The applicant is requesting five years of funding though the Mentored Career Development Award (K01) program to enhance his knowledge base and methodological skills for diffusion of renovation research-- specifically, to translate evidence-based care for depression into community substance use treatment settings. The applicant's strong background in medical sociology, the developmental course of substance use disorders, and health services/outcomes research is an ideal foundation for developing expertise in technology transfer in these settings. The proposed career development plan supports this goal by providing specific training in five areas: 1) organizational change theory and methods; 2) clinical provision of care for substance abuse and depression 3) the current organizational/policy structure of substance abuse and mental healthcare services, focusing on continuity of care within and across systems; 4) quantitative and qualitative methods pertinent to the proposed research plan; and 5) the ethical conduct of research. The research plan seeks to develop, implement, and test an organizational intervention in community substance abuse treatment settings to establish guideline-concordant treatment of comorbid depression. The intervention will assist programs in their own implementation of a guidelines-based treatment algorithm to improve the recognition of depression and initiation of pharmacotherapy. The algorithm will involve two assessment-to-treatment steps-- 1) early post-detoxification assessment of depressive symptoms plus a patient history of depression, with initiation of pharmacotherapy if the patient reports both current symptoms and a history of major depression during periods of sobriety; 2) assessment of depression symptoms at least 4 weeks post-detoxification, with initiation of pharmacotherapy if an independent diagnosis of depression is indicated. We know from previous guideline implementation research that the simple dissemination of guidelines does little to influence provider/system behavior. Rather, a multi-component diffusion of innovation intervention is necessary to maximize the adoption of guideline concordant behavior. Study 1 analyzes the barriers and facilitators to technology transfer of depression management in participating facilities. These data will inform the development of the technology transfer intervention, its implementation tools, and the depression algorithm. Study 2 implements and tests the intervention. The evaluation will examine program- and provider-level outcomes. Program level outcomes will include feasibility, extent of adoption of the algorithm, and provider/organizational attitudes and beliefs about the intervention's design and effectiveness. Patient-level outcomes will include depressive symptoms, substance use outcomes, medication adherence quality of life, and services use.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Scientist Development Award - Research & Training (K01)
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Human Development Research Subcommittee (NIDA)
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Hilton, Thomas
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University of Arkansas for Medical Sciences
Schools of Medicine
Little Rock
United States
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Curran, Geoffrey M; Sullivan, Greer; Mendel, Peter et al. (2012) Implementation of the CALM intervention for anxiety disorders: a qualitative study. Implement Sci 7:1-11
Curran, Geoffrey M; Bauer, Mark; Mittman, Brian et al. (2012) Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 50:217-26
Mancino, Michael; Curran, Geoffrey; Han, Xiaotong et al. (2010) Predictors of attrition from a national sample of methadone maintenance patients. Am J Drug Alcohol Abuse 36:155-60
Curran, Geoffrey M; Thrush, Carol R; Smith, Jeffrey L et al. (2005) Implementing research findings into practice using clinical opinion leaders: barriers and lessons learned. Jt Comm J Qual Patient Saf 31:700-7