Adapting intake procedures to improve treatment delivery in addiction treatment

这项以患者为导向的指导研究职业发展应用程序(K23)将为 马戈·赫洛克博士将成为新墨西哥大学(UNM)和研究中心的独立研究员 关于酒精、药物使用和成瘾(CASAA)。她的目标是开发集成和测试的专业知识 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。作为开发专业知识的第一步 成瘾实施科学，候选人提出了一项原创的、有指导的研究研究，重点是 用循证干预取代全面评估(动机访谈[MI]) 在客户最初接触成瘾治疗计划期间，以提高客户的进入、参与度和 留存。成瘾治疗方案的过早辍学率最高，大约 44%的客户在入职评估后退出。以评估为基础的摄入量可能是导致高 由于强调收集信息而不是探索客户原因，客户中途退学率 寻求治疗。这项研究建立在大量文献的基础上，支持MI作为其他证据的前奏- 基于治疗，通过使用有效性-实施混合设计来促进治疗参与 为了(1)在病人进入和参与治疗时检查MI的临床效用，以及(2)使用 采用混合方法评价治疗人员对实施可行性的看法。另外， 治疗因素(准备改变；工作联盟)被认为是 在给定治疗前因素的情况下，与敬业度相关的结果往往可以解释 客户退学。这项有指导的学习将提供实践培训，以帮助应聘者发展以下专业知识 建立她自己的独立成瘾研究项目。在她的指导团队的指导下，朱莉博士。 赫洛克的培训计划和指导性学习是整合的，将在 以下领域：(1)开展成瘾治疗方案的临床疗效研究(Theresa Moyers&Barbara McCrady；UNM)，(2)实施理论和应用(Geoffrey Curran；UAMS& (3)执行进程评价(Theresa Moyers；UNM&Geoffrey Curran； (4)客户和提供商数据的高级量化分析(Katie Witkiewitz；UNM)。全 导师还将在整个颁奖期间协助赫洛克博士进行赠款准备和提交。在……里面 除了在CASAA接受培训外，赫洛克博士还将完成与该研究所的实质性课程工作 圣路易斯华盛顿大学实施科学学者和高级量化课程 在新墨西哥州大学。总体而言，赫洛克博士的培训目标和指导研究与NIDA对1)的关注是一致的 开发创新方法以改进医疗保健提供系统，以及2)确定 可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).