Accuracy of five on-site immunoassay drugs-of-abuse testing devices.

Many current "on-site" urine drug-testing products claim performance equivalent to laboratory testing. Five commercially available products (PharmScreen, Roche TestCup, Accusign DOA 2, Status DS, and American Bio Medica-Rapid Drug Screen) were challenged with quality-control specimens of known drug metabolite concentrations, 25% above and 25% below the SAMHSA cutoffs, and with known positive and negative donor specimens previously analyzed by immunoassay and gas chromatography-mass spectrometry. The results indicate discrepancies between claims and performance for all products, particularly with amphetamines. The implications for employer-based drug testing are discussed.

Delivering services to individuals with severe mental illness: SAMHSA falls short.

In the wake of the December 2012 mass shooting at an elementary school in Newtown, Connecticut, the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce of the U.S. House of Representatives held a hearing on the Substance Abuse and Mental Health Services Administration (SAMHSA) and its role in caring for people with severe mental illness. The author was among those who testified at the hearing. In this Open Forum she raises points made in that hearing-for example, that in embracing the recovery model and certain evidence-based practices, SAMHSA has been derelict in its duty to attend to the sickest individuals, those with chronic psychosis. She calls on the agency to embrace and promote a more balanced and pragmatic agenda.

Infrastructure Change Is Not Enough: An Evaluation of SAMHSA's Mental Health Transformation State Incentive Grants.

OBJECTIVE: The authors evaluated the Substance Abuse and Mental Health Services Administration's mental health transformation state incentive grant program, which provided more than $100 million to nine states to make infrastructure changes designed to improve services and outcomes. METHODS: The authors measured infrastructure changes, service changes, and consumer outcomes in the nine programs. Although the federal program had no logic model, the authors adopted a model that hypothesized positive, but small, correlations between the program elements. RESULTS: There were few statistically significant correlations and a number of negative correlations between infrastructure changes, service changes, and consumer outcomes. CONCLUSIONS: Federal investments should take into account evidence that infrastructure changes alone do not necessarily contribute to better consumer outcomes, support operationally defined infrastructure improvements, require that service improvements accompany infrastructure changes, and provide sufficient resources to oversee grantee behaviors. In addition, future evaluation should support evaluation best practices.

Assessing drinking outcomes in alcohol treatment efficacy studies: selecting a yardstick of success.

BACKGROUND: Although the number of alcohol treatment efficacy trials has mushroomed, there is no consensus on how best to measure outcomes. To advance the goal of establishing cross-trial consistency in measuring outcomes in clinical efficacy studies, the National Institute on Alcohol Abuse and Alcoholism convened a panel of experts and charged them with exploring, debating, and, ultimately, selecting a "sentinel" or "optimal" outcome measure to be used in future alcohol treatment studies. The goal of this article, one in a series of several presented at the National Institute on Alcohol Abuse and Alcoholism conference, is to discuss (1) the rationale underlying selection of an optimal outcome measure, (2) the necessary characteristics of an optimal outcome measure, (3) the utility of selecting an optimal measure, and (4) which drinking assessment methods could be used to collect data to portray the optimal outcome measure. METHODS: At a minimum, the criteria for an "optimal" measure include that it be psychometrically sound. In addition, it should have considerable currency in the field, thereby increasing its prospects for adoption. The measure should also be consistent with the concepts of greatest interest and relevance to the field (e.g., directly reflect the fundamental goal of alcohol treatment). In light of these highly desired features, percent of days heavy drinking was chosen at the conference as a practical and relevant measure of alcohol treatment outcome. CONCLUSIONS: Percent of days heavy drinking should be the optimal measure of alcohol treatment outcome. Currently, daily drinking estimation methods are the most useful for gathering data that can reflect the optimal measure. In addition, data gathered by daily drinking estimation methods can be used to study a variety of other outcome variables of interest to clinical researchers.

Outcomes and accomplishments of the circles of care planning efforts.

This paper presents outcomes and accomplishments of the first round of participating individuals, communities, and grantees of the Circles of Care program (CoC). While accomplishing all CoC program goals, the initiative supported grantees in developing individual service delivery system models and positioned each grantee advantageously for securing funds for future implementation. The process and products as described can now assist others in improving their own systems of care for Indian children, adolescents, and their families.