Flo A. Stein, MPH
NC PIC Project Manager
Chief, Community Policy Management
Division of MH/DD/SAS

EBP Quick Links
MH#1: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Mental Health Bulletin #1 - Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed to treat post-traumatic stress and related emotional and behavioral problems in children and adolescents.
MH#2: Integrated Dual Disorders Treatment (IDDT)
Mental Health Bulletin #2 - Integrated Dual Disorders Treatment (IDDT) requires that mental health and substance abuse treatment be delivered concurrently by a team of cross-trained clinicians within the same program.
MH#3: Wellness Management and Recovery (WMR)
Mental Health Bulletin #3 - The National Institute of Mental Health estimates that approximately 6% of the U.S. population has severe mental illness (SMI). For North Carolina, that percentage translates to approximately 200,000 people who suffer from severe psychiatric disorders.
MH#4: Family Psychoeducation
Mental Health Bulletin #4 - Persons with severe mental illness (SMI) often rely on family members for the majority of their needed support, and it is estimated that 35-60% of adults with SMI live with family members.
SA#1: Contingency Management (CM)
Substance Abuse Bulletin #1 - Contingency management (CM) is a motivational incentive intervention in which clients with substance use disorders receive small rewards for attending treatment, taking prescribed medication, providing negative urine samples, or complying with other defined treatment-related goals.
SA#2: Strengthening Families Program (SFP)
Substance Abuse Bulletin #2 - The Strengthening Families Program (SFP) is a parenting and family strengthening program for high risk families. It combines science-based (1) parenting-skill training, (2) child life-skill building, and (3) family lifeskill education into a program that improves the child's social/life skills and family functioning and protects the children from the long-term risks of drug abuse.
SA#3: Seeking Safety
Substance Abuse Bulletin #3 - Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that may result from exposure and sometimes multiple exposures to highly traumatic events such as child abuse, accidents, violent personal assaults, military combat, or natural or human caused disasters.
SA#4: Matrix Intensive Outpatient Treatment
Substance Abuse Bulletin #4 - Matrix was developed in the 1980s by researchers at the University of Southern California and clinicians at the Matrix Institute on Addictions who found that clients addicted to stimulants were challenging the existing treatment system.
SA#5: The Seven Challenges
Substance Abuse Bulletin #5 - The Seven Challenges program was developed in the early 1990s by Dr. Robert Schwebel who recognized the lack of age appropriate substance abuse treatment models for adolescents.
Developing Effective, High-Quality Community Mental Health and Substance Abuse Services: A Guide for Local Management Entities
by Beth Melcher, Ph.D. This manual seeks to clarify and provide guidance to LMEs on how to successfully engage in the service development role. It promotes the implementation of evidence-based and best practice services and supports.
National Registry of Evidence-based Programs and Practices
NREPP is a searchable database of interventions for the prevention and treatment of mental and substance use disorders. SAMHSA has developed this resource to help people, agencies, and organizations implement programs and practices in their communities.

PIC Application
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Evidence-based Practices for Autism Spectrum Disorders

Earlier this year, Connie Wong and her colleagues at the University of North Carolina Frank Porter Graham Child Development Institute issued a report, Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder.  This report is a follow-up to a 2007 review by the National Professional Development Center (NPDC) on ASD,  which resulted in the identification of 24 practices that met the evidentiary criteria they had established. Briefs for each of the 24 practices may be downloaded here.

The recently released EBP report provides the results of an updated review of the literature. Using five databases (EBSCO, EMBASE, Medline, ISI, Sociological Abstracts) and a range of descriptors (e.g., autism, Asperger), the initial search generated over 29,000 articles published between 1990 and 2011), which were winnowed down to 1,090 after screening to ensure investigators employed an experimental, quasi-experimental, or single case design. One hundred fifty-nine reviewers were selected to review the articles; they were expected to complete training and meet inter-rater agreement criteria.  These reviewers then determined whether a practice met the level of evidence necessary to be classified as an EBP using the following criteria: (a) two high quality experimental or quasi-experimental design studies, or (b) five single case design studies conducted by three different research groups and involving a total of 20 participants across studies, or (c) there is combination of research designs, which must include at least one high quality experimental/quasi-experimental design and three high quality single case designs. From the 1,090 articles, 456 articles were accepted as providing scientific evidence. Content analyses of procedures produced 27 different practices (see report for details).

