Adapting intake procedures to improve treatment delivery in addiction treatment

此指导的以患者为导向的研究职业发展应用程序（K23）将为以下人员提供受保护的时间 博士Margo Hurlocker成为新墨西哥州大学（UNM）和中心的独立研究员 酒精，物质使用和成瘾（CASAA）。她的目标是发展专业知识， 临床试验设计中的实施策略，以改善治疗提供系统和客户 参与成瘾和其他行为治疗计划。作为发展以下方面专门知识的第一步， 成瘾实施科学，候选人提出了一个原创的，指导性的研究，重点是 用循证干预（动机性访谈[MI]）取代全面评估 在客户与成瘾治疗计划的初次接触期间， 潴留成瘾治疗计划有一些最高的过早辍学率， 44%的客户在接受评估后退出。基于评估的摄入量可能有助于高 由于强调收集信息而不是探讨客户的原因，客户退出率 寻求治疗这项研究建立在大量文献的基础上，这些文献支持MI作为其他证据的前奏- 通过使用有效性-实施混合设计， （1）在患者入院和参与治疗时检查MI的临床效用，以及（2）使用 混合方法的方法来评估治疗人员的实施可行性的观点。还有， 在治疗因素（准备改变，工作联盟）被视为假定的机制， 考虑到治疗前因素，与治疗相关的结局往往会解释治疗前因素的少量方差。 客户端dropout这项指导性研究将提供实践培训，以帮助候选人发展专业知识， 建立了自己的独立成瘾研究项目在她的导师团队的指导下， Hurlocker的培训计划和指导学习是一体化的，将促进在 以下领域：（1）在成瘾治疗计划中进行临床有效性研究（Theresa Moyers & Barbara McCrady; UNM），（2）实现理论与应用（Geoffrey Curran; UAMS & Kamilla Venner; UNM），（3）执行过程评价（Theresa Moyers; UNM & Geoffrey Curran; UAMS），以及（4）客户和提供商数据的高级定量分析（Katie Witkiewitz; UNM）。所有 导师还将协助博士Hurlocker在整个颁奖期间的赠款准备和提交。在 除了在CASAA的培训外，Hurlocker博士还将在该研究所完成实质性的课程， 圣路易斯华盛顿大学的实施科学学者和高级定量课程 在新墨西哥大学总的来说，Hurlocker博士的培训目标和指导研究符合NIDA对1） 开发创新方法，改善医疗保健服务系统，以及2）识别 可以促进患者参与的治疗中机制（例如，PAR-18-007）。

This Mentored Patient-Oriented Research Career Development application (K23) will provide protected time for Dr. Margo Hurlocker to become an independent researcher at the University of New Mexico (UNM) and Center on Alcohol, Substance use, And Addictions (CASAA). Her goal is to develop the expertise to integrate and test implementation strategies within clinical trial designs to improve the treatment delivery system and client engagement in addiction and other behavioral treatment programs. As a first step in developing expertise in addiction implementation science, the candidate proposes an original, mentored research study focused on replacing the comprehensive assessment with an evidence-based intervention (Motivational Interviewing [MI]) during a client’s initial contact with an addiction treatment program to improve client entry, engagement and retention. Addiction treatment programs have some of the highest premature dropout rates and approximately 44% of clients drop out after the intake assessment. The assessment-based intake may contribute to the high rates of client dropout given the emphasis on gathering information rather than exploring client reasons for seeking treatment. This study builds on a large body of literature supporting MI as a prelude to other evidence- based treatments to facilitate treatment engagement, by using an effectiveness-implementation hybrid design to (1) examine the clinical utility of MI at intake on client’s entry and engagement in treatment, and (2) use a mixed-methods approach to evaluate treatment personnel’s’ perspectives of implementation feasibility. Also, in-treatment factors (readiness to change; working alliance) are examined as putative mechanisms of engagement-related outcomes given pre-treatment factors tend to account for a small amount of variance in client dropout. This mentored study will offer hands-on training to help the candidate develop the expertise to establish her own independent addiction research program. With the guidance of her mentorship team, Dr. Hurlocker’s training plan and mentored study are integrated and will promote a comprehensive skill set in the following areas: (1) conducting clinical effectiveness research in addiction treatment programs (Theresa Moyers & Barbara McCrady; UNM), (2) implementation theory and application (Geoffrey Curran; UAMS & Kamilla Venner; UNM), (3) implementation process evaluations (Theresa Moyers; UNM & Geoffrey Curran; UAMS), and (4) advanced quantitative analyses of client and provider data (Katie Witkiewitz; UNM). All mentors will also assist Dr. Hurlocker in grant preparations and submissions throughout the award period. In addition to training at CASAA, Dr. Hurlocker will complete substantive coursework with the Institute for Implementation Science Scholars at Washington University in St. Louis and advanced quantitative coursework at UNM. Collectively, Dr. Hurlocker’s training goals and mentored study are in line with NIDA’s attention to 1) the development of innovative methods to improve the healthcare delivery system, and 2) the identification of in-treatment mechanisms that can promote patient engagement (e.g., PAR-18-007).