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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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.
Alpha test results for a Housing First eLearning strategy: the value of multiple qualitative methods for intervention design
(BMC, 2017-10-31) Ahonen, Emily Q.; Watson, Dennis P.; Adams, Erin L.; McGuire, Alan; Health Policy and Management, School of Public Health
Background Detailed descriptions of implementation strategies are lacking, and there is a corresponding dearth of information regarding methods employed in implementation strategy development. This paper describes methods and findings related to the alpha testing of eLearning modules developed as part of the Housing First Technical Assistance and Training (HFTAT) program’s development. Alpha testing is an approach for improving the quality of a product prior to beta (i.e., real world) testing with potential applications for intervention development. Methods Ten participants in two cities tested the modules. We collected data through (1) a structured log where participants were asked to record their experiences as they worked through the modules; (2) a brief online questionnaire delivered at the end of each module; and (3) focus groups. Results The alpha test provided useful data related to the acceptability and feasibility of eLearning as an implementation strategy, as well as identifying a number of technical issues and bugs. Each of the qualitative methods used provided unique and valuable information. In particular, logs were the most useful for identifying technical issues, and focus groups provided high quality data regarding how the intervention could best be used as an implementation strategy. Conclusions Alpha testing was a valuable step in intervention development, providing us an understanding of issues that would have been more difficult to address at a later stage of the study. As a result, we were able to improve the modules prior to pilot testing of the entire HFTAT. Researchers wishing to alpha test interventions prior to piloting should balance the unique benefits of different data collection approaches with the need to minimize burdens for themselves and participants. Electronic supplementary material The online version of this article (10.1186/s40814-017-0187-y) contains supplementary material, which is available to authorized users.
Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in “real-world” research
(BMC, 2021-02-04) Dir, Allyson L.; Watson, Dennis P.; Zhiss, Matthew; Taylor, Lisa; Bray, Bethany C.; McGuire, Alan; Psychiatry, School of Medicine
Background: This manuscript provides a research update to the ongoing pragmatic trial of Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment), an emergency department-based peer recovery coaching intervention for linking patients with opioid use disorder to evidence-based treatment. The research team has encountered a number of challenges related to the "real-world" study setting since the trial began. Using an implementation science lens, we sought to identify and describe barriers impacting both the intervention and research protocols of the POINT study, which are often intertwined in pragmatic trials due to the focus on external validity. Method: Qualitative data were collected from 3 peer recovery coaches, 2 peer recovery coach supervisors, and 3 members of the research team. Questions and deductive qualitative analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Results: Nine unique barriers were noted, with 5 of these barriers impacting intervention and research protocol implementation simultaneously. These simultaneous barriers were timing of intervention delivery, ineffective communication with emergency department staff, lack of privacy in the emergency department, the fast-paced emergency department setting, and patient's limited resources. Together, these barriers represent the intervention characteristics, inner setting, and outer setting domains of the CFIR. Conclusion: Results highlight the utility of employing an implementation science framework to assess implementation issues in pragmatic trials and how this approach might be used as a quality assurance mechanism given the considerable overlap that exists between research and intervention protocols in real-world trial settings. Previously undocumented changes to the trial design that have been made as a result of the identified barriers are discussed.
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.
Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial
(BMC, 2017-12-15) Watson, Dennis P.; Ray, Bradley; Robison, Lisa; Xu, Huiping; Edwards, Rhiannon; Salyers, Michelle P.; Hill, James; Shue, Sarah; Social and Behavioral Sciences, School of Public Health
Background There is a lack of evidence-based substance use disorder treatment and services targeting returning inmates. Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT) is a community-driven, recovery-oriented approach to substance abuse care which has the potential to address this service gap. SUPPORT is modeled after Indiana’s Access to Recovery program, which was closed due to lack of federal support despite positive improvements in clients’ recovery outcomes. SUPPORT builds on noted limitations of Indiana's Access to Recovery program. The ultimate goal of this project is to establish SUPPORT as an effective and scalable recovery-oriented system of care. A necessary step we must take before launching a large clinical trial is pilot testing the SUPPORT intervention. Methods The pilot will take place at Public Advocates in Community Re-Entry (PACE), nonprofit serving individuals with felony convictions who are located in Marion County, Indiana (Indianapolis). The pilot will follow a basic parallel randomized design to compare clients receiving SUPPORT with clients receiving standard services. A total of 80 clients within 3 months of prison release will be recruited to participate and randomly assigned to one of the two intervention arms. Quantitative measures will be collected at multiple time points to understand SUPPORT’s impact on recovery capital and outcomes. We will also collect qualitative data from SUPPORT clients to better understand their program and post-discharge experiences. Discussion Successful completion of this pilot will prepare us to conduct a multi-site clinical trial. The ultimate goal of this future work is to develop an evidence-based and scalable approach to treating substance use disorder among persons returning to society after incarceration. Trial registration ClinicalTrials.gov (Clinical Trials ID: NCT03132753 and Protocol Number: 1511731907). Registered 28 April 2017.
