Comments on: Implementation science: Filling the gap between research & practice

By: Nwhal

Nwhal — Sun, 18 Apr 2010 22:48:21 +0000

Change is probably the hardest thing to ever do because it involves a fear of the unknown. I think one thing people need to recognize is that it will not just be a battle but sometimes an uphill battle. Patience is required for change. I also agree that in order for an addict to change, that ultimately it comes down to him wanting to change. He or she wants to change because they want to, not for anybody else but for themselves.

By: Azusa

Azusa — Fri, 11 Dec 2009 18:41:37 +0000

I just watched the video “Understanding Treatment”, and thank you for creating this comprehensive piece for the public. Even though you talked about it in class, I watched it over and over again because I wanted to have a fixed understanding of treatment.
Until I came to your class, I didn’t have almost any idea what treatment for addiction was like, even though I had some knowledge about addiction itself. I knew so many people around me who had suffered or was suffering from addictive behaviors, but didn’t know what to do with them, not being able to think of what to say.
I didn’t think, honestly, addiction issue lied so deep inside of the addicts, and thought it was easy to be treated once they were in treatment. Understanding addiction is so essential to be working with juveniles in my future. Last year, I was working with the teenage girls who had children or were pregnant in a residential treatment center, but I never really paid attention to their addiction problems they had. Now, I think I should have listened more about it in deeper level when the girls shared their exeriences with me. I think I should have cerebrated more, giving more warm, proud, and affirming words when one of the girls said “Azusa, it’s the first anniversary for me, clean and sober! ”
The idea of disconnectedness in system treatment is so important for me and all people related to this field, because it is the huge block to be moved in order to improve addiction treatment in general. I also appreciate the slide of interacted factors that might create the addiction issues people are suffered from. This helps me to think and see critically what the real issues are, addiction is a form of expression.
Manage, resolve and create is an overreaching model of addiction treatment; and this is a good indicator for me to see what we can start to work on in order to manage addiction as a goal.
I really appreciated the video that gave me better understanding of its complexity of the addiction problem.

By: Haley Weiner

Haley Weiner — Fri, 11 Dec 2009 12:31:43 +0000

Hmm, that algorithm shows some pretty serious implications for the implementation of any American systems right now, not just addiction management, namely because we’re broke! So you know cheap is going to be part of the equation. That just leaves fast or good…I have heard that much of the Federal stimulus money is yet unspent, because a lot of the “shovel ready” projects that were supposedly ready to be implemented in order to promote industry in this country actually aren’t. In a cash-strapped economy, it seems like something like implementation science would be the first to go, as to the untrained eye it might seem like something that could be sidestepped, though of course, the successful application of knowledge is dependent on the logistics of actually making it happen!

By: sarahk

sarahk — Fri, 11 Dec 2009 03:06:06 +0000

This brings a lot of ideas up about education for those working in the public sphere who may encounter individuals with addictions. First, educating social work clinicians by giving them one class on substance abuse is not enough. Many clinicians in the field of psychotherapy will be treating clients who struggle with addiction, and will not be well educated on what to do with such a client. Second, a friend of mine at OHSU said that through his four years as a medical student, he had to sit through just one four hour lecture on how best to deal with patients coming through the hospital who may have addictions. They proposed the CAGE questions, and not much more. As research has shown, this is not enough to get an individual to accept that they may be struggling with addiction, though it may encourage them to think more deeply about it, assuming that they are coherent when they receive the questions. Third, those working in the public education system, health care system, and other social services need to be given better options for assessment and diagnosis of patients with addictions. The research that has been done can greatly benefit addictions treatment today. Lastly, if this country spent half of what is spent promoting drug and alcohol use on a daily basis towards a better addictions treatment model, maybe there would be more people being helped.

By: Molly

Molly — Fri, 11 Dec 2009 00:21:25 +0000

I couldn’t agree more Dina! One of the main frustrations I had when I taught is that the structure of the education system: the class size, the mandated testing, and so on, made it nearly impossible to implement the effective practices that had been proven by research and taught to me in my graduate program. I also think your onto something with the visionary concept. Several stories come to mind, when I think of the word visionary. People who combine their vision with action have really had some tremendous outcomes. I’m going to the get some of the details wrong, but I believe it was in city in Brazil that elected an architect for mayor, and he came up with a radical yet simple way to transform the bus system that improved the lives of many people. I think the strength of his vision came from the combination of two things – one he seemed to be thinking outside of the box, and two, I think the situation was desperate enough that people were open and willing to try anything. That is one unfortunate issue I see with visionaries, it seems like that the situation has to be really desperate before visionaries can get the support they need to make really effective change, otherwise human nature seems to like to stay safely at the status quo. Another story that comes to mind is a primary care physician outside of Seattle who noticed recently that many of his patients were not showing up for general treatments or bringing their sick kids in. He started to ask around, and many of them said they couldn’t afford their insurance and their co-pays. He decided to stop working with the insurance companies and just had his clients pay affordable amounts out of pocket. The story claimed that he was making just as much as he did when he was billing with insurance, only now he has a lot less paperwork. Hopefully some of us can work within or outside of the system and make some significant changes!

