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Recent Projects

Tennessee’s Screening, Brief Intervention and Referral to Treatment (SBIRT) Health Professions Student Training

Pills and capsule with the flag of Tennessee.(series)

Funder: Substance Abuse and Mental Health Services Administration

This study capitalizes on relationships between the University of Tennessee College of Social Work and healthcare agencies throughout the state. The project will develop and implement a training program to teach Tennessee’s social work students and practicing healthcare professionals how to provide evidenced-based screening, brief intervention, brief treatment, and referral for specialty treatment to patients with, or at risk of, substance abuse disorders. The project will promote statewide adoption and practice of SBIRT by including currently practicing social workers in the training program and by disseminating the program’s methodologies and results to Tennessee’s healthcare community.

The Tennessee Residential Treatment Program for Pregnant and Postpartum Women

Funder: Substance Abuse and Mental Health Services Administration

The Tennessee Residential Treatment Program for Pregnant and Postpartum Women tackles the problem of substance use and abuse among pregnant and postpartum women. The program is intended to expand the availability of comprehensive, residential substance abuse treatment, prevention, and recovery support services for these women and their minor children, and includes non-residential services for their family members. The project’s focus is low-income (according to federal poverty guidelines) women, ages 18 and over, who are pregnant or postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who have limited access to quality health services.

The goal is to expand and enhance service capacity, including providing addiction peer recovery support services. Evidence-based parenting and treatment models, including trauma specific service in a trauma informed context, will be used to decrease the use and/or abuse of prescription drugs, alcohol, tobacco, illicit and other harmful drugs (e.g., inhalants) among pregnant and postpartum women; increase safe and healthy pregnancies; improve birth outcomes; reduce perinatal and environmentally related effects of maternal and/or paternal drug abuse on infants and children; improve the mental and physical health of the women and children; prevent mental, emotional, and behavioral disorders among the children; improve parenting skills, family functioning, economic stability, and quality of life; decrease involvement in and exposure to crime, violence, and neglect; and decrease physical, emotional, and sexual abuse for all family members.

Improving Family-to-Family Services in Children’s Mental Health

New York City

Funder: National Institute of Mental Health

This study is being conducted in collaboration with New York University School of Medicine Department of Child and Adolescent Psychiatry (Kimberly Hoagwood, PI).

National surveys indicate that the number of professional family-to-family peer advocates providing direct services to parents of children with psychiatric needs is increasing.

This new service enhancement addresses critical workforce shortages and has the potential to improve efficient delivery of clinical services. In New York State, family peer advocates (FPA) delivering family-to-family services (F2FS) work in 400 programs statewide, providing information and education, instructional skills (ie, parenting classes), concrete assistance (ie, respite), and advocacy. New York is in the process of doubling the number of FPA, establishing a certification process for the professionalization of this new workforce, and allowing F2FS to be billable under state regulations. The children’s mental health system has historically been unprepared to address chronic levels of unmet need among youth. Persistent inefficiencies in child mental health services and increased pressures for accountability create a pressing need for more efficient workforce models, such as those including FPA, to deliver quality services.

This study is examining agency-level infrastructure (eg, governance, hierarchy, financing), social context (culture, climate, attitudes), and process/content of services provided by family advisors in twenty mental health agencies in the state of New York to develop an enhanced empowerment intervention, called E2, to strengthen agency-level support for professional family advisors. The E2 intervention and the center’s organizational intervention, ARC, will subsequently be tested in ten agencies. The Center’s Organizational Social Context (OSC) measure is being used to assess and track the culture, climates, and work attitudes of the participating agencies over time. One aim of the study is to examine the feasibility and preliminary impact of the ARC intervention on agency context, FPA behavior, parent behavior, and youth functioning.

Using New Media to Reach African American and Hispanic/Latino MSM

Nashville Tennessee

Funder: Substance Abuse and Mental Health Services Administration

Since 2006 there has been a 140% increase in incidence in HIV for men aged 18-24. Almost all of these cases were among minority men who have sex with men.

This project incorporated new media as a component in a coordinated continuum of culturally competent outreach, HIV risk reduction interventions, access to pretreatment and substance abuse treatment services, and case management for young (18-24 year old) African American

and Hispanic/Latino men who have sex with men infected with or at risk for HIV/AIDS and substance abuse.

