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Introduction Project Extension for Community Healthcare Outcomes (ECHO™) is a hub-and-spoke knowledge-sharing network, led by expert teams who use multipoint videoconferencing to conduct virtual clinics with community providers in order to improve the quality of care. For this project, members of the Addiction Technology Transfer Center network applied this model in order to enhance workforce capacity to deliver clinical supervision for the treatment of substance use disorders. Methods Clinical supervisors ( n =66) employed in substance use disorder treatment programs were recruited to participate in this pilot study. The virtual ECHO clinic consisted of 12 total sessions, each lasting 1 hour and comprising a 15-minute mini-lecture on a clinical supervision topic and a 45-minute case presentation and review. All data were collected and analyzed between September 2016 and June 2017. Results Forty-eight staff attended at least one ECHO session (mean=6.38) and results are presented for 20 staff who completed the follow-up survey. Participants were highly satisfied with the overall intervention, organization of the clinic and the facilitation of Hub experts, relevance of the technical assistance to their work, and with the impact of the intervention on their effectiveness as a supervisor. Results also indicate that there were significant self-reported improvements in clinical supervision self-efficacy following participation in the ECHO clinic. Conclusions Results from this pilot study suggest that ECHO virtual clinics are feasible to implement for the purpose of workforce development, are well liked by participants, and can enhance clinical supervision self-efficacy among participants. Further research should explore the impact of self-efficacy on the effective implementation of clinical supervision practices. Supplement information This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

An implementation approach, featuring direct, onsite technical assistance is described, and findings from a pilot study assessing the capability of Federally Qualified Health Centers to provide integrated behavioral health services are presented. Investigators used the Behavioral Health Integration in Medical Care (BHIMC) index to measure integration at baseline and follow-up at four FQHCs in New Jersey. Results indicate that the average baseline capability score of 1.95 increased to 2.44 at follow-up, almost one-half point on the five-point BHIMC index. This pilot project demonstrates that co-occurring capability can be assessed, and system-wide technical assistance can be delivered to assist FQHCs in integrating behavioral health services. Future research should test technical assistance as an implementation strategy to promote the integration of medical care and behavioral health treatment on a wider scale.

Two nonspecific organizational factors-consensus, defined as agreement within staff and client groups, and concordance, defined as agreement between staff and client groups-were shown to influence client engagement in treatment in a national sample of 80 residential substance abuse treatment programs including 595 staff and 3,732 clients. Agreement was tested using a combined therapeutic community, cognitive-behavioral therapy, and 12-step treatment scale completed by staff and clients. Treatment engagement was measured by the combined scores on the three scales completed by the clients, including engagement, rapport with the counseling process, and confidence in treatment. Within-group consensus was measured by the standard deviations of the mean scores, whereas between-groups concordance was measured by the standard error of the difference between staff and client mean scores. Regression analyses showed that staff consensus was a significant independent predictor of client treatment engagement (p.05), whereas client consensus approached significance (p.10). Concordance was also a significant predictor of client engagement (p.002) after controlling for staff and client consensus. The potential contribution of the findings to a better understanding of program quality and effectiveness of programmatic interventions is discussed.

