EFFECTIVENESS BANK BULLETIN 8 October 2012
HOW TO GENERATE BETTER OUTCOMES FROM TREATMENT SYSTEMS
The new bulletin collating the latest additions to the Effectiveness Bank offers an evidence-based
primer on how to - and how not to - implement treatment improvements. Starting point was the review
(first entry) from two leading US scholars of tactics including incentives for outcomes and
evidence-based practices, regulations, credentialing requirements, and putting the money in the
hands of the patient. Then we chased up some of the most relevant of the recent studies they cited,
plus a later follow-up study. In the process we cast a research-informed eye over UK
payment-by-results schemes.
To view the whole bulletin click this link:
http://findings.org.uk/docs/bulletins/Bull_08_10_12.php
or click the links below to view an entry in the bulletin. If clicking does not work, paste the link
in to your web browser address box, being sure to enter the whole address.
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EXPERT ADVICE ON HOW TO GET THE TREATMENT SYSTEM WORKING BETTER
Improving the performance of treatment systems is no easy matter and prone to unintended
consequences. All the more welcome then is guidance from leading US experts with top-level
experience in drug policy in Britain and the USA. Their favourite tactic, rewarding services for
patient progress during treatment, is featured in UK payment-by-results schemes. These may, as the
experts say, be patient-focused, but are they patient-centred?
http://tinyurl.com/EfB-cdl/download.php?file=Humphreys_K_27.txt
GLOBAL PERFORMANCE FEEDBACK NO USE TO COUNSELLORS
It should have improved substance use outcomes and working and therapeutic relationships, but a
sophisticated system feeding back to counsellors the progress made by their caseload made no
positive differences. A later study (next entry) helped establish why.
http://tinyurl.com/EfB-cdl/download.php?file=Crits_Christoph_P_10.txt
FEEDBACK ON INDIVIDUALS HELPS COUNSELLORS REVERSE POOR PROGRESS
Evidence that an earlier attempt (previous entry) to improve outcomes by feeding back client
progress to counsellors failed because data was aggregated across a caseload rather than identifying
individuals doing poorly and recommending remedial actions. After remedying these deficits, a new
system significantly improved mental health and reduced substance use.
http://tinyurl.com/EfB-cdl/download.php?file=Crits_Christoph_P_14.txt
COMMON TREATMENT QUALITY YARDSTICK POOR REFLECTION OF PATIENT PROGRESS
This first major multi-modality test of a treatment engagement indicator widely used as a quality
yardstick in the USA found it only very weakly related to patient improvement seven months after
starting treatment, confirmation that simple measures like attendance and retention struggle to
capture what really helps patients get better.
http://tinyurl.com/EfB-cdl/download.php?file=Harris_AHS_7.txt
US PAYMENT-BY-RESULTS SCHEME DID NOT IMPROVE ENGAGEMENT WITH TREATMENT
In 2007-08 the US state of Maine introduced a scheme linking funding for outpatient treatment
services to performance in terms of waiting times and retention, but financial and service delivery
impacts were negligible. Were incentives too weak, or were services already doing as well as they
could - and what are the implications for UK payment-by-results schemes?
http://tinyurl.com/EfB-cdl/download.php?file=Brucker_D_2.txt
ACID TEST FOR IMPLEMENTING EVIDENCE-BASED TREATMENT
This large-scale US study addressed a key issue in advancing evidence-based practice - not
identifying those practices, but getting them implemented by commissioners and services. If it
proved difficult in these best-case scenario sites, it would be even more so without the support of
the research project and in less promising jurisdictions. There were major advances, but also slow
progress, reversals and resistance.
http://tinyurl.com/EfB-cdl/download.php?file=Schmidt_LA_4.txt
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Effectiveness Bank alerts are provided by Drug and Alcohol Findings (http://findings.org.uk) to
alert you to site updates and recent UK-relevant evaluation studies and reviews of drug/alcohol
interventions. Findings is managed by DrugScope, Alcohol Concern and the National Addiction Centre.
The Effectiveness Bank is supported by Alcohol Research UK and the J Paul Getty Jr Charitable Trust.
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