In the Diffusion of Innovations Everyone Changes: Linking Practice with Scientific Research

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In the Diffusion of Innovations Everyone
ChangesLinking Practice with Scientific
Research

• James L. Sorensen, Ph.D.
• University of California, San Francisco and San
  Francisco General Hospital.
• American Psychological Association
• San Francisco, CA (August 2007) Support from
  NIDA (U10DA15815, R01DA14922, R01DA014470,
  P50DA09253) and Robert Wood Johnson Foundation..

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DISSEMINATION, DIFFUSION

• Dissemination
• To scatter seed, far and wide
• Diffusion is a two-way process
• An intermingling of molecules

Everyone changes
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PREVIEW

• 1. Diffusion can be slow
• 2. Principles of successful diffusion
• What are the needs in substance abuse?
• Selected resources

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1. DIFFUSION CAN BE SLOW

• Why the long lag between knowledge and adoption?
• Scurvy 194 years

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Illustration of Diffusion Barriers The Dvorak
Keyboard
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LIVING HISTORY OF DIFFUSION The LCD Projector

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BRIEF HISTORY OF PROJECTION

• 2nd Century Magic Lantern
• 1888 discovery of liquid crystalline structure
• 1950s Kodachrome35 mm projectors
• 2004 Last Slide Projector made by Kodak
• 2010 LCD projector sales may top 7,000,000

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2. WHAT AFFECTS DIFFUSION OF INNOVATIONS?

• The nature of innovations
• Complex?
• Compatible?
• The organizations (the target of adoption)
• Organizational slack
• Fit with the clients
• Organizational climate
• Champions of change
• The dissemination process
• Active and in-person techniques work better
• Also are more costly

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3. DISSEMINATION NEEDS IN SUBSTANCE
ABUSEEffective Treatments

• Relapse Prevention
• Supportive-Expressive Psychotherapy
• Individualized Drug Counseling,
• Motivational Enhancement Therapy,
• Behavioral Therapy for Adolescents
• Multidimensional Family Therapy for Adolescents
• Multisystemic Therapy
• Combined Behavioral and Nicotine Replacement
  Therapy for Nicotine Dependence Addiction
• Community Reinforcement Approach Plus Vouchers
• Voucher-based Reinforcement Therapy for Patients
  in Methadone Maintenance Treatment
• Day Treatment with Abstinence Contingencies and
  Vouchers
• Matrix Model of Drug Abuse Treatment
• 1 Adapted from National Institute on Drug Abuse,
  1999. Principles of Drug Addiction Treatmetn
  A Research Based Guide. Availabile at
  http//www.nida.nih.gov/PODAT/PODAT4.html

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EVIDENCE-BASED INTERVENTIONS
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RESEARCH-DEVELOPED INTERVENTIONS

• Behavioral Treatments
• Motivational Interviewing
• Contingency Management
• Pharmacotherapy
• Naltrexone
• Buprenorphine

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Buprenorphine in WiredApril 2005
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4. RESOURCES

• CTN Dissemination Library
• Implementation Science
• USF review

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Clinical Trials NetworkDissemination Library
Technology Transfer in Drug Abuse
Treatment http//ctndisseminationlibrary.org
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Implementation Science(new journal)
http// www.implementation science.com
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USF Review

• http//nirn.fmhi.usf.edu

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IN SUMMARY

• Change is slow
• And sometimes never happens (keyboard)
• Many innovations can be useful in our field
• Reasons for change are multifactorial
• Need more information

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WHY LCD?

• Flexible
• Advances in technology
• Trained workforce (compatible)
• Dissemination methods?

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3. Needs in Substance Abuse Area WHY THE GAP?

• Little overlap between common treatment methods
  and those with scientific evidence
• Due in part to history of isolation from
  mainstream health care
• Treatments came from an alternate system of care,
  compassionate peers
• Resulting polarization of science vs. practice

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TREATMENT-DEVELOPED INTERVENTIONS

• Self-Help Programs
• Drug Courts

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An Alternative to Incarceration

• Behavioral Health Court offers counseling to
  criminal defendants with psychological disorders.
  Cheaper than jail, its changing lives.

• San Francisco Chronicle 1-23-2006

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RESEARCH NEEDS RE. DISSEMINATION

• Not much research in addictions area
• Top-down versus partnership models
• Adopt or Adapt (fidelity or reinvention?)
• Measures of diffusion
• Effectiveness of training

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DISSEMINATION RESEARCH NEEDS

• What learning experiences are needed?
• How do treatments work? (vs. black box)
• What prevents relapse? (to old ways)
• Individual organizational differences?
• What system factors matter?