Dennis P. Watson

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https://hdl.handle.net/1805/6822

The opioid epidemic has touched every corner of our nation. Decades of scientific evidence demonstrates pragmatic harm reduction approaches (e.g., syringe exchanges, opioid substitution, and naloxone access) are key to more effective opioid-related prevention and treatment, yet wide-held misconceptions regarding substance use and substance users have impeded their impact. These misconceptions are rooted in an ideology of “bootstrap individualism” and popular 12-step/abstinence-only approaches that have little scientific support. Thus, dissemination and implementation of scientific findings into opioid-related policy and practice is of critical importance.

Dr. Dennis Watson’s work in this area developed from his professional interests in mental health, substance use, and community need for research. In collaboration with Dr. Bradley Ray, his projects examine the opioid epidemic in Indiana. This includes three federally-funded evaluation studies of different Indiana-based prevention and treatment efforts and a study of the implementation and effectiveness of an emergency department-based intervention for connecting opioid overdose survivors to medication-assisted treatment. A major focus of his current work is ensuring effective communication of results to community members, advocates, and legislators, through his work with an interdisciplinary team of researchers.

Dr. Watson’s work to disseminate and implement scientific findings into opioid-related policy and practice in Indiana is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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From Structural Chaos to a Model of Consumer Support: Understanding the Roles of Structure and Agency in Mental Health Recovery for the Formerly Homeless
(2012-07) Watson, Dennis P.
Deinstitutionalization shifted the focus in mental health care from provider-guided treatment to consumer-centered recovery. In this article, I seek to develop a deeper understanding of the effect that the organization of mental health services offered in community settings has on the recovery process. I do this by presenting findings from the analysis of focus group and interview data collected from consumers and staff at four housing programs serving formerly homeless individuals with dual diagnosis. My findings highlight the importance of understanding the connection that exists between social structure and personal agency and the recovery process.
The Evolving Understanding of Recovery: What the Sociology of Mental Health has to Offer
(2012-11) Watson, Dennis P.
The meaning of recovery from serious mental illness (SMI) has evolved over time. Whereas it was not even considered to be a primary goal of treatment 30 years ago, it is the main focus of mental health policy today. These changes are partially the result of sociological research conducted during the age of institutional treatment and the early stages of community-based care. Despite these early influences, the sociology of mental health has largely overlooked the explicit study of recovery. This is because sociologists began shifting their focus from the study of SMI to the study of less severe mental health problems beginning in 1970s. In this article, I (a) discuss the evolving history of mental health recovery; (b) discuss how recovery is defined today in policy, practice, and research; and (c) present an argument for why sociological perspectives and methods can help shed light on the tensions between the definitions while assisting to develop better understandings of the recovery process. In this argument, I place particular attention on qualitative social psychological perspectives and methods because they hold the most potential for addressing some of the central concerns in the area of recovery research.
Understanding the Critical Ingredients for Facilitating Consumer Change in Housing First Programming: A Case Study Approach
(2013-04) Watson, Dennis P.; Wagner, Dana E.; Rivers, Michael
Housing First is a form of permanent supportive housing for chronically homeless consumers with mental health and substance abuse issues. In light of the model’s growing popularity and wide diffusion, researchers and policy makers have identified a need to better understand its critical ingredients and the processes through which they affect consumer outcomes. Researchers used a bottom-up approach to understand the critical ingredients of Housing First within community-based programs. Interviews and focus groups were conducted with 60 informants (staff and consumers) across 4 “successful” Housing First programs. Qualitative analysis demonstrated six program ingredients to be essential: (1) a low-threshold admissions policy, (2) harm reduction, (3) eviction prevention, (4) reduced service requirements, (5) separation of housing and services, and (6) consumer education.
Evaluation of Indiana Access to Recovery
(Office of the Vice Chancellor for Research, 2013-04-05) Watson, Dennis P.
This presentation will discuss the evaluation of Indiana’s Access to Recovery (ATR) program. ATR is a 4-year federal demonstration grant managed by Indiana’s Division of Mental Health and Addiction (DMHA). ATR provides clients with access to services that are considered necessary components of recovery, but are often not available under traditional funding schemes (e.g., transportation, food access, housing). The evaluation started in May of 2012, and it is being carried out in collaboration with DMHA with funding from the Solution Center. Undergraduate and graduate student evaluators from the Center for Health Policy (CHP) are carrying out their work under the supervision of a faculty mentor. To date these students have: completed a literature review to assist DMHA in understanding ways to incentivize the work being carried out by providers; carried out 6 client focus groups and 15 provider phone interviews for formative evaluation purposes; and developed a logic model of the program. Students have also provided ongoing feedback to DMHA through their attendance at regularly scheduled advisory board meetings. Students are currently in the process of analyzing a large administrative database to provide feedback related to the effectiveness of the program. These finding will be of great benefit to DMHA as they seek to secure additional funding for ATR after the initial demonstration comes to a close. The presentation will discuss some of the early findings of the evaluation and a number of the lessons that students have learned about working in collaboration with a government partner.
The housing first model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users
