Research That Matters (January 17 - 20, 2008)

Purpose: In 2003 the Oregon state legislature passed Senate Bill 267, which mandates that increasing percentages of state funding be used by substance abuse providers for evidence based practices (EBP's). As a focus on EBP's has emerged in health care, researchers have emphasized EBP's as the key to the advancement of addiction treatment (Leshner 2002), but many front-line counselors in the field express ambivalence about EBP's. Since taking effect in 2005, policy-makers across the country, at both state and municipal levels, are looking to the Oregon case as a possible model for their efforts to proliferate EBP's in substance abuse treatment. For such policy-makers, a question of particular interest is how front-line counselors will respond to the mandate and to EBP's in the context of a mandate to provide them; this paper explores this very question.

Methods: Narrative data from 8 focus groups with counselors at substance abuse agencies across Oregon (n=48) were analyzed. The agency sample includes participants located in six geographic regions throughout Oregon. Additional American Indian and Hispanic specific service providers were included to ensure a sample reflective of the state's diversity. Two significance standards for evaluating theme and content analyses (Luborsky, 1994): frequency of statements and direct statements of salience or meaning, were employed. Coding categories for qualitative data were determined through an iterative process of systematic data review and (re)classification (Agar, 1980; Good & Good, 1982). Subsequent to the application of closed codes, axial and selective codes were applied in ATLAS.ti analysis software to assist in the identification of patterns, relationships between categories and interpretive schemes among informants (Strauss & Corbin, 1990).

Results: Three themes emerged as particularly significant in the data. 1. Front-line counselors are especially concerned about how EBP's that are “manualized” (specifically prescriptive) will compromise their “clinical expertise” or “practice wisdom” and capacity to develop individual treatment programs for clients. 2. Data show that, in the context of the Oregon mandate, counselors' worries about control over clinical decisions are compounded by a strong and pervasive distrust of the government's involvement in clinical issues. 3. On the other hand, counselors are optimistic that the state mandate will bring increased credibility to their field, not simply because it will increase the use of EBP's, but because it reflects a governmental investment in substance abuse treatment generally.

Conclusions and Implications: It is well established that the success of any policy depends upon the practices of front-line workers who are implementing it (Lipsky 2006). Findings presented here show that if the Oregon model is the wave of the future, staff “buy-in” will be especially important, and that there is a need to develop EBP's that do not impinge upon counselors' clinical control and to involve counselors in the policy-making process so that they will not be resistant to it. At the same time, these findings suggest that policy-makers and counselors have an opportunity to cultivate the common goal of increasing the professional credibility of the field.