FRI is pleased to announce that Dr. Michael Gordon was recently interviewed by a reporter from WBAL-TV in Baltimore to discuss his 5-year National Institute on Drug Abuse (NIDA) funded study entitled “Long-acting naltrexone for pre-release prisoners: A randomized trial of mobile treatment,” which uses Vivitrol in an effort to help pre-release inmates reduce opiate-taking behavior as they transition back to the community.
FRI is pleased to announce that Dr. Shannon Gwin Mitchell will lead the evaluation of the National Council for Behavioral Health’s FaCES (Facilitating Change for Excellence in SBIRT) project. Funded by the Conrad N. Hilton Foundation, FaCES will assemble a team of national experts to develop a standardized implementation model – or a “change package” – for Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescent-serving primary care practices with a particular focus on Federally Qualified Health Centers. After developing the change package, the National Council will launch an SBIRT learning collaborative to test the effectiveness of the change package in primary care practices.
FRI is pleased to announce that Jan Gryczynski, along with Co-Investigators Drs. Robert Schwartz, Shannon Gwin Mitchell, and Christopher Welsh have received a grant award from the National Institute on Drug Abuse entitled “Navigation Services to Avoid Rehospitalization (NavSTAR) among substance users.” In recent years, the problem of repeat hospitalization has come under intense focus as a contributor to preventable morbidity and escalating healthcare costs. Substance use disorders (SUDs) are strongly associated with poor health outcomes and inefficient use of healthcare services, including repeat hospitalizations. Interventions that increase adherence to recommendations for outpatient medical care and SUD treatment could potentially help recently-hospitalized individuals to avoid unnecessary rehospitalization, associated morbidity, and medical expenses. This study is a randomized controlled trial comparing the effectiveness of Navigation Services to Avoid Rehospitalization (NavSTAR) vs. Treatment-as-Usual (TAU) for hospital patients with co-occurring medical problems and SUDs. Applying Andersen’s theoretical model of health service utilization, NavSTAR uses a small dedicated team to deliver the promising strategies of Patient Navigation and motivational interventions for hospital patients post-discharge, with the goal of facilitating engagement in outpatient medical and SUD treatment. Patient Navigators embedded within the substance abuse consultation liaison service at a large urban hospital will deliver patient-centered, proactive navigation and motivational services initiated during the hospital stay and continued for 3 months post-discharge. Participants randomized to TAU will receive usual care from the hospital and the substance abuse consultation liaison service. Participants will be assessed at study entry and again at 3-, 6-, and 12-months follow-up on various measures of healthcare utilization, substance use, and functioning. The primary outcome of interest is rehospitalization through 12 months. In addition, a range of secondary outcomes spanning domains of individual health, functioning, and service utilization will be assessed. The study will include an economic evaluation of NavSTAR from the service provider perspective. If NavSTAR proves to be effective and cost-effective in reducing rehospitalizations and improving outcomes in this high-risk patient group, it would have important implications for designing hospital discharge planning services, informing national cost containment initiatives, and improving public health.
FRI is pleased to announce that Jan Gryczynski, along with Co-Investigators Drs. Robert Schwartz, Shannon Gwin Mitchell, and Alexander Cowell have received a grant award from the National Institute on Drug Abuse entitled “A randomized trial of SBIRT services in school-based health centers.” Substance use among adolescents continues to be highly prevalent in the US. Likewise, many adolescents engage in sexual behaviors that place them at elevated risk for HIV and other sexually transmitted infections. Screening, brief intervention, and referral to treatment (SBIRT) is a promising approach for integrating substance use services into healthcare settings. School-based health centers (SBHCs) are a rapidly expanding model of healthcare delivery offering health services far beyond those of the traditional school health office. Implementing SBIRT in SBHCs could have major public health benefits, but research is needed to identify the most effective way to deliver SBIRT for adolescents in these settings. Two approaches for SBIRT that are particularly promising in their practicality, scalability, and sustainability are nurse practitioner-delivered brief intervention and computer-delivered brief intervention. We propose to conduct a randomized controlled trial to determine the comparative clinical effectiveness and cost-effectiveness of these two approaches in reducing marijuana use, alcohol use, and sex risk behaviors. The study will be conducted in SBHCs embedded within two public high schools in Baltimore, Maryland. SBHC patients ages 14-18, inclusive, will be screened for eligibility by research staff with the CRAFFT, a brief substance misuse screening instrument recommended by the American Academy of Pediatrics. The study will enroll 300 male and female adolescents who report risky marijuana or alcohol use. Participants will be randomly assigned to receive a nurse practitioner-delivered brief intervention (NBI) consisting of brief motivational advice as part of their medical visit, or a promising interactive computer-delivered brief intervention (CBI) based on motivational interviewing. Both intervention conditions will include HIV risk reduction content tailored based on individual risk factors, and both conditions will include a referral pathway for additional substance abuse assessment and possible treatment by specialized substance abuse treatment staff. Research assessments will be conducted at baseline and at 3- and 6-month follow-up, and will gather self-reported data on substance use and sexual risk behaviors. A focused economic analysis will compare the NBI and CBI conditions with respect to their incremental cost-effectiveness for selected primary behavioral outcomes and for quality-adjusted life years (QALYs). A qualitative process evaluation will examine adolescent participants’ and SBHC staff members’ perspectives on the competing BI strategies.