s / Drug and Alcohol Dependence 140 (2014) e2–e85 e31 Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders Michael Chaple1, Stanley Sacks1, M.T. French2, B. Sayed2, Lisa A. Marsch3 1 CIRP, NDRI, New York, NY, United States 2 University of Miami, Miami, FL, United States 3 Dartmouth Med Sch, Hanover, NH, United States Aims: (1) To test, among a sample of substance-abusing prisoners, the effectiveness of the Experimental condition (Therapeutic Education System [TES]), a computer-delivered treatment program, versus a control condition (Standard Care—group psychoeducation delivered by a trained clinician), on measures of self-reported drug use, HIV risk behavior, crime and reincarceration; (2) To compare the costs of administering both treatments in a prison setting. Methods: Employs random assignment to either (1) TES, or (2) Standard Care, in a multi-site trial conducted in 4 States and 10 prisons. This prospective longitudinal study obtains follow-up data post-prison discharge, interviews at 3and 6-months and criminal record checks to examine the comparative effectiveness of these interventions. Cost datawas also collected using amodified version of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Results: A total of 513 subjects participated in the study (TES N=258; Control N=255). Findings show no significant differences between TES and Standard Care on self-reported outcomes. Rates of incarceration at 12 months post-prison release will be reported. Cost comparisons, however, show that TES was 4–5 times (i.e. cost per client)more expensive to implement in prisonwhen compared to Standard Care. Conclusions: Results demonstrate the comparative effectiveness of TES and Standard Care. However, TES is 4–5 times more costly to implement. However, this is mainly due to the initial investment required for TES (e.g., license and equipment fees), making the average cost higher when delivered in the context of a short-term clinical trial with limited targeted enrollments. Thus, there are likely to be cost-savings with TES if this technological intervention can be implemented to its fullest capacity. This paper will review the methodological challenges of “scaling-up” costs. Financial support: This ongoing ARRA-funded NIDA study, begun in 2009, and is supported by Award Number RC2DA028967. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.105 Exposure to stressful life events mediates the relation between family history of substance abuse and childhood adjustment Nora E. Charles, Ashley Acheson, C.W. Mathias, D. Dougherty Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States Aims: Children with a family history of alcohol and other drug use disorders (FH+) are at increased risk for developing future substance use disorders relative to thosewithout such histories (FH−). The FH+ associated risk is thought to be related to behavioral and emotional maladjustment present prior to the initiation of substance use; however, it is unclear to what extent environmental stressors may be contributing to these deficits. The aim of the present research was to (1) quantify stressful life events in FH+ and FH− children and (2) determine the influence of these events on childhood adjustment. Methods: Children’s self-reported stressful life events and parents’ report of their children’s emotional and behavioral adjustment were examined in FH+ (n=234) and FH− (n=62) children (ages 10–12). Results: FH+ children reported significantly more stressful life events than did FH− children; specifically,more instances of abuse, household changes (moving, new people in home), family dysfunction (domestic violence, divorce), academic problems, exposure to crime, andfinancial problems. Parents of FH+childrenalso reported significantly higher levels of internalizing and externalizing symptoms in their children. Analyses of the relationships between family history, stressful life events, and child adjustment indicated that stressful life events explained much of the association between FH status and emotional and behavioral adjustment. Conclusions: FH+childrenexperiencemore stressful liveevents across a broad range of categories, and these stressful life events appear to relate directly to poorer emotional andbehavioral adjustment in these children. This research is part of a longitudinal study and the model reported here will be applied to future substance use among these children to determine towhat extent stressful life events contribute to problem substance use during adolescence. Financial support: National Institutes of Health (R01DA026868, R01-DA033997). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.106 Clinical supervision of drug counselors in Maldives Marek C. Chawarski1, A. Malik2, L. Hussain3 1 Yale School of Medicine, New Haven, CT, United States 2 UNODC, Male, Maldives 3 National Drug Agency, Male, Maldives Aims: To improve effectiveness of drug counseling in the Maldives (estimated up to 30,000 active drug users in a population of 329,000), we implemented and evaluated a clinical supervision training program. Methods: An 8-day workshop on effective drug counseling and clinical supervision skills included lectures, case discussions, and practical exercises. Preand post-workshop evaluation surveys evaluated knowledge and attitudes about drug use problems, prevention and recovery, drug counseling, clinical supervision, and self-evaluation of knowledge and professional skills learned during the workshop. Results: Workshop participants were 15 females and 2 males: mean age 30, 12 years of formal education, 6 years of experienceworkingwith drug users; highest professional degrees related to counseling included B.A. in psychology (5) and a counseling diploma (12). Differences between pre and post-evaluation results included shifts in the factors identified as the most important for recovery: from internal motivation (endorsed by 15 participants) and family and community support (10 participants endorsed) to availability and accessibility of effective medical treatments (10 endorsements), engagement in psychosocial/behavioral interventions (8), and lifestyle and behavior changes by the recovering individuals (6); and in the clinical supervision skills identified as most important: from a nonjudgmental attitude (11) and empathy (8) tomastery of professional skills by the supervising clinician (10 endorsements). Conclusions: Workshop participants increased their knowledge and practical expertise of evidence-based interventions, learnedabout objective evaluationmethods, anddevelopedgreater appreciation of the importance of delivering goal oriented and