TRI Appointment of Former SAMHSA Official: Mady Chalk, Ph.D. to Join Philadelphia-based Treatment Research Institute
A. Thomas McLellan, Executive Director of the Treatment Research Institute (TRI), announced today the appointment of Mady Chalk, Ph.D. to be Director of the Center for Performance-based Policy at TRI. Dr. Chalk will begin duties from the Washington office of TRI on November 7, 2005. She will lead TRI’s effort to assist state and local governments to effect evidence-based changes in their financing, regulatory, licensing and information requirements toward the broader goal of improving the delivery of addiction treatment.

Two premises will guide Chalk’s work in the Center, McLellan explained. The first is that evidence should be the foundation for government practices as well as clinical practices. There has been recognition of the need for empirical evidence to justify clinical interventions, therapies and medications. Yet there is an equal but less recognized need for evidence-based licensing, regulatory, information reporting and financing practices. These administrative practices can either enhance or impede the quantity and quality of clinical care, he argues.

The second premise: that “evidence” of effectiveness need not always originate with academics; it can come from systematic evaluation of city, county and state government procedures and policies. McLellan emphasized that many states and cities have found innovative and practical methods for removing barriers to treatment, for making treatment more accountable and for rewarding the best providers. For example, in Oklahoma, waiting times for treatment admission were dramatically reduced by adjusting administrative practices that were hampering clinical assessment. “There is a need to bring these and other exemplary practices into wider appreciation and to systematically test their effectiveness and practicality in multiple settings,” McLellan added.

Dr. Chalk’s appointment to TRI continues her twenty-year career in addiction and mental health treatment, policy and research. In the federal government she was Director of the Division for Services Improvement in the Center for Substance Abuse Treatment in SAMHSA, and for a period of time was Director of its Office of Managed Care. Chalk is an expert in the organization and financing of treatment systems in both the public and private sectors – and in the policies that govern treatment delivery. She was the architect of the Target Cities and the State-wide Screening, Brief Interventions and Referral to Treatment programs. With the Robert Wood Johnson Foundation as partner, she led the Network for Improvement of Addiction Treatment, the first program to promote better treatment access and broader service availability through implementation of best practices. She was also responsible for linking the Addiction Technology Transfer Centers with NIH to foster dissemination and adoption of evidence based practices in the treatment field.

Chalk’s experience with federal policy and administration of addiction treatment combines well with the clinical research and evaluation experience of the Treatment Research Institute, McLellan noted. “She will work with other TRI researchers to develop the Center as an “incubator” where state and local policy makers, fiscal managers, elected officials and treatment providers can meet with clinical and policy researchers to exchange ideas and develop testable strategies,” he added.

The Center's inaugural project will be a series of forums showcasing evidence of existing administrative practices that have produced better treatment efficiency and accountability. Capturing the spirit of the new Center, Chalk said “Just as scientific evidence is essential for developing clinical practices, systematic examination of government policies, regulations and financing practices as well as the organization of services is also essential to improve the delivery of care in this country.”

Washington: Voters Approve Smoking Ban
On November 8, Washington State residents took health concerns to the polls, passing Initiative 901.  The Initiative’s provision to ban smoking is the most stringent statewide ban in the nation, prohibiting smoking within 25 feet of doors, windows and vents of public places. Washington is the second state to approve a smoking ban by ballot measure, after Florida’s “Smoke-Free for Health” passed in 2002.

Washington adds to the growing list of states with variations of state-wide indoor smoking bans—Alaska, Arizona, California, Connecticut, Delaware, Florida, Idaho, Massachusetts, Maine, Montana, New York, Oregon, Rhode Island, South Dakota, Utah, Vermont.  Most of the bans include exemptions, most commonly for bars. Washington’s law, however, makes no exceptions for public facilities and workplaces; the only exempt areas are most private residences and home-based businesses. 

The state Health Department plans to mail informational materials to businesses and the public about the changes, including a “to-do” list for business owners and managers, complimentary no-smoking signs, and a list of frequently asked questions about the new law. Many business owners are concerned about the possibility of losing customers to casinos and restaurants on tribal land, which are not subject to state regulations. Yet other businesses that currently allow smoking see potential for growth, as they will now attract a wider, less specific clientele.

Researcher’s say vouchers work because they replace one immediate reward—the high—with another. Yet it is the long-term outcomes and potential for relapse that raise skepticism among others in the field. Many in the addictions field are skeptical of contingency management programs, better known as reward programs.  Treatment experts and researchers, among others, question the use of scarce treatment dollars for rewards.  Moreover, experts emphasize that it is unclear whether results will last after the reward is taken away because it is not followed up with any counseling or treatment, there is no continuing care.

The state’s District Attorneys General Conference, with a grant from the Office of the Governor, will take methamphetamine education to students in all 31 Judicial Districts.  The yearlong campaign will focus on middle school and high school students.  Information will be distributed at schools, and to counselors and coordinators in each school system.  Included in the educational materials is a 20 minute DVD that explores the meth problem in Tennessee through the stories of four recovering meth addicts. Additionally, information will be available at health departments and law enforcement agencies throughout the state.  The initiative also includes an interactive website that provides information on how to join the District Attorneys’ Anti-Meth Task Force, which is open to individuals, businesses, organizations and others concerned about the growing methamphetamine problem in Tennessee; allows youth to share stories about how meth has affected their lives; and provides fact sheets and downloadable materials about methamphetamine and the dangers of meth use.

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