By: Molly

Molly — Fri, 11 Dec 2009 00:14:57 +0000

There was a program on NPR last Friday and the subject was “Can Science make Psychotherapy more Effective.” This is the link:
http://www.npr.org/templates/story/story.php?storyId=121092295.
The main topic was – if we have empirically proven psychotherapy methods why aren’t they being taught and why aren’t they being practiced. The debate ends without any conclusions, but it’s an interesting exploration of the very issues your blog is commenting on, implementation. I didn’t feel very encouraged by the debate, as it seems to run into the same dead end feeling, like so many debates in this country, i.e., health care reform. We humans tend to see things how we see them, and it’s pretty hard for us to see them any other way, but on the brighter side, it does seem that as people plod along and make small steps towards a goal, larger scale change does eventually happen!

By: Meghan

Meghan — Thu, 10 Dec 2009 04:21:12 +0000

I really like what Kelly said about how we need to change addiction treatment to cheap and good, rather than cheap and fast. As we have learned in class through lecture and research articles, fast addictions treatment is rarely effective. It may work for a little while but typically the addiction is either resumed or replaced by a different addiction or behavior. I think this emphasizes the importance in long-term treatment/care for people with addictions. This can be done cheaply (self-help groups, sponsors, etc.) and also moves away from the “get in, get out” view of addiction treatment

By: Kelly L

Kelly L — Wed, 09 Dec 2009 22:25:08 +0000

I agree that our socieity has seemed to have continually implemented the “cheap” and the “fast”. From household appliances, to laptop computers, to school programs, to addictive treatment programs, we can find cheap and fast strategies that have continued to fail.

We must shift these implementation strategies to cheap and good, and take the focus off of fast. Things that are done hastily are more likely to fail. The most important focus should be on creating addiction treatment programs that are good, and only then we can worry about the cheap factor. It is interesting that this brings me back to my very first response a couple months ago, in which I responded about our society’s addiction to time. It seems that everyone on all levels of the system is affected by this time addiction, hence, why we create things so quickly. Quality solutions are far more important than quick solutions. I have recently slowed my life down in areas that I have the ability to do so, and have noticed that I am incredibly happier as a result. So, slow down Americans!

By: Troy S

Troy S — Tue, 08 Dec 2009 22:38:24 +0000

Unfortunately seems as though our health care system is doomed to continue devaluing”good” in the cheap/fast/good trifecta. With the widespread need for health care and the astronomical costs of our existing health care system, any solution that is good but not fast or cheap (as cheap is often dependent on being fast) will not satisfy the people who budget tax dollars or institutional expenditures, and it will not satisfy the voting public who need to be convinced of the necessity of good care over fiscal conservation. That is a tall order, as the broad societal benefits of good mental health are not as tangible as, say, springing for a medical operation that resolves an easily definable and observable problem.

Of course, Wexelblat’s scheduling algorithm is not a hard and fast law. To varying degrees, solutions may be discovered that are cheap, fast, and good. In those instances, such a satisfying solution is likely to be adopted quickly and without controversy, although as Dr. Fitzgerald notes, translating ideal treatments to consumer benefits is dependent on effective implementation, an area where funding is lacking.

By: Kendra

Kendra — Sun, 06 Dec 2009 19:49:28 +0000

Great post, Deena, I couldn’t agree more! So much of what we’ve talked about it this course has direct connection to the world of education. We desperately need visionary leaders in this realm if we want to see change.

As noted in previous posts, the changes that are needed in education, health care, and addiction treatment, are complicated. We can’t expect quick-fixes and therefore, we need to be ready to work hard and even face discomfort. What I think is most important is that in our efforts to bring change, our goals remain clear, attainable, and incredibly worth it.

As counselors working in the field of addictions, we need to be convinced that our efforts are worthwhile. In the midst of greater contexts in need of reform (health care, education, etc.) our goal of providing holistic, effective therapy to our clients must remain clear and attainable or we will become satisfied with the status quo. We depend on others (and ourselves) to research the best practices in a way that makes them feasible and worthwhile.

Likewise, our clients will be looking to us to provide assurance: that even though managing addictions is incredibly difficult and at times uncomfortable, it is worth it. Reminding myself that we all need this hope in order to create change in our lives, it’s easier to remember that really, we’re all in the same boat.