Evidence-Based Practice for Adolescent Substance Abuse August 30, 2008
Posted by rickbarth in Youth.1 comment so far
This is a new document from North Carolina that does a very find job in overviewing the issues, describing 11 evidence based interventions, and providing a fairly clear discription (in Appendix B) regarding their basis for rating these as evidence based. Although Julia Littel has warned us to be cautious about interventions even when they have the consensus support of many evaluative groups, this is still a good starting point. Although it is certainly possible that some of the interventions in this document will not turn out to be as powerful as hoped (and some have very few studies behind them) It is quite unlikely–at least in the short term–that any interventions not in this document would be stronger than the ones discussed here. The project has a distinguished national advisory board to provide some additional insight that might not be available in the published literature about these studies. Here is how they describe their purpose:
What information does this primer contain? This primer contains a brief overview of 11 evidence-based treatment programs (EBTs) and one evidence-based assessment commonly used in the adolescent substance abuse field. They were selected because of their inclusion in several databases of EBPs and the strength of the literature available on them. See Appendix B for a matrix that summarizes those databases and which EBPs they include. A brief description of behavior therapy and cognitive-behavioral therapy comes first because they form the foundation of several of the treatments presented. We also are including a four-page fact sheet for caregivers that provides a brief description of each approach. The primer concludes with additional resources highlighting the most current available research on each EBP (see Appendix C).
Enjoy. (The first of these is the full primer and the second is the caregiver material)
National Institute of Mental Health (NIMH) Strategic Plan 2008 August 29, 2008
Posted by rickbarth in Uncategorized.1 comment so far
NIMH’s strategic plan is out and although it largely addresses research that needs to be done there are also important portions of this 39 page document that direct attention to issues related to evidence based practices. In one pithy section, NIMH Director Tom Insel indicates that research will be directed at the 4 Ps of research: “increasing the capacity to Predict who is at risk for developing disease; developing interventions that Preempt (or interrupt) the disease process; using knowledge about individual biological, environmental, and social factors for Personalized interventions; and ensuring that clinical research involves Participation by the diversity of persons involved in health care. (p. ii). This presages much about the report with regard to the idea of developing personalized approaches that use genetic assessments and and psychometric developments to determine the best course of treatment for individuals. There is also a very brief but fascinating discusison of what they expect to happen with regard to the treatment of PTSD–treatments involving behavioral interventions and medical treatments that appear to be able to substantially reduce fearful responses. If you are interested in the future of mental health research and treatment this is a good glimpse into the NIMH’s direction
http://www.nimh.nih.gov/about/strategic-planning-reports/nimh-strategic-plan-2008.pdf
CBT for SSRI-Resistant Depressed Adolescents August 17, 2008
Posted by rickbarth in Uncategorized.add a comment
I found this video on Information for Practice, a terrific resource if you don’t know it, http://www.nyu.edu/socialwork/ip/.
The video discusses a large multi-site 4 armed randomized clinical trial that examines depressed adolescents who do not benefit from medications known as SSRIs [Selective serotonin reuptake inhibitors](examples are Prozac, Zoloft, Paxil, Celexa). The study compares change to another SSRI, CBT plus another SSRI, change to a major antidepressant [venlafaxine, a SNRI] (e.g., Effexor), or CBT plus the venlafaxine. The results show that the youth do better with CBT plus medication and that the youth who took the SNRI had more side effects (as researchers and clinicians would predict from prior experience with these medications) but no better reduction in depression for the youth. Thus there is no evidence to suggest that prescribing the SNRI is needed. The CBT plus the SSRI was the best for SSRI resistant youth because it had fewer side effects but no less benefit. There were no completed suicides in this study and no differences in suicide rates by group. A nice study that adds to the growing information that supports the use of CBT and SSRIs.
The video discussing this research is at: http://www.medscape.com/viewarticle/579034
The study citation is: Brent, D., Emslie, G., Clarke, G., Wagner, K. D., Asarnow, J. R., Keller, M., et al. (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression – The TORDIA randomized controlled trial. Jama-Journal of the American Medical Association, 299(8), 901-913.
Improving Prisoner/inmate Reentry and Transitions August 8, 2008
Posted by rickbarth in Uncategorized.add a comment
This very intertesting new website from the Justice Center of the Council of State Governments may be a “best practice” when it comes to organizing information that “should” be collected to help with the planning and provision of services to help prisoners, ultimately, succeed in their return to the community. The website identifies issues that warrant screening and assessment as well as the timing of those assessments and, in the details section, summaries of the kind of assessments that are available. Now, we should all recognize that “assessments do not an intervention make” and that there has to be much more than assessments to yield meaningful results but assessments do have an important role if subsequent services are available and the assessments are scored in a timely and meaningful way to help guide the selection and delivery of assessments. I’m not sure that this is true in the area of prisoner/inmate reentry and there is no evidence presented to show that using this website actually improves outcomes. It’s worth a look, anyway, becuase it may be the best that we have to go on, at this point: http://tools.reentrypolicy.org/assessments/focusarea/Physical+Health
A longer press release for the site is pasted below:
| August 5, 2008
CSG Justice Center Releases Innovative Web-Based Tool to Help State and Local Officials Improve Prisoner/Inmate Reentry
The Council of State Governments Justice Center unveiled today a first-of-its-kind interactive online tool for state and local government professionals working to make prison and jail reentry safer and more successful. The tool was developed with support from the Bureau of Justice Assistance, U.S. Department of Justice, to familiarize state and local government officials with different assessment instruments used in corrections systems across the nation to gauge the risks and needs of someone admitted to prison or jail. “The only way we can stop the cycle of recidivism is to start planning for an individual’s return to the community from the very first step he or she takes into a prison or jail,” said Justin Jones, Director of the Oklahoma Department of Corrections. “Prison and jail officials need the latest thinking on assessment tool options to inform prison and jail programming, as well as decisions about release and community supervision.” According to the Justice Center, such information is typically collected through a series of screenings, assessments, and evaluations conducted before sentencing and immediately after admittance to a correctional institution. This information should be updated periodically throughout the person’s incarceration and during any community supervision. The information also should be used to make decisions about how to manage risk, deliver treatment and other services, and allocate resources. “One reason this tool is so valuable is because it allows staff to search for key information at particular decision points (such as admission to a facility) or to search by topic areas (such as risk and security classifications, mental health, substance abuse, education, employment, housing, family relationships, and financial status),” said AT Wall, Director of the Rhode Island Department of Corrections. “Each of these categories includes descriptions of information to gather, examples of validated assessment instruments, resources and recommendations about prioritization, and suggestions for who should be charged with collecting each kind of data.” The online resource is part of a larger toolkit the Justice Center plans to release in fall 2008 that will include a policy guide and three case studies of the collective experiences of jurisdictions that applied the guide’s recommendations to improve their assessment processes. The availability of the complete toolkit will be announced this fall in an upcoming issue of the Reentry Policy Council’s newsletter. Users can access the online assessments tool on the Reentry Policy Council website at http://tools.reentrypolicy.org/assessments/chart. The Council of State Governments Justice Center is a national nonprofit organization that serves policymakers at the local, state, and federal levels from all branches of government. It provides practical, nonpartisan advice and consensus-driven strategies-informed by available evidence-to increase public safety and strengthen communities. For more resources on reentry, please visit the Justice Center Reentry Policy Council website- http://www.reentrypolicy.org/. |
