National Frontier and Rural ATTC

National Addiction Workforce Work-GroupDecember 10, 2012

Serve as the national subject expert and key resource to PROMOTE the awareness

and implementation of telehealth technologies

PREPARE pre-service addiction treatment and allied health students on using

telehealth technologies by developing and disseminating academic curricula for

infusion into existing courses;

Create addiction treatment telehealth competencies and develop policy

recommendations for national license portability to encourage the addiction treatment and recovery workforce to ADOPT the use of telehealth services;

Use state-of-the-art culturally-relevant training and technical assistance activities

to help the frontier/rural addiction treatment and recovery workforce IMPLEMENT telehealth services.

Definitions

Telehealth ‘refers to the use of telecommunications and information technologies to provide access to health information and services across a geographical distance.’

Telemedicine –’Use of medical information exchanged from one site to another via electronic communications to improve patients’ health status’

Telehealth is not about technology itself but is a bridge to relationship with the patient in order to

provide care. Shore, 2012

Definitions

• Synchronous communications- Telephone counseling• Asynchronous Communications-

email or web-based programs• Some web-based programs include

both type of communications

National Addiction Workforce Group

Purpose: To assist/advise NFAR staff on issues relating to frontier/rural addiction treatment workforce- retention, recruitment, and training.

National Addiction Workforce Group

Membership: NASADADSAASATTCsWorkforce researchersRural/frontier treatment providersState Treatment Providers Associations

National Addiction Workforce Group

Commitment:

First Year 4 meetings

NASADAD Survey

• In 2009, Addiction treatment providers in 16 states reported offering treatment services using telehealth (16 states out of the 37 states that responded to the survey) • 25 states reported providing

mental health treatment services using telehealth

Brief Review of Research

Telehealth Research

• 141 Randomized Control Trials–148 telemedicine interventions with

nearly 37,000 patients–108 of the trials were favorable toward

telemedicine intervention–38 trials showed no statistical differences

CBT4CBT is a computer-based version of cognitive behavioral therapy

(CBT) used in conjunction with standard clinical care for current substance users. Six modules and

follow up assignments focus on key concepts in substance use, including

cravings, problem solving and decision making skills.

TES is an interactive, web-based program theoretically grounded in the

evidence-based Community Reinforcement Approach (CRA) to

behavior therapy

Theoretical Approach: Community Reinforcement Approach (CRA) behavior therapy; contingency management (CM)

Target Substance: Poly-substance use

Mōtiv8 is a web based contingency management program for smoking cessation using a home

monitoring system

Subjects log onto a website and use video recording software to record and submit videos of breath carbon monoxide (CO) samples. The Mōtiv8 application uses a

web-based interface for collecting data, automating immediate voucher (incentive) delivery, and some versions of the application include a group support

forum.

MES is a computer-based brief intervention with the goal of facilitating

self-change, treatment engagement, and/or motivation to change via a single

intervention session.Theoretical Approach:

Motivational interventionTarget Substance: Multiple substances,

poly-substance use

cMET/CBT/CM is a computer-delivered intervention for cannabis

use disorders, incorporating features of three evidence-based treatments: cognitive behavioral therapy (CBT), motivational enhancement therapy

(MET), and contingency management (CM). Nine sessions presented over 12 weeks offer computer-assisted

instruction

MyStudentBody is an interactive, web-based brief intervention for alcohol use

in college student populations

Theoretical Approach: Screening and Brief intervention

Target Substance: Alcohol

McClure, Acquanta, Harding, & Stitzer In Press

• Surveyed 8 urban clinics in Baltimore (266 patients)• Client’s Access to:–Mobile Phone- 91%– Text Messaging- 79%– Internet/Email/Computer 39-45%

Training Substance Abuse Clinicians in Motivational Interviewing Using Live

Supervision via TeleconferencingTeleconferencing supervision (TCS)

was developed to provide remote, live supervision for training MI

TCS shows promise for promoting new counseling behaviors following

participation in workshop training. Smith, et al., 2012 Journal of Consulting and Clinical Psychology;80(3):450-464

Needs AssessmentGoals

Determine the •use of telehealth by treatment providers, especially those in frontier/rural areas•regulations/issues regarding telehealth •interest in/use of telehealth recovery support services •use of telehealth in providing clinical supervision to addiction treatment clinical staff

Target populations• SSAs and/or NTNs • State credentialing boards • Recovery community programs• Clinical Supervisors from all 10 regions

Methodology

Collect quantitative and qualitative data regarding•use of telehealth in providing addiction treatment services, clinical supervision, and recovery support •interest among treatment provider administrators in offering telehealth from a business practice perspective•training/TA needs