TY - JOUR
T1 - Implementing methadone medical maintenance in community-based clinics
T2 - Disseminating evidence-based treatment
AU - King, Van L.
AU - Burke, Christopher
AU - Stoller, Kenneth B.
AU - Neufeld, Karin J.
AU - Peirce, Jessica
AU - Kolodner, Ken
AU - Kidorf, Michael
AU - Brooner, Robert K.
N1 - Funding Information:
This work was supported by a grant from the Open Society Institute (Principle Investigator: V. King) and Postdoctoral Training Grant NIDA 5T32 DA07209 (Principle Investigator: G. Bigelow). We thank the research staff of The Johns Hopkins University School of Medicine (Kori Kindbom, Samantha Dibastiani, Rachel Burns, and Jeff Depo) and the staff of the participating programs for their interest and involvement in the project.
PY - 2008/10
Y1 - 2008/10
N2 - Methadone medical maintenance (MMM) is an effective intervention that minimizes the demands of opioid agonist treatment without compromising good treatment response. Despite the benefits of MMM to both patients and treatment programs, little information is available to help community-based programs implement MMM and select patients who might benefit from this intervention. This study evaluates the impact of a seven-session seminar presentation combined with optional on-site consultation on subsequent changes in clinical programming and on the opinions of community-based treatment staff (n = 96) in five methadone maintenance treatment clinics regarding both the adoption of an MMM protocol and the use of an adaptive stepped care model to deliver it. The presentations were developed based on results from a randomized clinical trial (King, V. L., Kidorf, M. S., Stoller, K. B., Schwartz, R., Kolodner, K., Brooner, R. K. (2006) A 12-month controlled trial of methadone medical maintenance integrated into an adaptive treatment model. Journal of Substance Abuse Treatment 31, 385-393.) together with other studies of MMM to help program staff (a) understand the risks and benefits of MMM, (b) develop criteria to choose who may benefit from MMM, and (c) implement an adaptive stepped care delivery system that includes MMM as the least restrictive level of care. A survey of clinic staff opinion about MMM and stepped care was administered at baseline and at five other points over the course of the 1-year project. Overall, the presentations were rated highly favorable for content and presentation (3.3 on a 4-point scale). At the 12-month follow-up, staff were more likely to believe that MMM facilitates patient participation in community-based rehabilitation oriented activities (p = .026) and that MMM patients receive adequate counseling services (p = .025) and were more likely to support treatment that matches patients who are stable with minimal intensities of care (p = .041). One clinic modified its routine care to an adaptive stepped care model in response to the presentations, and 3 of the 5 clinics used MMM levels of treatment intensity at the end of the project. The results suggest that seminar presentations combined with on-site consultation may be a beneficial mechanism for helping staff at community-based programs learn about and adopt effective interventions developed and tested using rigorous research designs.
AB - Methadone medical maintenance (MMM) is an effective intervention that minimizes the demands of opioid agonist treatment without compromising good treatment response. Despite the benefits of MMM to both patients and treatment programs, little information is available to help community-based programs implement MMM and select patients who might benefit from this intervention. This study evaluates the impact of a seven-session seminar presentation combined with optional on-site consultation on subsequent changes in clinical programming and on the opinions of community-based treatment staff (n = 96) in five methadone maintenance treatment clinics regarding both the adoption of an MMM protocol and the use of an adaptive stepped care model to deliver it. The presentations were developed based on results from a randomized clinical trial (King, V. L., Kidorf, M. S., Stoller, K. B., Schwartz, R., Kolodner, K., Brooner, R. K. (2006) A 12-month controlled trial of methadone medical maintenance integrated into an adaptive treatment model. Journal of Substance Abuse Treatment 31, 385-393.) together with other studies of MMM to help program staff (a) understand the risks and benefits of MMM, (b) develop criteria to choose who may benefit from MMM, and (c) implement an adaptive stepped care delivery system that includes MMM as the least restrictive level of care. A survey of clinic staff opinion about MMM and stepped care was administered at baseline and at five other points over the course of the 1-year project. Overall, the presentations were rated highly favorable for content and presentation (3.3 on a 4-point scale). At the 12-month follow-up, staff were more likely to believe that MMM facilitates patient participation in community-based rehabilitation oriented activities (p = .026) and that MMM patients receive adequate counseling services (p = .025) and were more likely to support treatment that matches patients who are stable with minimal intensities of care (p = .041). One clinic modified its routine care to an adaptive stepped care model in response to the presentations, and 3 of the 5 clinics used MMM levels of treatment intensity at the end of the project. The results suggest that seminar presentations combined with on-site consultation may be a beneficial mechanism for helping staff at community-based programs learn about and adopt effective interventions developed and tested using rigorous research designs.
KW - Adaptive care
KW - Methadone medical maintenance
KW - Research dissemination
KW - Stepped care
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U2 - 10.1016/j.jsat.2007.12.002
DO - 10.1016/j.jsat.2007.12.002
M3 - Article
C2 - 18294805
AN - SCOPUS:51249097228
SN - 0740-5472
VL - 35
SP - 312
EP - 321
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
IS - 3
ER -