Fact Sheets for each of the 27 practices may be downloaded here.

For a copy of the report, click here.


1  The NPDC on ASD is a multi-university center that operates through three sites: the FPG Child Development Institute at the University of North Carolina at Chapel Hill,  the M.I.N.D. Institute at University of California at Davis Medical School, and the Waisman Center at the University of Wisconsin at Madison.
Innovative Technologies Summit

On March 12, 2014, the North Carolina Practice Improvement Collaborative, in partnership with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Governor’s Institute on Substance Abuse, hosted the Innovative Technologies Summit at the Raleigh Convention Center.  As the last of three meetings in 2013-14 under the banner, Improving Outcomes:  Improving Lives, this meeting featured three speakers; an interactive showcase of 12 vendors of assistive technologies; and a five-person panel on adoption and implementation.

H. Westley Clark, M.D., J.D., M.P.H., Director, Center for Substance Abuse Treatment, U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), gave the keynote address on Innovative Technologies: Improving Practice, Protecting Privacy.  SAMHSA has a health innovative technologies (HIT) strategic initiative, supported by nine goals.  SAMHSA currently funds East Carolina University for its project, Operation Reentry North Carolina: Veteran Resiliency and Reintegration Through Technology.  To facilitate the integration of standards-based HIT within the behavioral health field, SAMHSA recently hosted three regional HIT conferences.  Dr. Clark also addressed the challenges of privacy, confidentiality, and security.

Melissa Pinto, Ph.D., R.N., Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, addressed benefits and concerns about the use of behavioral health technology (BHT); how BHT impacts the clinical relationship and care; the state of the science of BHT; and eSMART technology in her presentation, Evolving Role of Technology in Behavioral Health and Developmental Disabilities.  She emphasized the growing importance of BHT in that 75% of patients identify one or more structural or psychological barriers to care and that access to care is more difficult for minority groups and individuals living in rural areas.  Through BHT, patients will gain more access, consumers and insurance companies will pay less, additional flexibility will be added, consumers will be empowered, and consumers will receive continuing and integrated care.

Rodney Bell, Principal, ASSET (Adopting/Applying Systems, Software, and Engineering Technology) Consulting, presented on Technology for People with Cognitive Disabilities: The Promise, Pitfalls, and Push.  He promoted the use of technologies for individuals with developmental disabilities through the web, smart mobiles, assistive apps, and residential supports.  These technologies will change providers’ practice, consumers’ lives, and governance (e.g., waivers, reimbursement, ethics).  Because technology is outpacing society and governance, there is a need for service providers to exercise caution and to always keep the end user in mind.  Privacy and reimbursement are issues to be addressed as personal information needs to be secure and technologies need to be financially feasible.  A workforce that is technologically competent, with corresponding job descriptions and salaries, must be developed and nurtured.

Aldona Zofia Wos, MD, Secretary, North Carolina Department of Health and Human Services discussed the technology Initiatives of the North Carolina Department of Health and Human Services.  She spoke of the need to collaborate with industry to harness technology so it facilitates independent living and recovery.  Secretary Wos asked the audience to identify what our constituents need, how to use the technologies, and how to fund them.  To the LMEs-MCOs, she said, “What are you waiting for?  Use the technologies to do the best that you can.”  In addition, she promoted a statewide telepsychiatry initiative in emergency rooms and a pilot mobile technology project to combat childhood obesity.  She concluded stating that she is open to all new projects and initiatives in behavioral health.  Click here for a press release from Sec. Wos’s office about our Summit.