FRI is pleased to announce that Shannon Gwin Mitchell, Ph.D., along with Co-Investigators Drs. Robert Schwartz, Marc Fishman, Laura Dunlap, and Gary Zarkin have received a grant award from the National Institute on Drug Abuse entitled “Health Services Research: Extended Release Naltrexone for Opioid-Dependent Youth.” This study is a 6-month, two-group random assignment comparative effectiveness trial of XR-NTX v. Treatment as Usual (TAU) for 340 opioid-dependent youth ages 15-21. TAU will consist of the typical treatment approach provided to opioid-dependent youth in the US, namely buprenorphine for the treatment of opioid withdrawal followed by counseling with or without continued buprenorphine. The study’s aims are: (1) to determine the relative effectiveness of XR-NTX compared to TAU for opioid-dependent youth in terms of the following 3- and 6-month outcomes: a) days in treatment; b) opioid use; c) other drug (cocaine and marijuana) and alcohol use; d) criminal behavior and arrests; and e) relapse to DSM-IV defined opioid dependence; (2) to examine the impact of XR-NTX on HIV drug- and sex-risk behaviors at 3- and 6-month follow-up and HIV infection status at 6-months; and (3) to evaluate the cost, cost-effectiveness, and cost-benefit of XR-NTX v. TAU among opioid-dependent youth.
FRI is pleased to announce that Cathy J. Reback, Ph.D. was awarded a NIH NIDA R01 grant entitled, “Theory-based Text Messaging to Reduce Methamphetamine Use and HIV Risks among MSM.” Methamphetamine use among men who have sex with men (MSM) is deeply integrated into socio-sexual networks including commercial sex venues and digital spaces such as cell phone applications, websites, and digital chat rooms to “hook up” for sex. Thus, methamphetamine use is highly associated with HIV infection due specifically to concomitant high-risk sexual behaviors that occur while using the drug. Text-messaging is a novel, feasible, and sustainable approach for targeting high-risk, out-of-treatment MSM; particularly, MSM who fail to attend face-to-face or site-based interventions. A real-time text-messaging intervention capitalizes on a communication channel to which this population will attend at the exact time they are most likely to make high-risk sexual decisions. The “real-time” theoretically based text-messaging HIV prevention intervention will reach out-of-treatment, methamphetamine-using MSM while they are in the contexts of greatest risk and interrupt both drug use and HIV sexual risk behaviors. The study will assess the impact of an 8-week, gay-specific, theory-based text-messaging intervention designed to decrease methamphetamine use and HIV sexual risk behavior and, for the HIV-infected participants, simultaneously increase HIV antiretroviral treatment/adherence in out-of-treatment, methamphetamine-using MSM. Participants will receive text messages that are personally tailored to fit their risk profile; the theory-based text messages serve as the mechanisms of behavior change. Participants will be randomized into one of three conditions: Group 1: culturally relevant theory-based text messages interactively transmitted by peer health educators; or, Group 2: the same culturally relevant theory-based text messages transmitted by automation; or, Group 3: assessment-only control with no theoretically based text messages. All participants will receive brief weekly text-message assessments on their methamphetamine use and HIV sexual behaviors in the previous seven days. The study will determine differential immediate and sustained effects and cost effectiveness of the text-messaging intervention to reduce methamphetamine use and concomitant HIV sexual risk behaviors and, for the HIV-infected participants, increase HIV antiretroviral treatment/adherence.
FRI is pleased to announce that Cathy J. Reback, Ph.D. was awarded a HRSA SPNS grant entitled, “Enhancing Linkages to and Retention in HIV Primary Care for Transgender Women of Color: The Alexis Project.” Transwomen of color experience a number of psychosocial challenges including discrimination, prejudice, stigmatization, and social/economic marginalization, which stand as obstacles to HIV care and other needed services. The Alexis Project will incorporate three proven models, Social Network Recruitment (network), Peer Health Navigation (individual) and Conditional Cash Transfer (structural), into one multi-leveled project to identify, recruit, test, link, treat and retain transwomen of color into quality HIV care. Through Social Network Recruitment, local transwomen will recruit transwomen of color from their social, sexual and drug-using networks into the project for either testing (HIV unknown status) or (for those who are aware of their HIV infection but not in care) to the combined Peer Health Navigation and Conditional Cash Transfer intervention. The project goals are 1) to conduct formative evaluation to develop the design, measures, and procedures for The Alexis Project, 2) to identify, recruit and test transwomen of color in Los Angeles County through the Social Network Testing Program, 3) to directly link HIV-infected transwomen of color identified through the Social Network Testing Program to a Peer Health Navigator, 4) to identify transwomen of color who are already aware of their HIV infection but have never been engaged in care or have refused a referral to care or have dropped out of care and to directly link to a Peer Health Navigator, 5) to link HIV-infected transwomen of color to quality HIV care, 6) to work with HIV-infected transwomen of color to address the barriers in their life that limits or impedes their access to HIV care and, 7) to retain HIV-infected transgender women of color in HIV care to reach and sustain HIV milestones. Peer Health Navigators will work with participants to identify HIV care services and other needed services, develop specific client-centered treatment plans, remove barriers to those services and access those services. Conditional Cash Transfer will provide increasing valuable incentives for attending HIV medical visits and reaching and sustaining HIV milestones. This multi-tiered, comprehensive approach, which includes network, individual and structural components, will serve to optimize HIV health outcomes for transwomen of color.
