DoubleTree Hotel
Rockville, Maryland
September 11, 1997

Elizabeth Robertson, Ph.D.
Prevention Research Branch
Division of Epidemiology and Prevention Research

Summary

Meeting Goals:

• Identify examples that illustrate the integration of research-based family substance abuse prevention interventions into health care and social service programming.
• Discuss ways in which health care providers can be influenced to integrate prevention intervention programs, program components, and knowledge.
• Explore types of research that would facilitate the integration of prevention interventions into health care settings.

Meeting Process:

The open agenda for the meeting included introductory remarks from participants and open discussion to define the issues involved and to recommend action.

Content:

The increased role of managed care is having a dramatic impact on health care services.

• Managed care sites provide opportunities for potentially efficacious prevention interventions.
• Managed care organizations (MCOs) may be better sites for health care services researchers than social service agencies, but may exclude or underrepresent high-risk populations that have no access to health insurance plans.
• The focus of research should be on the health care delivery system and employees and how they relate to the family.
• Health care purchasers (e.g., businesses, governments) can influence provision of health services; providers must offer an array of services to remain competitive.
• Policy-based, process-based prevention trials are important.

A five-phase framework, based on articles by Greenwald and Cullen, was suggested to help define a research agenda and to study prevention practices.

• Epidemiology (hypothesis development/surveys or major purchaser groups)
• Etiology (methods development)
• Efficacy
• Effectiveness
• Dissemination

Meeting participants made the following recommendations for prevention programs:

• Promote and popularize prevention.
• Define tasks and terms.
• Determine essential family intervention program elements, core components, and minimum standards.
• Identify prevention programs with validated practices and recorded, established results.
• Monitor prevention programs from outside the system.
• Encourage management information systems to enhance data collection.
• Form community prevention advocacy groups to influence public policy and perceptions.
• Develop measurement instruments with appropriate length and implementation feasibility.
• Adopt standardized outcome measures that can be linked to cost data.

Participants discussed the following cost and funding issues:

• Funding is an obstacle to adopting model programs.
• Incentives for prevention programs in MCOs need to be built into cost reimbursement.
• Mandating prevention programs through use of Medicaid dollars needs to be explored.
• More cost-effectiveness, cost-benefit, and cost-offset studies are needed.
• Contracts with state and federal agencies would generate cost information in the public domain.

Conclusion:

Participants agreed that the health care delivery system offers a potential pathway to expand family-focused prevention services. The service delivery approach offers researchers an opportunity to examine programming results, effectiveness, outcomes, and costs of prevention interventions.

Products and Follow-up:

• Convene a second meeting that includes greater representation from managed care organizations, social service organizations, existing service delivery systems, and health care economists.
• Concentrate on program development in health services research.
• Draft a plan for prevention services delivery for participant review.
• Develop a companion booklet to DEPR’s Preventing Drug Abuse Among Children and Adolescents: A Research-Based Guide.