationship between suicidality, acute mental health symptoms, and substance abuse. Methods: Data are presented from a sample of 354 HIV+ or at-risk Latino substance-using men and women presenting to residential substance abuse treatment. Statistical analyses describe lifetime history of suicidal ideation and suicide attempts and the association with acute mental health symptomatology such as lifetime history of hearing voices, strong fears, feelings that people were against them, manic, panic, obsessive thoughts, and family and self-history of substance abuse. Results: 129 (36.4%) clients reported having suicidal ideation, and 101 (28.5%) attempted suicide at least once. Over one-third of clients reported hearing voices, having strong fears, feeling that people were against them, and obsessive thoughts. Almost half (49.6% and 42.7%) reported feelings of manic or panic. Bivariate analyses found lifetime history of family substance abuse (having a family member who abused alcohol, cocaine, or heroin) and personal history of cocaine and alcohol use were significantly associated with increased likelihood of suicidality. Conclusion: Preliminary findings suggest that high rates of suicidal ideation and suicide attempts among Latino substance users demand interventions adapted to Latino populations with co-morbid acute mental health and substance use disorders. The severity of need in this population highlights the importance of further research.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Purpose: Prior work by these authors has identified that clinical staff who reported higher levels of barriers in implementing an evidence-based practice (EBP) also report higher levels of modifications in implementing EBPs. This study explores for 311 addiction treatment staff, the ten most commonly implemented evidence-based practices (EBPs), EBP fidelity, and specific barriers associated with the implementation of the ten EBPs. Methods: This mixed methods study used open-ended qualitative data to identify the type of barriers staff experienced and level of modifications made to EBPs. A 10-point ordinal variable measured levels of modification. For each EBP, the mean modification score (MMS) and the most commonly identified barriers are presented. Results: Data analyses identified that staff reported different levels of modifying EBPs, by type of EBP. Specifically, the EBPs reported to have been the most modified were the Peer to Peer Recovery Model and Motivational Enhancement Therapy (MMS score > 4). The two EBPs rated as having been changed the least were MI and Case Management (MMS <3). The EBP modification scores for staff implementing MI (n = 72) were higher when staff experienced barriers related to clients and to the logistics of implementation, compared to their counterparts. Discussion: Barriers to EBP implementation are clearly associated with fidelity. As this and prior papers by the authors suggest, staff who experience different types and levels of barriers make changes to the EBP responding to these barriers. Funders of EBP implementation need to provide ongoing technical assistance to reduce barriers to EBP implementation.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Co-morbid mental health disorders are common among individuals with substance use disorders. Treatment integration is imperative for vulnerable populations with disparate needs and access to health services. Homeless, Latino drug users have been identified as underutilizing behavioral health care. This exploratory study examined whether severity of need was associated with level of motivation to enter mental health treatment for a sample of 214 homeless Latino drug users who reported mental health symptoms in the past year. The data originated from a five-year program effort to increase utilization of substance abuse and mental health treatment among homeless Latino drug users. In-person interview data was analyzed using bivariate and multivariate analysis. Severity of need was measured as 1) self-reported mental health symptomology in the past 30 days; 2) self-reported history of victimization; and 3) substance use severity. The analysis controlled for demographic characteristics, social support for recovery, prior use of psychopharmacological medication, and prior substance abuse treatment use. The analysis identified that female gender and a history of having been physically attacked, mugged, or robbed were associated with increased motivation to seek mental health treatment. These findings underscore the importance of early identification and support for treatment among marginalized populations. Insufficient research has been conducted exploring the complexity of victimization, substance use disorders, and mental health disorders among Latino populations. Consequently, few evidence-based practices have been developed and implemented that target Latinos experiencing co-morbid disorders. There is a pressing need for comprehensive, culturally responsive public health prevention efforts that support treatment engagement.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: ABSTRACT Background: This qualitative effort examines training related facilitators and barriers to implementing evidence-based practices (EBPs) in 285 community-based addiction treatment organizations (CBOs) nationwide that were funded by SAMHSA/CSAT to implement EBPs. Methods: Using qualitative interviews, authors explored staff (n = 514) descriptions of training as a facilitator or barrier to implementation. Training related factors were described 663 times as facilitators (by 440 staff) and 233 times as barriers (by 170 staff). Responses were coded using content analysis. Results: Specific characteristics of the training received, such as, access to expert knowledge and quality, as well as ongoing training were described as central facilitating factors to EBP implementation. Key reasons training was perceived as a barrier included: amount of training, training did not fit current staff and/or organizational needs, training for some EBPs was perceived to be too demanding, and difficulty accessing training. Conclusions: Since government funders of addiction treatments require that CBOs implement EBPs and they provide training resources, the quality, flexibility and accessibility of the available training needs to be promoted throughout the addiction treatment network. Only 17% of CBOs reported that they used the SAMHSA-funded ATTC (Addiction Technology Transfer Center) training centers and 42% used SAMHSA technical assistance. Hence, federally-funded resources for training were not always used.
    Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. 10/2013;
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    ABSTRACT: Prior studies by the authors identified that clinical staff who reported that their treatment unit had lower levels of organizational readiness to change experienced higher levels of barriers in implementing an evidence-based practice (EBP). The current study examined whether clinical staff perceptions of their treatment unit's organizational readiness to change were also associated with their adherence to EBP protocols during EBP implementation. Adherence was examined through a variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Multivariate regression analyses identified that clinical staff who had five or more years of addiction counseling experience, who rated staff in their organization as having higher levels of influence, who less frequently implemented new counseling interventions and who reported higher levels of barriers when implementing a newly funded EBP also reported that their program made more modifications to the EBP in the implementation process. Finally, staff who implemented MI compared to any other EBP reported lower levels of EBP modifications. Implications: Continued federal funding is needed to enhance treatment unit organizational resources in order to reduce barriers and promote adherence to EBPs. Also, funders of treatment need to continue to provide ongoing technical assistance and training opportunities to promote implementation of EBPs with fidelity.
    Journal of substance abuse treatment 08/2013; · 2.90 Impact Factor
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    ABSTRACT: In this Robert Wood Johnson Foundation-funded study (2009-2011), treatment staff (n = 178) from 330 federally funded U.S. addiction treatment programs provided data through semistructured telephone interviews about factors that facilitated their implementation of four evidence-based practices (EBPs). Such studies can assist the addiction field in improving EBP implementation and ultimately, client care. Research questions: What factors were identified as facilitating implementation of the four EBPs? And, Do facilitating factors vary by EBP? Coders classified facilitating factors (n = 518) using a six-category schema. Results showed that although facilitating factors varied by EBP, organization-related factors dominated. Study implications and limitations are described.
    Substance Use &amp Misuse 06/2013; · 1.11 Impact Factor
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    ABSTRACT: Background/Purpose: Prior studies by the authors have found that the level of organizational capacity in a substance abuse treatment (SAT) organization is associated with clinical staff perceptions of the level of difficulty of implementing an evidence-based practice (EBP). This study is the next step in our ongoing research effort examining whether higher levels of organizational capacity (or readiness for change measured through the TCU-ORC) are also associated with staff fidelity in EBP implementation. Research indicates that the quality of EBP implementation strongly influences outcomes, and that higher fidelity to the EBP produces superior clinical results (Drake, Goldman, Leff, & Lehman, 2001; Torrey et al., 2001). If key elements are omitted during replication, the outcomes tend to be less positive or even contradictory (Mowbray, Holter, Teague, & Bybee, 2003). Further, without fidelity criteria for the specific EBP, it is not possible to determine whether unsuccessful outcomes are due to a failure of the intervention or a failure to implement the intervention as intended. Methods: The analytic sample included 349 clinical staff from community-based SAT organizations. Fidelity was explored through a continuous variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Bivariate analysis (one-way ANOVA and correlation analysis for categorical and continuous variables, respectively) examined the statistical relationship between all independent variables (age, gender, number of years of education, years of experience in drug abuse counseling, organizational affiliation with a research institution, type of treatment unit, primary service area, program duration, type of EBP implemented, rating of barriers to implementation, and the 18 TCU-ORC subscales) and the dependent variable. A multilevel linear regression model was developed using all variables significant at the bivariate level (p< 0.05). Results: Accounting for other organizational factors, multivariate regression methods identified several program and staff characteristics associated with more modifications to the EBP. Findings indicated that clinical staff who worked in an organization that less frequently adopted new counseling interventions and techniques, who reported a higher level of barriers in implementing the EBP, who reported implementing Motivational Interviewing (MI) rather than other EBPs, and who had more years of addiction counseling experience also reported making more modifications to the EBP. Conclusions/Implications: Findings suggest that organizations as a whole, not just individual staff, need training on EBPs. Organizations new to using EBPs need to receive agency-wide training to understand fidelity requirements. This is a complex process; without it, EBPs could be modified in such a way that they lose the specific “active ingredients” that have therapeutic effect. Organizations need to help staff anticipate possible implementation barriers and problem-solve to reduce them. Concerning specific EBPs, staff who implemented MI, in contrast to other EBPs, made higher levels of modifications. Such modifications may be more likely when an EBP is more flexible (i.e., less dictation of components, format, and timing by the EBP designers). With such EBPs, staff may need more guidance about what elements should and should not be modified.