This project combined expanded community-based outreach programming through the use of social networking pretreatment services and the use of electronic media specifically tailored to be relevant to young gay and bisexual men. The project utilized peer mentors who used new media to provide prevention messages and outreach services to a well-defined, high risk, and difficult to reach population—young minority men who have sex with men.

Testing an Organizational Implementation Strategy in Children’s Mental Health

St. Louis

Funder: National Institute of Mental Health

Several government reports have called for the development of effective community-based mental health services implementation strategies and NIMH has made the development of such strategies a top priority. However, very few implementation strategies have been developed to date and almost no empirical tests of such strategies have been conducted using true experimental designs. As a result, there is much more to learn about strategies that can be used by

community-based agencies to improve the way they deliver mental health services.

This study experimentally tested the effects of the ARC (Availability, Responsiveness, and Continuity) organizational implementation strategy on the mental health services provided to youth in a sample of fourteen community-based mental health agencies in St. Louis, Missouri. The study was conducted by the developers of ARC from the Children’s Mental Health Services Research Center, in collaboration with the Center for Mental Health Services Research at Washington University in St. Louis.

The ARC implementation strategy provides the organizational tools, principles, and framework necessary for an organization to identify and address barriers to implementing effective services. Examples of service barriers include problems that plague mental health service systems nationwide, such as the use of ineffective treatment models, high staff turnover, client dropouts from treatment, inefficient referral networks, inaccessible services, and staff resistance to service improvement efforts. We argue that a mental health agency’s ongoing capacity to improve the services it provides requires an implementation strategy that identifies and addresses such barriers in the organization’s social context, service structure and core technology.

HIV/AIDS Primary Prevention Program with Caribbean Youth

St. Thomas

Funder: Substance Abuse and Mental Health Services Administration

This project offered outreach, pretreatment, and treatment services designed to reduce high-risk HIV-related behaviors among substance using young adults (ages 18-24) in the US Virgin Islands. The project built on existing relationships between the University of Tennessee, Norfolk State University (an HBCU-Historically Black College and University), and the

Virgin Islands to deliver an evidence-based program of culturally specific HIV and substance abuse interventions. The goal was to reduce HIV among a group of US citizens—young adults in the Virgin Islands—who are dramatically affected by HIV.

The need for HIV prevention programming in the US Virgin Islands is enormous. The incidence of HIV/AIDS in the Caribbean region is 1.6%, the second highest in the world (UNAIDS, 2006). Moreover, HIV incidence continues to increase. For the third year in a row the USVI leads the nation with the highest number of confirmed HIV cases at 272.7 per 100,000 citizens (CDC, 2007).

As the epidemic has spread, the primary mode of transmission has shifted to heterosexual transmission fueled by substance abuse-related risks (Camera et al., 2003)This project sought to directly impact this shift by increasing the availability of integrated substance abuse pretreatment and early intervention treatment services. In addition the project emphasized culturally specific HIV prevention services for young adults of African descent, a group that has traditionally been underserved (or altogether unserved) by the current service system.

The program was based on a package of evidence-based interventions including outreach, motivational interviewing and the community reinforcement approach. The specific interventions were developed and evaluated by the project director and members of the implementation team and adapted to be culturally responsive to the target population. The program was initially implemented on the island of St. Thomas and then expanded to St. John and St. Croix.

Expanded Care Coordination through the Use of Health Information Technology in Rural Tennessee

Cades Cove road in spring colors and fog.

Funder: Substance Abuse and Mental Health Services Administration

This project facilitated engagement with substance abuse and mental health services for individuals living in extremely rural and underserved areas of Appalachia in Tennessee. The project used Health Information Technology (HIT), including web-based services, smart phones, and behavioral health electronic applications to expand and enhance the

ability of service providers to communicate with, track, and help ensure treatment continuation for persons in treatment. The project used technology to support recovery and resiliency efforts and promote wellness by improving service engagement through electronically delivered strengths-based case management techniques and other evidence-based models. The project specifically targeted two of the state’s most rural and underserved counties in East Tennessee, Campbell and Sevier.