The Alexis Project is named after Alexis Rivera who died on March 28, 2012, – while the grant application was in development – at the age of 34, from complications related to HIV. Alexis was a proud Latina transwoman; a community activist, a peer advocate and a gatekeeper. When she was just 20 years old, Alexis worked with Dr. Reback as a community outreach worker targeting and reaching high-risk transwomen. Alexis’ premature death spoke to the ardent need of the HRSA application. During the development of the grant, the research team chose to honor the life of Alexis Rivera through this project.
FRI is pleased to announce that Shannon Gwin Mitchell, Ph.D., along with Co-Investigators Robert Schwartz and Barry Brown, have received a grant award from the National Institute on Drug Abuse entitled “SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers.” The proposed study is significant because it will help determine whether one adolescent Screening, Brief Intervention and Referral to Treatment (SBIRT) implementation strategy is superior to the other in terms of reach, cost effectiveness, and acceptability within urban Federally Qualified Health Center settings, thereby filling a gap in scientific knowledge at a time when SBIRT is poised to be brought to scale under health care reform to reduce the public health burden of adolescent substance misuse. The study is highly innovative because it will be the first implementation study of adolescent SBIRT and one of the first prospective trials to use an implementation science conceptual framework for substance abuse interventions. Furthermore, the study will provide novel cost data which can help to guide public and private health care policy-makers as well as clinic directors about the widespread adoption of SBIRT in adolescent health care. FRI congratulates Dr. Mitchell, and her colleagues, regarding receipt of this grant award.
This new R01 represents Dr. Mitchell’s second major federal grant, as she was awarded an ARRA “Challenge Grant” in 2009. As a result of the awarding of this new R01, Dr. Mitchell has been promoted to Senior Research Scientist at FRI. FRI also wishes to congratulate Dr. Mitchell on this noteworthy professional accomplishment.
Dr. Thomas Hanlon has had a long and distinguished career in the areas of personality assessment and treatment evaluation. His initial research experience involved conducting clinical psychopharmacological trials largely involving the treatment of schizophrenic and other seriously ill psychiatric patients. During this same period, he also participated in early treatment evaluation studies of the effectiveness of narcotic antagonists in the treatment of heroin drug addiction. The second stage of his involvement in treatment evaluation studies (which involved collaboration with Dr. David Nurco of Friends Social Research Center) included designing and conducting numerous psychosocial outpatient treatment trials involving addicted substance abusers under probation and/or parole supervision by the Maryland Department of Corrections. Examining the early developmental experiences of these addicted individuals led to Dr. Hanlon’s interest and involvement in drug abuse prevention studies of at-risk adolescent minority youth, first in community behavioral clinics and subsequently within the public school system. (Dr. Hanlon’s extensive list of publications reflects this transitional aspect of his professional experience.) The latter part of his professional career as a senior investigator has also involved the mentoring of junior professional staff at FRI on the analysis, interpretation, and write-up of prevention research findings, with more recent emphasis on the avoidance of sexually transmitted infections, including HIV.
Originally a Maryland State employee, Dr. Hanlon entered State service as a research scientist assigned to the research center at Spring Grove State Hospital, which subsequently became the Maryland Psychiatric Research Center (MPRC) following the reception of a Center foundation grant from the federal government. Having obtained his Ph.D. degree in 1958 from Catholic University of America, Dr. Hanlon became a faculty member of the University of Maryland Medical School when the MPRC was incorporated into the Medical School’s Department of Psychiatry. Dr Hanlon retired from State service in July of 1991.
Dr. Hanlon has had a long association with FRI initially working in conjunction with Dr. Albert Kurland and other founding members of the FRI organization in establishing a program of research at Spring Grove originally involving treatment efforts targeting chronic psychiatric illness. During these early years, Dr. Hanlon was the first recipient of educational support from FRI that enabled him to complete his doctoral training. During his long-term association with FRI, Dr. Hanlon served for 11 years as the Chairman of FRI’s IRB and contributed importantly to the early growth of FRI as a viable research organization.
FRI is pleased to announce that Shannon Gwin Mitchell, Ph.D., Research Scientist, has received a grant award from the Abell Foundation to collect 12-month follow-up data on 100 study participants currently enrolled in her NIDA-funded study entitled “Intensive Outpatient v. Outpatient Treatment with Buprenorphine among African Americans.” This new grant award will provide approximately $30,000 to cover the costs of paying research participants, the salary of a research assistant, and other research-related expenses. The funding period for this award is from September 2011 through October 2012. FRI congratulates Dr. Mitchell regarding receipt of this grant award.
