• Examining the sustainability potential of a multisite pilot to integrate alcohol screening and brief intervention within three primary care systems.

      King, Diane; Hanson, Bridget (Oxford Academic, 1/23/2018)
      The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to post implementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multi clinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.
    • An environmental scan of the role of nurses in preventing fetal alcohol spectrum disorders.

      King, Diane; Hanson, Bridget; Porter, Rebecca; Edwards, Alexandra (PubMed, 1/25/2018)
      Nurses are in an ideal position to talk to their patients of reproductive age about alcohol use and encourage the prevention of alcohol-exposed pregnancies. Effective conversations can be efficiently included in the clinical encounter to identify alcohol misuse and offer appropriate follow-up. This report presents results of an environmental scan of resources relevant to nursing professionals and nurses' role in addressing alcohol misuse. Gaps in nursing education and practice guidelines with regard to defining the nursing role in preventing alcohol-exposed pregnancies were revealed. Findings identified a need to promote adoption among nurses of evidence-based preventive practices to prevent alcohol misuse.
    • The Feasibility of Adopting an Evidence-Informed Tailored Exercise Program within Adult Day Services: The Enhance Mobility Program.

      King, Diane; Faulkner, S.A.; Hanson, Bridget (Taylor & Francis Group, 11/29/2017)
      This article uses the RE-AIM framework to evaluate the feasibility of implementing Enhance Mobility (EM), a tailored, evidence-informed group exercise and walking program for older adults with dementia, into an adult day services center. Participant physical performance outcomes were measured at baseline and 8 months. Program staff were interviewed to understand implementation challenges. Participant outcomes did not change significantly, though gait speed improved from limited to community ambulation levels. Implementation challenges included space reallocation and adequate staffing. Adopting EM in adult day services is feasible, and has potential to reach older adults who could benefit from tailored exercise.
    • Minimal Intervention Needed for Change: Definition, Use, and Value for Improving Health and Health Research

      King, Diane (PubMed, 2014-03-01)
      Much research focuses on producing maximal intervention effects. This has generally not resulted in interventions being rapidly or widely adopted or seen as feasible given resources, time, and expertise constraints in the majority of real-world settings. We present a definition and key characteristics of a minimum intervention needed to produce change (MINC). To illustrate use of a MINC condition, we describe a computer-assisted, interactive minimal intervention, titled Healthy Habits, used in three different controlled studies and its effects. This minimal intervention produced modest to sizable health behavior and psychosocial improvements, depending on the intensity of personal contacts, producing larger effects at longer-term assessments. MINC comparison conditions could help to advance both health care and health research, especially comparative effectiveness research. Policy and funding implications of requiring an intervention to be demonstrated more effective than a simpler, less costly MINC alternative are discussed
    • What patients want: Relevant health information technology for diabetes self-management.

      King, Diane (Springer, 2015-03-05)
      Health information technology has great potential to promote efficiency in patient care and increase patient-provider communication, and patient engagement in their treatment. This paper explored qualitatively what patients with type 2 diabetes want from electronic resources that are designed to support their diabetes self-management. Data were collected via interviews and focus groups from managed care patients who had completed participation in either a web-based (MyPath) or in-person group-based (¡Viva Bien!) longitudinal diabetes self-management study. Content analysis identified common themes that highlighted participant interest in virtual and electronic programs to support diabetes self-management goals, and their desired content and features. Eighteen ¡Viva Bien! participants completed telephone interviews and 30 MyPath participants attended seven focus groups in 2010-2011. All participants expressed a preference for face-to-face contact; however, most participants were also interested in using technology as a tool to support daily diabetes self-management decisions and to receive tailored information. Choice of technology, personalized instruction on how to use program features, and the ability to exchange information with their healthcare team were desired by all participants. Participants were divided on whether virtual social support networks should be closed to friends and family, should include other program members (peers), or should be open to anyone with diabetes. Participants aged 65 and older stressed the desire for technical support. What patients wanted from technology is real-time assistance with daily behavioral decision-making, ability to share information with their healthcare team, connections with others for support, and choice.
    • Baseline Opioid Survey: Access, Consumption, Consequences, and Perceptions among Young Adults in Alaska