The project was built around an existing collaboration with the Helen Ross McNabb Center (HRMC), Tennessee’s oldest mental health center, and infrastructure developed by the Children’s Mental Health Services Research Center and the HRMC in two previous SAMHSA/CSAT projects that were delivered electronically. Specifically, “Using Computers for Campus Screening and Brief Interventions for Substance Abuse” targeted college students who use substances and “E-therapy for Screening and Interventions for Vulnerable Young Adults with Substance Abuse and Co-morbidity” provided outreach and initial services for rural substance users. This project expanded on those efforts, focusing on using electronically delivered interventions to increase service engagement for individuals enrolled in substance abuse services. The objective was to increase the number of individuals who engage in and benefit from comprehensive treatment and recovery services for behavioral health.

E-therapy Screening and Interventions for Vulnerable Young Adults with Substance Abuse and Co-morbidity

Computer and stethoscope

Funder: Substance Abuse and Mental Health Services Administration

This project used Internet-based interventions and peer outreach to provide substance use and abuse information, screening, feedback on individual drug patterns, prevention and treatment interventions, and referrals to rural young (ages 18-24) adults. This population included young military men and women returning from Afghanistan and Iraq suffering with

PTSD and related disorders, in addition to substance abuse. The project was based on the previous success of these interventions in the SAMHSA-funded project “Using Computers in Campus Screening and Brief Interventions for Substance Abuse.”

In rural East Tennessee, alcohol and marijuana use by young adults has been historically problematic. Within the last few years, methamphetamine use by young adults has increased significantly in the region, resulting in its dubious distinction as one of the epicenters of this epidemic.

Within this sparsely populated mountainous rural area, traditional office-based services are limited and often inaccessible due to distance and lack of transportation. E-therapy seeks to offset these barriers to service.

Young adults who completed the project’s brief interventions and in need of further help were referred to more formal services offered by collaborating community service providers. Electronic outreach efforts targeted young adults.

HIV/AIDS and Substance Abuse Primary Prevention in Minority Adolescents


Funder: Substance Abuse and Mental Health Services Administration

The focus of this project was the implementation and evaluation of a program designed to prevent adolescents from engaging in substance abuse and sexual activities that place them at risk for contracting HIV/AIDS. The project, which includes a special emphasis on minority youth, was offered through a number of community venues.

The prevention program used small group educational techniques based on 1) the Teams-Games-Tournaments (TGT) alcohol prevention curriculum, which has been cited as a model program in SAMHSA’s National Registry of Effective Programs and Practices (NREP) and by the Office of Juvenile Justice and Delinquency Prevention, and 2) the Reducing the Risk (RTR) curriculum. Both have been empirically evaluated as effective methods of helping adolescents to develop skills that can prevent substance abuse and high-risk sexuality. The project assessed participants before participating in the program, post participation, and at three-month follow-up. Dependent variables included the adolescents’ knowledge of, attitudes toward, and behavior related to HIV/AIDS and substance abuse. Additionally, the adolescents’ self-efficacy and quality of peer and parental relationships were assessed.

Assessing the Organizational Social Context of Child Welfare Systems: Implications for Research and Practice

Funder: W.T. Grant Foundation

This study: (1) provided the first assessment of the a priori measurement model and psychometric properties of the Organizational Social Context (OSC) measurement system in a US nationwide probability sample of child welfare systems; (2) illustrated the use of the OSC in constructing norm-based organizational culture and climate profiles for child welfare systems; and (3) estimated the association of child welfare system-level organizational culture and climate profiles with individual caseworker-level job satisfaction and organizational commitment.

The study applied confirmatory factor analysis (CFA) and hierarchical linear models (HLM) analysis to a US nationwide sample of 1,740 caseworkers from eighty-one child welfare systems participating in the second National Survey of Child and Adolescent Well-being (NSCAW II). The participating child welfare systems were selected using a national probability procedure reflecting the number of children served by child welfare systems nationwide.

The a priori OSC measurement model was confirmed in this nationwide sample of child welfare systems. In addition, caseworker responses to the OSC scales generated acceptable to high scale reliabilities, moderate to high within-system agreement, and significant between-system differences. Caseworkers in the child welfare systems with the best organizational culture and climate profiles reported higher levels of job satisfaction and organizational commitment. Organizational climates characterized by high engagement and functionality, and organizational cultures characterized by low rigidity were associated with the most positive work attitudes.

Conclusions: The OSC is the first valid and reliable measure of organizational culture and climate with US national norms for child welfare systems. The OSC provides a useful measure of organizational social context for child welfare service improvement and implementation research efforts, which include a focus on child welfare system culture and climate.