The interactive showcase on innovative technologies featured twelve vendors:

  • ASI-MV and CHAT by Inflexxion – Tom Jackson and Mike Waldron
  • Assistance Technology Works – Dawn Sowers, M.A.
  • Coleman Institute for Cognitive Disabilities, University of Colorado – Rodney Bell
  • GSTS Designs, LLC – Lance Hatfield
  • North Carolina Assistive Technology Program – Sonya Clark
  • PHIT for Duty – Paul Kizakevich and Randy Eckhoff, Research Triangle Institute
  • Qualifacts – Dan Baron and Jenny Milose
  • Simply Home – Allen and Drue Ray
  • Smart Homes & Business – Jerry Tester, Whitney Hasson, and Erin Huddleston
  • Assistive Technologies for Veterans – Kelly Ramsey, US Department of Veterans Affairs
  • VGo – Lee Weinberg, MD and Mark Scheurlein
  • Alcohol Comprehensive Health Enhancement Support System (A-CHESS) – Fiona McTavish, University of Wisconsin

Moderated by Flo Stein, a five-member panel discussed the Advancement and Opportunities for Technology in North Carolina.  Panel members included:

  • Kenneth Bausell, North Carolina Division of Medical Assistance
  • Stephanie Gilliam, North Carolina Division of Health Service Regulation
  • Tammy Koger, North Carolina Assistive Technology Program
  • Sandee Resnick, North Carolina Resource and Regulatory Management
  • Cindy Ehlers, East Carolina Behavioral Health LME-MCO

Members of the panel addressed the identification of current assistive technologies, barriers hampering the utilization of innovative technologies, regulations, funding resources and reimbursement, application, and recommended future steps to support innovative technology.

One hundred forty-two individuals, representing family members, state agencies, LME-MCOs, provider agencies, and universities, attended the event.  Eighty-five respondents were asked to complete the question asking which technologies they would recommend for adoption.  Smart home technology topped the list (21 respondents), followed by mobile apps developed by the Department of Veterans Affairs (15), A-CHESS (12), and telepsychiatry and other therapeutic extenders (8).  Communication devices, electronic health records, PHIT for duty, myStrength.com, and VGo each received three mentions.

In order to prepare for the Summit, a resource handout was developed.  This handout is included here as well as materials submitted by vendors.  For the downloadable copy of each of the apps from the Department of Veterans Affair, here is the website. The Journal of the American Medical Association has recently published two opinion pieces on the use of online technologies and mobile apps in health.  The first was cited by Dr. Clark and addresses the utility of online technologies.  The second asks the question about the effectiveness of the new apps. Both may be downloaded directly from their site.

For additional information, please contact Leesa Galloway, LME-MCO Systems Performance, Community Policy Management, NC DMH/DD/SAS.

Presentations & Handouts from the Meeting
H. Westley Clark, M.D., J.D., M.P.H. – PowerPoint and video
Melissa D. Pinto, Ph.D. – PowerPoint and video
Rodney Bell – PowerPoint and video (begins at 42:00 minute mark)
Secretary Aldona Wos – video, with link to press release (see above)

Discourse SBIRT Flyer
VGo in the News
Innovative Technologies: Resource Handout
Mobile Apps released by the VA National Center for PTSD
NC Council Signs Agreement with myStrength.com
Software Advice Handout
The Fix – Recovery: There’s an App for That

 

Recent Resources on Substance Use Disorders

Standards of Care:  For the Addiction Specialist Physician
Funded by the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the National Institute on Alcoholism and Alcohol Abuse, the American Society of Addiction Medicine (ASAM) developed Standards of Care:  For the Addiction Specialist Physician. Standards of care are outlined in six areas:  assessment and diagnosis; withdrawal management; treatment planning; treatment management; care transitions and care coordination; and continuing care management.  Even though North Carolina has 49 ASAM physicians, not all physicians who provide treatment and care of substance use disorders are members of ASAM.  They would find this guideline to be useful as well.

Alcohol-Attributable Deaths and Years of Potential Life Lost — 11 States, 2006–2010
According to a study released by the Centers for Disease Control and Prevention in the March 13 issue of Morbidity and Mortality Weekly Report, excessive alcohol use is a leading cause of preventable death and years of potential life lost in the 11 states that were studied.  North Carolina was one of the states that contributed to the sample and fell in the middle of average annual alcohol-attributed death rate of 28.5, compared to New Mexico at 50.9 and Utah at 22.4.  The median death rate for North Carolina was highest for American Indian and Alaska Natives (35.2), followed by African Americans (29.3), white non-Hispanic (28.6), white Hispanic (20.5), and Asian, Native Hawaiian, and Pacific Islanders (8.8).  According to the study, a median of 1,600 deaths and 43,000 years of life lost annually are due to excessive drinking. About 70% of these deaths and 80% of the years of life lost involved working-aged adults, on pages 213-216.