      Barnett, Jodi; Hanson, Bridget; Smith, Oliver (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-05-01)
      In September of 2015, SAMHSA awarded the Partnerships for Success (PFS) grant to the State of Alaska  Department of Health and Social Services, Division of Behavioral Health (DBH). The PFS grant program is  a five‐year effort that focuses on preventing and reducing substance use and building prevention  capacity at both the state and community levels. DBH provides leadership for the project and facilitates  the conduct of project activities by community‐level coalitions. Additionally, DBH contracted with the  Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA)  to conduct a comprehensive evaluation of the PFS project.   Using a data‐informed prioritization process to narrow the substance abuse focus of the grant, the State  Epidemiological Outcomes Workgroup chose two PFS priority areas: 1) non‐medical use of prescription  opioids among 12‐25 year olds; and 2) heroin use among 18‐25 year olds. Data on the use of and  consequences related to prescription opioids and heroin in Alaska are described below.  Partnerships for Success (PFS) Priority Area: Non‐Medical Use of Prescription Opioids  Data from the National Survey on Drug Use and Health (NSDUH) indicate that young adults aged 18‐25  consistently have the highest percentage of non‐medical use of prescription pain relievers in Alaska  compared to youth aged 12‐17 and adults aged 26 and older (see Figure 1).1,2,3 While small decreases in  use were observed among all age groups from 2009 to 2014, the age‐specific pattern remained  consistent.   Figure 1. Past year non‐medical use of prescription pain relievers in Alaska from 2009 to 2014 by age  Additional data requested from NSDUH (see Table 1) indicated no significant change in non‐medical use  of prescription pain reliever estimates among 12‐25 year olds in Alaska between years 2007‐2010 and  2011‐2014 but a decreasing trend was observed for past year use and past year prescription pain  reliever dependence or abuse.4 0 5 10 15 2009-2010 2011-2012 2013-2014 Percentage 12-17 years 18-25 years 26+ years 4 Table 1. Past year non‐medical use of prescription pain reliever estimates among individuals aged 12  to 25 in Alaska from 2007 to 2014  1 Dependence/abuse is based on definitions found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV)  Estimates of past year non‐medical use of prescription pain relievers among individuals aged 12 and  older in Alaska are slightly higher than national estimates but both follow a small decreasing trend in use  from 2009 to 2014 (see Figure 2).1,2,3 Figure 2. Past year non‐medical use of prescription pain relievers among individuals aged 12 and older in  the U.S. and Alaska from 2009 to 2014  Other indicators related to non‐medical use of prescription opioids in Alaska have also decreased slightly  or stabilized in recent years. Treatment admissions for synthetic opiates (opiates or synthetics including  Methadone, Oxycodone, or Oxycontin) as a primary, secondary, or tertiary substance of abuse have  stayed relatively stable from 2013 to 2015 (1,052 to 1,011 treatment admissions), according to the  Alaska Automated Information Management System (AKAIMS).5  Age‐adjusted overdose death rates in  Alaska have decreased from 11.2 per 100,000 in 2009 to 8.5 per 100,000 in 2015. Although overdose  deaths from prescription opioids are decreasing, Alaska still has higher rates of overdose deaths from  prescription opioids than the nation overall (7.3 vs. 5.1 per 100,000 in 2012).6 
    • Baseline Opioid Survey: Access, Consumption, Consequences, and Perceptions among Young Adults in Alaska

      Barnett, Jodi (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-05-01)
    • Prevention of Fetal Alcohol Spectrum Disorders: Practice Behaviors, Attitudes, and Confidence among Members of the American College of Nurse-Midwives

      Neander, Lucia; Hanson, Bridget; Porter, Rebecca (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-06-01)
      As part of an ACNM collaboration with the Centers for Disease Control and Prevention (CDC) and its partners and grantees on a project to prevent fetal alcohol spectrum disorders (FASDs), ACNM members were surveyed to generate an assessment of practice behaviors of certified nurse-midwives and certified midwives related to the prevention of FASDs. The information will be used as a baseline from which to measure change in nurse-midwives’ and midwives’ practice behaviors over the course of the project. Results from the assessment will also be used to inform detailed collaborative activities between ACNM and CDC grantees whose efforts specifically target nurse-midwives (i.e., University of Alaska Anchorage (UAA), University of California San Diego, University of Pittsburgh).
    • Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

      Elkins, Amanda; Barnett, Jodi; Hanson, Bridget; Smith, Oliver (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-08-01)
      The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.
    • Medicaid Policies for Alcohol SBI Reimbursement

