North Carolina Improves Evidence-Based Practices

Like most states, North Carolina has limited financial resources. Things are especially tough for those working to reduce alcohol and substance abuse in the state. Substance abuse shares a state government division with mental health and developmental disabilities, but its funding is much more limited than the other two sections. Fortunately, the state has found a way to overcome that problem.

"The way to get more out of your dollar is to improve your practices," explained Flo A. Stein, M.P.H., Chief of Community Policy and Management at the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. "In fact, our legislature has taken the lead in calling for a reformed system that pays for practices that there's evidence to support. As a result, we've been actively encouraging practice change."

Much of that support has come from SAMHSA'S Center for Substance Abuse Treatment (CSAT). Since 2001, the state has been using funding from CSAT's Practice Improvement Collaboratives program (See SAMHSA News, Volume IX, Number 3, p. 8) to help bridge the gap between research and practice. And now one community in North Carolina is taking the next step to integrate evidence-based practices even further, with a new CSAT grant called Strengthening Treatment Access and Retention, as well as other SAMHSA-funded efforts. Improving Practices

According to Ms. Stein, the umbrella under which all of the state's practice improvement activities for addiction take place is the Practice Improvement Collaboratives grant. The 3-year project is designed to help grantees set an agenda for improving addiction services and adopting evidence-based treatment practices.

Practice

Improvement Collaboratives

Forging Partnerships

Bringing researchers and practitioners together plays a key role in achieving these goals, explained project officer Susanne R. Rohrer, R.N., a public health analyst in CSAT's Division of Services Improvement. "The goal is to bring researchers and practitioners together to lay the foundation for collaborative efforts," she said. "It's a feedback loop: The researchers encourage the practitioners to adopt best practices, and then the practitioners provide feedback to the researchers."

The way to get more out of your dollar is to improve your practices.

That's just what's happening in North Carolina, where the grantee is a nonprofit organization called the Governor's Institute on Alcohol and Substance Abuse, Inc., in Research Triangle Park. According to principal investigator Wei Li Fang, Ph.D., Director for Research and Development at the Institute, the project ensures that

practitioners are not only using best practices, but also using them correctly.

"We've had severe budget cuts in the last few years, so there's not as much money going to continuing education," Dr. Fang explained. "There are also problems with burn-out and staff turnover. What we're trying to do is to identify practitioners' needs and provide them with the necessary training, support, and encouragement to adopt best practices."

The project has four specific objectives: Developing and implementing a statewide agenda to improve practices. Dr. Fang and her colleagues have worked with substance abuse directors and clinicians around the state to come up with a training agenda. Training priorities identified so far are relapse prevention, co-occurring substance abuse and mental health disorders, and motivational interviewing. Motivational interviewing is a counseling style designed to help clients change their behavior by exploring and resolving their ambivalence about that behavior.

Once trained, practitioners are expected to spread the word to others. After providing scholarships to an intensive training program on co-occurring disorders, for example, the Practice Improvement Collaboratives project expects the 17 participating practitioners to make five presentations each to other clinicians and members of the community in the next year.

Expanding and strengthening the integration of a statewide network of researchers, substance abuse treatment providers, educators, policymakers, advocates, consumers, and others. The project has created five regional consortia to help meet its goals.