So far I have attempted to provide a broad framework within which to consider the importance of managerial and organisational integration. Inevitably in so doing I have found it necessary to raise wider educational and training issues which influence not only conceptual skills but also attitude. Indeed I have, on occasion, moved my argument or perspective to even wider considerations; issues pertaining to national culture. Culture, education policy or structure, industrial organisation, all interact in subtle and perhaps devious forms. Thus a cultural framework which is “overly status or class conscious” reflects this in its educational system. Most likely it is more predisposed to segment its secondary and tertiary education systems according to similar principles. It may well encourage separation of the university and technical college or polytechnic system to a degree that is industrially and commercially counterproductive — and integratively devisive. Such an educational system will no doubt require “preselection and filtering” which relies upon early, too early, subject specialisation; it may, subsequently, influence adversely the need for individuals and subgroups to communicate more intimately and to organise themselves more closely. In fact it may ensure the continuance of barriers, hierarchies, and polarised attitudes of class, structure and function all the way across and through commerce and industry.

A National Survey

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Government Printing Office expands database access

A conceptual framework for drug treatment process and outcomes.

Staff turnover in mental health service organizations is an ongoing problem with implications for staff morale, productivity, organizational effectiveness, and implementation of innovation. Recent studies in public sector services have examined the impact of organizational culture and climate on work attitudes (i.e., job satisfaction and organizational commitment) and, ultimately, staff turnover. However, mediational models of the impact of culture and climate on work attitudes have not been examined. The present study examined full and partial mediation models of the effects of culture and climate on work attitudes and the subsequent impact of work attitudes on staff turnover. Multilevel structural equation models supported a partial mediation model in which organizational culture had both direct influence on work attitudes and indirect influence through organizational climate. Work attitudes significantly predicted one-year staff turnover rates. These findings support the contention that both culture and climate impact work attitudes and subsequent staff turnover.

Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services.

Nineteen staff and clients in a Native American healing lodge were interviewed regarding the therapeutic approach used to address the legacy of Native American historical trauma. On the basis of thematic content analysis of interviews, 4 components of healing discourse emerged. First, clients were understood by their counselors to carry pain, leading to adult dysfunction, including substance abuse. Second, counselors believed that such pain must be confessed in order to purge its deleterious influence. Third, the cathartic expression of such pain was said by counselors to inaugurate lifelong habits of introspection and self-improvement. Finally, this healing journey entailed a reclamation of indigenous heritage, identity, and spirituality that program staff thought would neutralize the pathogenic effects of colonization. Consideration of this healing discourse suggests that one important way for psychologists to bridge evidence-based and culturally sensitive treatment paradigms is to partner with indigenous programs in the exploration of locally determined therapeutic outcomes for existing culturally sensitive interventions that are maximally responsive to community needs and interests.

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A community-based treatment for Native American historical trauma: Prospects for evidence-based practice.

The toughest job you'll ever love: a Pacific Northwest Treatment Workforce Survey.

ContextThe shift to Medicaid managed care has raised numerous concerns about
access to publicly funded substance abuse treatment. The implementation of
a capitated chemical dependency benefit within the Oregon Health Plan in 1995
provided an opportunity to study the impact of funding mechanisms on access.ObjectivesTo determine to what extent access to publicly funded substance abuse
treatment changed following the shift to managed care in Oregon and to examine
factors associated with that change.DesignAnalysis of statewide treatment and Medicaid eligibility data.Setting and PatientsAll Medicaid-eligible persons aged 12 to 64 years who were enrolled
in the Oregon Health Plan during 1994 (88,320), 1996 (170,387), 1997 (160,929),
or 1998 (149,877).Main Outcome MeasuresAccess rates (the number of unique individuals admitted to treatment
during a calendar year divided by the average number of enrolled members)
computed before (1994) and after (1997) implementation of the capitated benefit.
Analyses were replicated with data for 1996 and 1998.ResultsThe percentage of Medicaid-eligible persons admitted to substance abuse
treatment programs during a calendar year increased from 5.5% of the average
number of enrolled members per month in 1994 to 7.7% in 1997, following the
shift to managed care. For 1996 and 1998, the rates were 6.9% and 7.7%, respectively.
Access rates varied considerably among the 7 largest prepaid health plans
after adjusting for case mix. Operating characteristics of these prepaid health
plans, such as the method of reimbursing treatment providers, were significant
predictors of access after controlling for member characteristics.ConclusionAccording to our analyses, Medicaid-eligible persons in Oregon observed
an increase in access to substance abuse treatment after a shift to managed
care.

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Access to substance abuse treatment services under the Oregon Health Plan.

Access barriers to substance abuse treatment for persons with disabilities: an exploratory study.

Objectives. Although American Indians and Alaska Natives have high rates of substance abuse, few data about treatment services for this population are available. We used national data from 1997–2002 to describe recent trends in organizational and financial arrangements. Methods. Using data from the Indian Health Service (IHS), the Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, the Henry J. Kaiser Family Foundation, and the Census Bureau, we estimated the number of American Indians served by substance abuse treatment programs that apparently are unaffiliated with either the IHS or tribal governments. We compared expected and observed IHS expenditures. Results. Half of the American Indians and Alaska Natives treated for substance abuse were served by programs (chiefly in urban areas) apparently unaffiliated with the IHS or tribal governments. IHS substance abuse expenditures were roughly what we expected. Medicaid participation by tribal pr...

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Organization and Financing of Alcohol and Substance Abuse Programs for American Indians and Alaska Natives

Medicaid conversion from fee for service to managed care raised numerous questions about outcomes for substance abuse treatment clients. For example, managed care criticisms include concerns that clients will be undertreated (with too short and/or insufficiently intense services). Also of interest are potential variations in outcome for clients served by organizations with assorted financial arrangements such as for-profit status versus not-for-profit status. In addition, little information is available about the impact of state Medicaid managed care policies (including client eligibility) on treatment outcomes. Subjects of this project were Medicaid clients aged 18–64 years enrolled in the Oregon Health Plan during 1994 (before substance abuse treatment managed care, N=1751) or 1996–1997 (after managed care, N=14,813), who were admitted to outpatient non-methadone chemical dependency treatment services. Outcome measures were retention in treatment for 90 days or more, completion of a treatment program, abstinence at discharge, and readmission to treatment. With the exception of readmission, there were no notable differences in outcomes between the fee for service era clients versus those in capitated chemical dependency treatment. There were at most minor differences among various managed care systems (such as for-profit vs not-for-profit). However, duration of Medicaid eligibility was a powerful predictor of positive outcomes. Medicaid managed care does not appear to have had an adverse impact on outcomes for clients with substance abuse problems. On the other hand, state policies influencing Medicaid enrollment may have substantial impact on chemical dependency treatment outcomes.

Roy M. Gabriel

Papers

The toughest job you'll ever love: a Pacific Northwest Treatment Workforce Survey.

Access to substance abuse treatment services under the Oregon Health Plan.

Access barriers to substance abuse treatment for persons with disabilities: an exploratory study.

Organization and Financing of Alcohol and Substance Abuse Programs for American Indians and Alaska Natives

Outcomes for medicaid clients with substance abuse problems before and after managed care