Center for Evaluation and Applied Research: Initatives to Promote the Health of Vulnerable Populations

Physician Training and Clinical Support Center for Methadone Prescribers (PCSS - M)

Over the past several years the prescribing of methadone has dramatically increased, both for the treatment of opioid dependence and for the treatment of chronic pain. Methadone is a well-studied, safe, and efficacious medication when prescribed and consumed properly. When used inappropriately, however, risk of overdose is high. Consequently, increased prescribing, coupled with minimal provider training on its use, has resulted in a significant increase in methadone related deaths. Responding to this need, the SAMHSA-funded Physician Clinical Support System for Methadone (PCSS-M), organized and managed by the American Society of Addiction Medicine (ASAM), educates and mentors physicians and other health care professionals on methadone treatment for opioid addiction and/or pain management. The Center for Evaluation and Applied Research has been contracted to develop a web-based resource center (www.pcssmethadone.org) with relevant educational materials and to design and implement an evaluation of the PCSS-M. Focusing primarily on process, the evaluation uses both quantitative and qualitative methods to gather data on utilization of the web-based resource center and mentorship services, as well as increases in knowledge related to methadone treatment and changes in methadone treatment practice among PCSS-M participants.

Integrated Buprenorphine and HIV Care Evaluation and Support Center (BHIVES)

The Drug Addiction Treatment Act of 2000 and the approval of buprenorphine (BUP) for the office-based treatment of opioid addiction provide a new opportunity to integrate addiction treatment and primary care. The Health Resources and Services Administration (HRSA), through its Special Projects of National Significance (SPNS), funded a five-year initiative to develop model programs that integrate HIV primary care and BUP treatment. NYAM, working in collaboration with the Yale University School of Medicine, Weill Cornell Medical College and each of the model programs, received funding for a multisite evaluation and technical assistance center as part of the initiative. The BHIVES multisite evaluation utilized a mixed method approach that incorporated medical chart review data, quarterly in-person assessments of health and functioning, qualitative interviews and satisfaction surveys, and site visits and in-depth interviews with project staff and stakeholders. Evaluation findings, which will be disseminated through a special supplement to JAIDS, will describe program outcomes with respect to HIV disease progression, use of opioids and other drugs, mental health status, and quality of life. In addition, we will address the feasibility of replicating effective program models; the human and financial resource requirements of integrated care; policy recommendations to promote better integration of medical and substance use services; and the broader impact of integrated services on providers, institutions, and local systems. NYAM has developed and maintains the project website (www.bhives.org), which houses information on buprenorphine and the project, conference presentations, and instruments and other forms utilized for implementation of the evaluation.

Steps to Safety

A project of Palladia, Inc., Steps to Safety, offers a comprehensive, integrated treatment program designed to address past trauma, support recovery, and promote housing stability among homeless men entering into Palladia's inpatient and out-patient substance abuse treatment programs. With funding through SAMHSA's Treatment for the Homeless initiative, the evaluation of Steps to Safety includes process and outcome measures collected from program participants and Palladia staff. Specific evaluation objectives are to: 1) document participation in the program, including number and characteristics of participants and their retention in the intervention; 2) assess program outcomes with respect to substance abuse treatment, mental health and housing readiness; 3) describe program implementation including facilitators and impediments to implementation and changes made to the original design; and 4) assess satisfaction and suggestions for improvement, from the perspective of clients and staff.

Community Factors, HIV and Related Health Outcomes in Men Who Have Sex with Men

This collaboration between the New York Academy of Medicine, The New York Blood Center (Project Achieve) and New York University is a multi-level, cross sectional study designed to identify key neighborhood-level characteristics within an urban environment that may influence sexual risk behaviors, drug and alcohol use and depression among men who have sex with men. Funded by National Institute of Child Health and Human Development, the Center for Evaluation and Applied Research has taken the lead on the qualitative component of the study, which included interviews with 30 men and analysis and reporting on interview results. Preliminary findings have been described in an upcoming article in a special issue of AIDS and Behavior.

Heroin Cessation and HIV Risk

There is a large body of literature describing substance use initiation, co-morbidities, risk behaviors, and the consequences of use. Treatment outcome research is also copious and significantly contributes to our understanding of cessation, albeit within a specific context. Yet few studies have focused explicitly on cessation, examining the multiple factors that motivate and facilitate it. Similarly, there is relatively little research on changes in substance use among community-derived samples and incorporating the perspectives of users. As part of the Center for Urban Epidemiologic Studies NIDA funded Heroin Cessation Project, The Center for Evaluation and Applied Research conducted a series of qualitative interviews with current and former heroin users to explore factors associated with heroin cessation, including barriers and facilitators to success. Findings form the basis of a stand-alone substudy and were used to inform the development of the case control survey instrument.

Physician Training and Clinical Support Center for Buprenorphine Prescribers (PCSS-B)

Because buprenorphine (BUP) may be prescribed for the treatment of opioid addiction by physicians in office-based settings, it has tremendous potential to both expand treatment capacity and to create new options for people unable or unwilling to seek treatment at methadone or other opioid treatment programs. The American Society of Addiction Medicine's (ASAM) PCSS-B project, funded (2005-2010) by SAMHSA's Center for Substance Abuse Treatment, was designed to support physicians and other health care providers who are new to BUP treatment and who would benefit from clinical guidance and/or training. The Center for Evaluation and Applied Research conducted a process and outcome evaluation of the PCSS-B, focused on program utilization, characteristics of program participants, and satisfaction with the program activities. Findings have been described in numerous presentations and in two journal articles.