Role of Federal Funding and Barriers in Implementation of Evidence-Based Practices for Substance Abuse Treatment

Background/Purpose:  Research studies have highlighted the importance of using empirically supported treatment (evidence-based practices (EBPs)) as the most effective means to reduce addiction. Even though significant federal funding has been committed to support implementation of EBPs in community-based treatment organizations (CBOs) systematic study of the policy-components of EBP implementation is limited to date.  This study examined whether addiction treatment provider receipt of federal funding for implementing EBPs from different types of funding mechanisms were associated with staff:

1)         Perception of level of barriers experienced when implementing an EBP,

2)         Reports of level of modifications made to an EBP when implementing it, and

3)         Attitudes about EBPs (nine questions)

Methods: Data sources included interviews with 510 clinical staff from community based treatment organizations (CBOs) nationwide who received CSAT/SAMHSA funding (2003-2008) to implement EBPs.  Bivariate analysis and regression modeling methods examined the relationship between type of funding mechanism and the three dependent variables.  In the regression models, the study controlled for staff, geographic, treatment unit characteristics and treatment unit organizational readiness to change (TCU-ORC). 

Results: Multivariate analyses identified that receiving funding from different types of federal funding mechanisms was associated with reporting staff reporting different levels of barriers, modifications and attitudes toward EBP implementation. The linear regression identified staff in organizations that were funded by the funding mechanism targeting youth were significantly more likely to report higher levels of modifications to their EBP.   Staff who worked in organizations that received funding to implement EBP to enhance their treatment capacity or funding mechanisms targeting homeless our youth populations reported higher levels of barriers to the implementation of their EBP, controlling for staff and treatment unit characteristics. Those who received funding from Pregnancy Postpartum grants, who had more years of experience in drug abuse counseling, longer length of time in their current job and who reported lower levels of training needs reported in the organization, higher levels of influence, higher levels of adaptability within the organization were significantly associated with staff having more supportive attitudes toward the use of pharmacotherapy in their organization.

Conclusions/Implications: Addiction program staff and directors may be more likely to perceive barriers to EBP implementation based on the requirements of a specific funding mechanism.  For example, if the RFA has very detailed specification and requirements, agencies may try to mold themselves to fit these requirements in order to access much-needed funding streams. This could be interpreted by the organizations as a barrier to EBP implementation.  This issue is important for policy-makers to consider as they define the unique funding requirements in each RFA.  Funding mechanisms that are more likely to link those who provide services to vulnerable populations may, in particular, be impacted by these limitations. Finally, also, it seems as though organizational and staff capacity are important indicators of staff attitudes about pharmacotherapy.