Substance abuse treatment is often complicated by a client's family, employment, psychiatric, or legal problems. When these co-existing issues are addressed with evidence-based practices (EBPs), outcomes improve. The expansion of EBPs is especially important regarding Medication-Assisted Treatment (MAT), which is the subject of a number of federal and state treatment initiatives. However, despite extensive efforts to educate clinicians through training, the integration of EBPs into clinical settings continues to lag. EBPs are most likely to be implemented if information is available at the point of service. These challenges strongly suggest the need for a technical solution. This proposal seeks to develop a clinical decision support (CDS) system within electronic health records (EHRs) through a collaboration of two companies that have developed a national standing in substance abuse treatment - Inflexxion (Newton, MA) and FEi (Columbia, MD). Inflexxion and FEi are seeking to develop the Behavioral Health Advisory Module (BHAM). This CDS will "plug into" Web Infrastructure for Treatment Services (WITS), a web-based EHR supported by FEi. By applying advanced statistical techniques (latent class analysis) and data mining to the extensive WITS dataset, we can assess the relationships between client profiles, delivered services, and outcomes. BHAM can identify which profile best fits a client and provide: (1) tailored, evidence-based practice recommendations, and (2) client engagement strategies (which have been shown to improve outcomes). In Phase I, we: completed a model comprised of three profiles of opiate/opioid users;developed an interactive prototype of BHAM;and demonstrated acceptance of the CDS concept by substance abuse experts and clinicians. The concept was also reviewed and supported by CDS and substance abuse expert consultants. The goal of Phase II is to fully develop and test BHAM in substance abuse treatment centers. The field test will examine the primary hypotheses that, relative to the Control condition, counselors in treatment facilities assigned to the BHAM program will provide or offer their clients significantly greater matched evidence-based and wraparound services. We will also examine the extent to which clients being treated by counselors in the Experimental condition, relative to the Control Condition, demonstrate significantly: (1) greater engagement in treatment, (2) fewer alcohol/drug relapses, and (3) greater psychosocial functioning. And finally, we will examine the cost effectiveness of BHAM.
The public health potential of this project is very significant, and will shift the paradigm away from an asynchronous, training-based, evidence-based practice (EBP) implementation model, to a data-driven, continuing care model. The Behavioral Health Advisory Module (BHAM) can help serve the critical public health goal of overcoming barriers to the implementation of EBPs. It can also assist substance abusers in maintaining their engagement with treatment and achieving better overall outcomes.