      Porter, Rebecca R.; Hanson, Bridget; Smith, Oliver (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-08-01)
      The purpose of this report was to review existing reimbursement policies by state Medicaid agency, including the District of Columbia (D.C.), in order to understand similarities and differences associated with financial compensation for alcohol screening and brief intervention (SBI) services. Alcohol SBI is an evidence-based practice known to help reduce atrisk alcohol consumption among patients who drink too much. 1 Although alcohol SBI was designed to be a population-based approach to address unhealthy alcohol consumption, its current utilization is limited. 2 Implementation of the practice into routine clinical care remains a challenge at the health system level even with support from federal resources (e.g., SBIRT: Screening, Brief Intervention, and Referral to Treatment). One way to encourage the uptake of alcohol SBI/SBIRT among providers is to ensure that the service is reimbursable by third-party payers. However, reimbursement opportunities vary by state and payer, and in some locations are non-existent. Information about the current status of policies will assist in the development of policies and incentives to encourage healthcare providers and systems to submit claims for alcohol SBI/SBIRT and potentially increase the routine uptake of the service in clinical care
    • Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

      Elkins, Amanda (Center for Behavioral Health Research & Services, University of Alaska Anchorage, 2017-08-01)
    • Culturally-Relevant Online Education Improves Health Workers' Capacity and Intent to Address Cancer

      Cueva, Katie; Dignan, Mark; Revels, Laura; Cueva, Melanie (Springer, 2018-01-24)
    • Statute and implementation: How phantom policies affect tenure value and support

      Defeo, Dayna; Hirshberg, Diane; Berman, Matthew (Center for Alaska Education Policy Research, University of Alaska Anchorage, 5/10/2018)
      Using survey responses from public school teachers and principals in Alaska, this article describes their understanding of tenure statute, and how that understanding affected support, perceived effectiveness, and valuation of tenure. Teachers and principals who inflated tenure protections were more likely to support it; the more teachers inflated tenure protections, the higher dollar value they placed on it. The article discusses the fiscal and policy implications of tenure inflation, noting that this garners the most criticism from education reformers, but concomitantly constitutes cost savings for taxpayers.
    • Lessons Learned from Community-Based Participatory Research: Establishing a Partnership to Support Lesbian, Gay, Bisexual and Transgender Aging-in-Place.

      King, Diane (PubMed, 6/1/2017)
      BACKGROUND: Due to a history of oppression and lack of culturally competent services, lesbian, gay, bisexual and transgender (LGBT) seniors experience barriers to accessing social services. Tailoring an evidence-based ageing in place intervention to address the unique needs of LGBT seniors may decrease the isolation often faced by this population. OBJECTIVE: To describe practices used in the formation of a community-based participatory research (CBPR), partnership involving social workers, health services providers, researchers and community members who engaged to establish a LGBT ageing in place model called Seniors Using Supports To Age In Neighborhoods (SUSTAIN). METHODS: A case study approach was employed to describe the partnership development process by reflecting on past meeting minutes, progress reports and interviews with SUSTAIN's partners. RESULTS: Key partnering practices utilized by SUSTAIN included (i) development of a shared commitment and vision; (ii) identifying partners with intersecting spheres of influence in multiple communities of identity (ageing services, LGBT, health research); (iii) attending to power dynamics (e.g. equitable sharing of funds); and (iv) building community capacity through reciprocal learning. Although the partnership dissolved after 4 years, it served as a successful catalyst to establish community programming to support ageing in place for LGBT seniors. CONCLUSION: Multi-sector stakeholder involvement with capacity to connect communities and use frameworks that formalize equity was key to establishing a high-trust CBPR partnership. However, lack of focus on external forces impacting each partner (e.g. individual organizational strategic planning, community funding agency perspectives) ultimately led to dissolution of the SUSTAIN partnership even though implementation of community programming was realized.
    • Safe, Affordable, Convenient: Environmental Features of Malls and Other Public Spaces Used by Older Adults for Walking.

      King, Diane (PubMed, 7/14/2015)
      BACKGROUND: Midlife and older adults use shopping malls for walking, but little research has examined mall characteristics that contribute to their walkability. METHODS: We used modified versions of the Centers for Disease Control and Prevention (CDC)-Healthy Aging Research Network (HAN) Environmental Audit and the System for Observing Play and Recreation in Communities (SOPARC) tool to systematically observe 443 walkers in 10 shopping malls. We also observed 87 walkers in 6 community-based nonmall/nongym venues where older adults routinely walked for physical activity. RESULTS: All venues had public transit stops and accessible parking. All malls and 67% of nonmalls had way finding aids, and most venues (81%) had an established circuitous walking route and clean, well-maintained public restrooms (94%). All venues had level floor surfaces, and one-half had benches along the walking route. Venues varied in hours of access, programming, tripping hazards, traffic control near entrances, and lighting. CONCLUSIONS: Despite diversity in location, size, and purpose, the mall and nonmall venues audited shared numerous environmental features known to promote walking in older adults and few barriers to walking. Future research should consider programmatic features and outreach strategies to expand the use of malls and other suitable public spaces for walking.