    The Society for Social Work and Research 2013 Annual Conference; 01/2013
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    ABSTRACT: Using a sample of 280 Puerto Rican drug users with a history of incarceration residing in Massachusetts, we explore whether a significant association exists between social and economic factors (maintaining social network contacts, receiving public assistance) and lifetime incarceration. Analysis of survey data using regression methods shows that respondents who live in their own home, receive public assistance, and have recent familial contact are significantly less likely to have been incarcerated in the past 6 months. Among study participants, men and those who initiated heroin use at younger ages are more likely to have greater lifetime incarceration totals. Practice implications are discussed.
    Journal of Ethnicity in Substance Abuse 01/2013; 12(2):179-95.
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    ABSTRACT: Background: Recent studies of injection drug users (IDUs) in Puerto Rico indicate widespread use of xylazine (horse anesthesia) mixed with heroin and cocaine. This study describes use of xylazine/mix and HIV risk behaviors. Methods: Data from 374 Puerto Rican IDUs was gathered through Spanish in-person interviews. Bi-variate and multivariable analyses were conducted to explore the association between xylazine use and HIV risk behaviors (sharing drug-paraphernalia, unprotected sex, sex work, injecting others) controlling for demographic characteristics, health care utilization; housing status, substance use history; and mental health symptoms. Results: On average, participants began using heroin and cocaine mixed with xylazine at age 31, whereas use of the same drugs without xylazine began between ages 18-21. Incidence of xylazine/mix injection in the sample was high (69.3%). At first use, participants who injected xylazine/mix knew it was not pure heroin because they felt a different high (76%) or had developed severe abscesses (28%). Bivariate analysis identified that xylazine/mix use was significantly associated with sharing drug-paraphernalia, unprotected sex, and injecting others. Logistic regression analysis, with all variables significant at the bivariate level, indicate that xylazine/mix use was significantly associated with higher numbers of unprotected sexual contacts in the last 30 days, controlling for age, gender, number of sexual contacts and homelessness (p≤.05). Conclusions: Future HIV prevention efforts in Puerto Rico must address xylazine/mix use and its association with HIV risk behaviors. The migratory pattern of Puerto Ricans IDUs traveling to and from the USA mainland, possibly carrying xylazine, raises additional public health concerns.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: In-person interview data from 13,903 individuals assessed for a drug use disorder in the Swedish welfare system from 2002-2008, were analyzed using logistic regression methods. Second generation immigrants with non-Scandinavian parents were 41% more likely to report a history of compulsory treatment compared to those born in Sweden to Swedish parents after controlling for age, gender, education, mental health treatment homeless status history, and criminal justice history. Implications include the need to study acculturation, stigma, and discrimination-related factors as well as to promote culturally competent outreach to immigrant populations.
