Spectrum is a national leader in delivery of evidence-based substance abuse treatment services. Recently, there has been growing interest in developing a research capability to explore and increase understanding of treatment processes and further improve program effectiveness. Spectrum’s interest in research is demonstrated by the recent formation of an Institutional Review Board (IRB) that is needed to approve federally funded research projects conducted at Spectrum and the creation of a research advisory group.
As Spectrum more actively engages in research, it is important to deepen our understanding of the research “business.” As Spectrum’s Senior Research Advisor, I have conducted a survey with a small group of my senior colleagues 1 who are recognized leaders in treatment research and the application of research findings. The purpose of my informal survey was to help inform the current Spectrum research initiative and provide ideas on some strategies to maximize benefits to the programs and contribution to the treatment field.
The interviews explored a set of questions 2 designed to give insight into what treatment questions research has been most able to clarify, what are some of the most important research findings that have impacted the field, what major questions remain unanswered and where is research going in the next 5-10 years. The interview was completed with questions about the role treatment programs can play in facilitating research especially potential roles for large multi-state treatment organizations such as Spectrum Health Systems. This survey information will provide information for this blog and several additional blogs.
Typically, researchers develop proposals and write grant submissions with agreements from treatment providers to allow access to clients for study. One overriding observation is that clinicians and program operators usually have relatively little input into the design of studies and interpretation of data. Also they typically receive only minimal financial benefits since most funding is used to pay the researchers.
It is important to understand that grants include both direct and indirect costs. Direct costs pay for the actual research (research staff salaries, travel, client fees, etc.) while indirect costs refer to additional administrative fees (office support, rents, utilities, etc.) paid to research organizations. These fees can range anywhere from 40% to 90% beyond the basic research study cost.
My colleagues generally expressed that programs need to take a larger role in research studies for a few primary reasons. First, since clinicians are very in tune with what is going on in treatment programs and client-related issues versus researchers who typically have limited treatment experience, their input is highly valuable at all levels of a research study. There is a sense among some of the respondents that too much research is esoteric and of limited value in the “real world.”
The problem is that, although clinicians often serve as research advisors, their opinions are less valued since they are viewed as having limited mastery of theory and methodology. One well known researcher recalled a meeting with a federal funding agency where their project officer “joked” that clinicians’ views were welcome but they don’t actually have a vote. A common recommendation was that large treatment organizations should press for a more significant voice when research is in the planning phase and have equitable relations written into the interagency agreement.
A second major reason for programs to be more proactive is to insure the accuracy and relevance of the interpretation of results. A few of my colleagues mentioned that they had experiences where they thought something in a program was not working but when discussing the issue with treatment staff found out that there were administrative challenges that impacted the delivery system and that the actual treatment component being studied did not receive a fair test. Programs need to ensure that the researchers present preliminary results before publishing their findings to ensure accuracy and meaningful interpretations.
Finally, it is obvious that treatment programs like Spectrum that serve diverse treatment populations in multiple settings could seek a greater share of the indirect costs and direct funding. Since Spectrum has recently formed an IRB, the organization can now house the research and be eligible for a significant portion of the indirect costs. Organizations with IRBs can also negotiate for a reasonable share of support staff needed to support the study.
Upcoming blogs will explore the results of specific survey questions with a focus on better understanding of the world of funded research. I feel strongly that treatment research needs programs to be full partners in all stages of the research process, starting with the questions needing study all the way through to interpretation and publication of results.
1Kevin Knight, Ph.D., Gerald Melnick, Ph.D., Roger Peters, Ph.D. Michael Prendergast, Ph.D., Arthur Lurigio, Ph.D., and Pamela Rodriguez, MA.
2What are the three top issues treatment research has clarified?
Specify the 3-5 most important well-documented treatment findings?
What are the major unanswered questions in treatment research?
Where do you see treatment research going in the next 5 to 10 years?
What role can substance abuse programs play to facilitate research?
What could large treatment organizations to facilitate your work?