(2013-05) Watson, Dennis P.; Orwat, John; Wagner, Dana E.; Shuman, Valery; Tolliver, Randi
Background The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing. Methods The HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states. Results The results provided evidence for the overall reliability and validity of the index. Conclusions The results demonstrate the index’s ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM.
Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study
(BioMed Central, 2014) Watson, Dennis P.; Young, Jeani; Ahonen, Emily Q.; Xu, Huiping; Henderson, Macey; Shuman, Valery; Tolliver, Randi; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
Background: There is currently a lack of scientifically designed and tested implementation strategies. Such strategies are particularly important for highly complex interventions that require coordination between multiple parts to be successful. This paper presents a protocol for the development and testing of an implementation strategy for a complex intervention known as the Housing First model (HFM). Housing First is an evidence-based practice for chronically homeless individuals demonstrated to significantly improve a number of outcomes. Methods/design: Drawing on practices demonstrated to be useful in implementation and e-learning theory, our team is currently adapting a face-to-face implementation strategy so that it can be delivered over a distance. Research activities will be divided between Chicago and Central Indiana, two areas with significantly different barriers to HFM implementation. Ten housing providers (five from Chicago and five from Indiana) will be recruited to conduct an alpha test of each of four e-learning modules as they are developed. Providers will be requested to keep a detailed log of their experience completing the modules and participate in one of two focus groups. After refining the modules based on alpha test results, we will test the strategy among a sample of four housing organizations (two from Chicago and two from Indiana). We will collect and analyze both qualitative and quantitative data from administration and staff. Measures of interest include causal factors affecting implementation, training outcomes, and implementation outcomes. Discussion: This project is an important first step in the development of an evidence-based implementation strategy to increase scalability and impact of the HFM. The project also has strong potential to increase limited scientific knowledge regarding implementation strategies in general.
Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment
(Office of the Vice Chancellor for Research, 2014-04-11) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah E.; Watson, Dennis P.
Urban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, conducting workshops on cutting-edge developments in urban health, and bridging campus and community efforts in public health, including the Reconnecting to Our Waterways (RWO) initiative.
Access to Recovery and Recidivism Among Former Prison Inmates
(Sage, 2015) Ray, Bradley; Grommon, Eric; Buchanan, Victoria; Brown, Brittany; Watson, Dennis P.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
Access to Recovery (ATR) is a SAMHSA-funded initiative that offers a mix of clinical and supportive services for substance abuse. ATR clients choose which services will help to overcome barriers in their road to recovery, and a recovery consultant provides vouchers and helps link the client to these community resources. One of ATR’s goals was to provide services to those involved in the criminal justice system in the hopes that addressing substance abuse issues could reduce subsequent criminal behaviors. This study examines this goal by looking at recidivism among a sample of clients in one state’s ATR program who returned to the community after incarceration. Results suggest there were few differential effects of service selections on subsequent recidivism. However, there are significant differences in recidivism rates among the agencies that provided ATR services. Agencies with more resources and a focus on prisoner reentry had better recidivism outcomes than those that focus only on substance abuse services.
The Meaning of Recovery from Co-Occurring Disorder: Views from Consumers and Staff Members Living and Working in Housing First Programming
(Springer, 2015-03) Watson, Dennis P.; Rollins, Angela L.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
The current study seeks to understand the concept of recovery from the perspectives of consumers and staff living and working in a supportive housing model designed to serve those with co-occurring disorder. Interview and focus group data were collected from consumers and staff from four housing programs. Data analyzed using an approach that combined case study and grounded theory methodologies demonstrate that: consumers’ and staff members’ views of recovery were highly compatible and resistant to abstinence-based definitions of recovery; recovery is personal; stability is a foundation for recovery; recovery is a process; and the recovery process is not linear. These themes are more consistent with mental health-focused conceptions of recovery than those traditionally used within the substance abuse field, and they help demonstrate how recovery can be influenced by the organization of services in which consumers are embedded.
Traits of patients who screen positive for dementia and refuse diagnostic assessment
(Elsevier, 2015-06) Fowler, Nicole R.; Frame, Amie; Perkins, Anthony J.; Gao, Sujuan; Watson, Dennis P.; Monahan, Patrick; Boustani, Malaz A.; Department of Medicine, IU School of Medicine
BACKGROUND: As part of the debate about screening for dementia, it is critical to understand why patients agree or disagree to diagnostic assessment after a positive screening test. We used the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire to measure the characteristics of patients who screened positive for dementia but refused further diagnostic assessment. METHODS: Survey of patients ≥65 years old without a diagnosis of dementia attending primary care clinics in Indianapolis, IN, in 2008 and 2009. RESULTS: Five hundred and fifty-four individuals completed the PRISM-PC and 63 screened positive. Of those, 21 (33%) accepted and 42 (67%) refused diagnostic assessment. In adjusted models, having larger stigma domain scores and living alone were significantly associated with increased odds of refusing the diagnostic assessment. CONCLUSION: Despite screening positive, many patients refused a diagnostic assessment. Living alone and the perceived stigmas of dementia are associated with the refusal of diagnostic assessment for dementia.

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