    Substance Use &amp Misuse 11/2011; 47(1):67-77. · 1.11 Impact Factor
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    ABSTRACT: Prior studies have identified that working in an addiction treatment unit with higher levels of organizational capacity is a factor associated with positive staff attitudes about evidence-based addiction treatment practices (EBPs). The study presented here explored whether staff perceptions about the organizational capacity of their treatment unit are also associated with staff experience of barriers to implementing EBPs. Multivariate regression methods examined the relationship between the clinical staff (n = 510) and director (n = 296) perceptions of organizational capacity (Texas Christian University Organizational Readiness for Change [TCU ORC]-staff and TCU ORC-director) and level of barriers experienced when implementing a new EBP controlling for a range of treatment unit characteristics, staff characteristics, and type of EBP implemented. For both samples, reporting higher levels of stress in their organizations was significantly associated with reporting higher levels of barriers when implementing a new EBP. For clinical staff only, experiencing lower levels of program needs in their organization, working in a program that had been in existence for a shorter period, and implementing motivational interviewing techniques compared with other EBPs were all factors significantly associated with experiencing lower levels of barriers with EBP implementation.
    Journal of substance abuse treatment 10/2011; 42(3):231-8. · 2.90 Impact Factor
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    ABSTRACT: This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs. 
    American Journal on Addictions 03/2011; 20(3):271-84. · 1.74 Impact Factor
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    ABSTRACT: This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected.
    Evaluation and program planning 03/2011; 34(4):382-9. · 0.89 Impact Factor
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    ABSTRACT: This article describes the association between substance use, sexual identity, and seeing a health care provider on a regular basis for 257 men who have sex with men (MSM). Data from in-person interviews were gathered from MSM who resided in Massachusetts between 2003 and 2007. A logistic regression analysis that controlled for demographic characteristics, health insurance status, HIV/AIDS status, drug use, and social support revealed that MSM who identified as heterosexual, compared with those who identified as gay or bisexual, were 60% less likely to access a health care provider on a regular basis. Further, the likelihood of seeing a provider regularly was 54% lower for MSM who had used illegal drugs in the past 30 days and 32% higher for MSM who had more social support. Study limitations and implications are discussed.
    Substance Use &amp Misuse 01/2011; 46(4):452-9. · 1.11 Impact Factor
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    ABSTRACT: This qualitative research effort explored implementation of evidence-based practices (EBPs) in 100 community-based addiction treatment organizations (CBOs) nationwide. The study describes CBO program director attitudes on: (1) satisfaction with EBPs they were mandated to implement; (2) the extent to which their organization modified the EBPs; (3) reasons for modifications; and, (4) the standards they used for modifications. Findings indicate that program directors were highly positive both about EBPs implemented and the modifications made to those EBPs. A broad range of modifications were identified; most common were adding or deleting intervention sessions in efforts to serve the needs of a specific client population. Given the addiction treatment field's lack of standards for modifying EBPs, it is not surprising that little consistency occurred in modification efforts. As government funders of addiction treatments require that CBOs implement EBPs, standards need to be created for modifying and adapting the EBPs while maintaining their fidelity.
    Addictive behaviors 01/2011; 36(6):630-5. · 2.25 Impact Factor
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    ABSTRACT: Objectives: Many vulnerable patient groups with addiction disorders receive treatment from independent, small community-based organizations (CBOs). A Robert Wood Johnson Substance Abuse Policy Research Program study surveyed CBO program directors in addiction treatment centers with grants from CSAT to implement evidence-based practices and assessed director attitudes regarding use of pharmacological and behavioral evidence based treatments. Methods: Data from online surveys completed by 250 CBO program directors were analyzed using one-way ANOVA and regression methods. Five point Attitudinal Likert scales (McCarty et al., 2007) were used to assess attitudes regarding a range of evidence addiction treatments Findings: Significant results include: directors of programs serving higher percentages of homeless had more negative attitudes about use of buprenorphine and naltrexone; directors serving higher percentages of clients with co-morbid addiction and mental health disorders had more negative attitudes toward buprenorphine; directors serving higher percentages of Latinos had more negative attitudes toward routine screening for psychiatric disorders and use of psychiatric medications; directors in organizations with greater staffing and training resources had more positive attitudes about pharmacological and behavioral therapies. Implications: CBOs providing substance abuse treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological, evidence-based interventions. These attitudes may result in CBOs underutilizing the range of evidence-based treatments available that may benefit their client populations. Learning Objectives: 1. Discuss potential health impacts of having vulnerable subgroups underutilize pharmacological therapies for addiction disorders. 2. Identify strategies to increase knowledge about the range of evidence based addiction treatments available in addiction treatment CBOs.
    138st APHA Annual Meeting and Exposition 2010; 11/2010