Resources on Teen Substance Use
Common Sense for Drug Policy, a nonprofit organization dedicated to educating its readership about drug policies, hosts a website that provides research, statistics, and resources on substance use by youth.  It may be particularly useful for those interested in preparing grant applications or educational materials for legislators.  For example, current posts include prevalence rates, lifetime use of specific illegal drugs, and availability of specific drugs.

CASA of Columbia University offers useful reports and other publications on addiction prevention and substance abuse.  In 2011, it released the report, Adolescent Substance Use: America’s #1 Public Health Problem.

Resources for Indiv. with Intellectual and Developmental Disabilities

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders:

On November 19, 2013,. Jarrett Barnhill, MD, presented on MH-ID: Misuse of Psychotropic Medications to the IDD-PIC (Click here for a copy of the PowerPoint presentation).  We recently came across this article published by Spencer and her colleagues in the October 2013 issue of Pediatrics and are sending out the results of this study as a follow up.  Spencer and her colleagues reported on a study in which they examined rates and predictors of psychotropic medication use and multiclass polypharmacy in over 33,500 commercially insured children with autism spectrum disorders (ASD). They found the following:

  • 38% of the children took antidepressants and ADHD medications
  • 28% took antipsychotics and ADHD medications
  • 20% took antipsychotics and antidepressants
  • 18% took antipsychotics, antidepressants, and ADHD medications

The researchers noted that the number of prescriptions per child increased with age–33% of children age 10 and younger and 60% of older children took more than one medication. The likelihood of psychotropic use and/or polypharmacy was highest among older children, those who had a psychiatrist visit, and those with evidence of co-occurring conditions. The researchers said the results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD.  For a copy of Spencer’s article, Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders, please click here.

Financing Long-term Services and Supports for Individuals with Disabilities and Older Adults:

In June 2013, the Forum on Aging, Disability, and Independence of the Institute of Medicine and the National Research Council hosted a workshop on Financing Long-term Services and Supports for Individuals with Disabilities and Older Adults. Participants examined the financing of long-term services and supports for working-age individuals with disabilities and among individuals who are developing disabilities as they age. The National Academies Press recently released the workshop proceedings, which may be downloaded for free by clicking here.

Promoting Equal Access to Technology

Promoting Equal Access to Technology for Individuals with Intellectual and Developmental Disabilities

In recent years, the use of technology in daily life has steadily grown, but individuals with intellectual and developmental disabilities have not necessarily been able to keep up with the pace due to financial and other barriers.  This has led to the establishment of the Technological Assistance Institute for Intellectual Disability and the Center for Accessible Technology, institutes that promote availability and access to technology for everyone, including individuals with disabilities. The Technological Assistance Institute for Intellectual Disability offers webinars, trainings, and online resources for the blind, deaf and hard of hearing, learning disabled, physically disabled, and speech and language impaired.  The Center for Accessible Technology promotes direct service, consultation, and advocacy.

In 2001, the University of Colorado founded the Coleman Institute for Cognitive Abilities to “catalyze and integrate advances in science, engineering, and technology to promote the quality of life and independent living of people with cognitive disabilities.” The Institute was instrumental in the funding of the nation’s first Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies, which has conducted research in skill building and coaching, employment, robotics, and interactive platform development for cognitive technologies at home, school, work and community.  The Institute is also responsible for the State of the States in Developmental Disabilities Project, which provides longitudinal data on intellectual and developmental disabilities by state.

At the October 2013 meeting of the 13th Annual Coleman Institute National Conference on Cognitive Disability and Technology, nearly 150 national (e.g., American Association on Intellectual and Developmental Disabilities, the ARC, American Network of Community Options and Resources), state, and local disability organizations and numerous individuals endorsed a declaration attesting to The Rights of People with Cognitive Disabilities to Technology and Information Access.  If you or your agency wants to endorse the declaration, click here.

Funded wholly or in part by the federal Substance Abuse Prevention and Treatment Block Grant Fund (CFDA #93.959) as a project of the NC Division of Mental Health, Developmental Disabilities & Substance Abuse Services.