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.
Effects of smoke-free air law on acute myocardial infarction hospitalization in Indianapolis and Marion County, Indiana
(BMC Public Health, 2018-02-09) Weaver, Anne M.; Wang, Yi; Rupp, Katelin; Watson, Dennis P.
Background A comprehensive smoke-free air law was enacted on June 1, 2012 in most of Marion County, Indiana, including all of the City of Indianapolis. We evaluated changes in acute myocardial infarction (AMI) admission rates in Indianapolis and Marion County before compared to after the law. Methods We collected AMI admissions from five Marion County hospitals between May 2007 and December 2014. We used Poisson regression to evaluate the overall effects of the law on monthly AMI hospitalizations, adjusting for month, seasonality, meteorology, air pollution, and hospital utilization. We tested the interactions between the law and AMI risk factors on monthly AMI admission rates to identify subpopulations for which the effects might be stronger. Results Monthly AMI admissions declined 20% (95% CI 14–25%) in Marion County and 25% (95% CI 20–29%) in Indianapolis after the law was implemented. We observed decreases among never (21%, 95% CI 13–29%), former (28%, 95% CI 21–34%), and current smokers (26%, 95% CI 11–38%); Medicaid beneficiaries (19%, 95% CI 9–29%) and non-beneficiaries (26%, 95% CI 20–31%). We observed decreases among those with a history of diabetes (Yes: 22%, 95% CI 14–29%; No: 25%, 95% CI 18–31%), congestive heart failure (Yes: 23%, 95% CI 16–30%; No: 24%, 95% CI 17–31%), and hypertension (Yes: 23%, 95% CI 17–28%: No: 26%, 95% CI 15–36%). Conclusions We observed decreases in AMI admissions comparable with previous studies. We identified subpopulations who benefitted from the law, such as former and current smokers, and those without comorbidities such as congestive heart failure and hypertension.
Emergency department-based peer support for opioid use disorder: Emergent functions and forms
(Elsevier, 2019) McGuire, Alan B.; Gilmore Powell, Kristen; Treitler, Peter C.; Wagner, Karla D.; Smith, Krysti P.; Cooperman, Nina; Robinson, Lisa; Carter, Jessica; Ray, Bradley; Watson, Dennis P.; School of Public and Environmental Affairs
Emergency department (ED)-based peer support programs aimed at linking persons with opioid use disorder (OUD) to medication for addiction treatment and other recovery services are a promising approach to addressing the opioid crisis. This brief report draws on experiences from three states' experience with such programs funded by the SAMHSA Opioid State Targeted Repose (STR) grants. Core functions of such programs include: Integration of peer supports in EDs; Alerting peers of eligible patients and making the patient aware of peer services; and connecting patients with recovery services. Qualitative data were analyzed using a general inductive approach conducted in 3 steps in order to identify forms utilized to fulfill these functions. Peer integration differed in terms of peer's physical location and who hired and supervised peers. Peers often depend on ED staff to alert them to potential patients while people other than the peers often first introduce potential patients to programming. Programs generally schedule initial appointments for recovery services for patients, but some programs provide a range of other services aimed at supporting participation in recovery services. Future effectiveness evaluations of ED-based peer support programs for OUD should consistently report on forms used to fulfill core functions.
Erratum to: Examining Fatal Opioid Overdoses in Marion County, Indiana
(Springer-Verlag, 2017-04) Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena; School of Public and Environmental Affairs
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.

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