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Journal ArticleDOI

The staff workplace and the quality and outcome of substance abuse treatment.

01 Jan 1998-Journal of Studies on Alcohol and Drugs (Rutgers University Piscataway, NJ)-Vol. 59, Iss: 1, pp 43-51
TL;DR: The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment.
Abstract: Objective: The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment. Method: Patient care staff (N = 329) in 15 substance abuse treatment programs reported on the characteristics of their work environment and on their beliefs and treatment orientations about substance abuse. Patients in these programs (N = 3,228) reported on the treatment environment, their participation in treatment and self-help activities, and their treatment goals, confidence in achieving these goals, and coping skills at intake to and discharge from treatment. Results: Staff in supportive and goal-directed work environments were more likely to espouse disease model beliefs and a 12-step orientation toward substance abuse treatment. These work environments were associated with more supportive and goal-directed treatment environments. Pa...
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01 Jan 2010
TL;DR: Drymalski et al. as mentioned in this paper found that the initial severity of biopsychosocial issues and perceived consequences of substance abuse did appear to predict higher motivation for treatment, which itself appeared to predict greater length of time in treatment.
Abstract: PREDICTORS OF TREATMENT RETENTION AMONG HOMELESS MEN WITH SUBSTANCE USE DISORDERS Walter Matthew Drymalski, B.A., M.A Marquette University, 2010 Homelessness is a significant problem in the United States. Recent estimates suggest that nearly three million people experience homelessness over the course of a year. Further, the rates of substance abuse are considerably higher among the homeless than in the general population. Substance abuse treatment has been found to be effective in reducing substance use among those persons with substance use disorders, as well as ameliorating other consequences of substance abuse (e.g., reducing rates of crime associated with substance abuse and dependence). One of the more robust predictors of positive outcomes for substance abuse treatment is retention, which is defined as the length of time clients remain in treatment. However, while a considerable amount of research has been conducted regarding what predicts retention among non-homeless persons with substance use disorders, less is known about what predicts retention among homeless persons with substance use disorders. The following study was conducted to determine if a set of pre-treatment biopsychosocial variables could effectively predict retention among a cohort of homeless men with substance use disorders who were seeking treatment in a substance abuse clinic, which was located in a homeless shelter for men. Path analysis was used to compare two predictive models of retention. The results indicated that both models represented an adequate fit to the data, though each model explained approximately 15% of the variance in retention. In both models, initial severity of biopsychosocial issues and perceived consequences of substance abuse did appear to predict higher motivation for treatment, which itself appeared to predict greater length of time in treatment. However, nearly 85% of the variance in retention was not explained by either model. This suggests that the factors that lead homeless individuals to remain in substance abuse treatment over the long-term may be better accounted for by variables not in the model, such as during treatment “process factors,” rather than pre-treatment factors. Study implications, limitations, and directions for future research are discussed.

1 citations


Cites background from "The staff workplace and the quality..."

  • ...However, oth research suggests that in program environments which clients perceived to be supportive and goal-directed, clients not only attended more treatment sessions, but reported higher levels of satisfaction with treatment as well (Moos & Moos, 1998)....

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Journal ArticleDOI
TL;DR: In this article , a qualitative cross-sectional study was conducted to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychOSocial support for youths recovering from drug and substance abuse.
Abstract: Abstract Background The church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse. Methods This was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings. Results The interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support. Conclusions Acceptance of one’s addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.
01 Jun 2020
TL;DR: In this paper, a survey study draws from a national sample of Cooperative Extension personnel in 2009 to examine characteristics within their organizational context that facilitate successful change related to youth/family programming.
Abstract: The necessity to implement evidence-based programs to support the healthy development of youth and families is becoming part of national policy. Organizations that are not “ready” to do so will likely lose resources, disallowing them to serve as they have set out to do. Consequently, the current survey study draws from a national sample of Cooperative Extension personnel in 2009 to examine characteristics within their organizational context that facilitate successful change related to youth/family programming. Data were collected from 946 4-H/youth development or Family and Consumer Sciences employees at all levels. Self-reported indices of each state organization’s openness to change, leadership, morale, communication, and resources were constructed to assess the organizational context. Dependent variables included indicators of readiness to implement prevention and evidence-based programming. Results suggest that the organizational context was strongly associated with indicators of readiness for evidence-based prevention programming, and specifically, the clarity of communication was most important.
Journal ArticleDOI
TL;DR: An analysis of research in several disciplines concerning outcome studies related to adolescent chemical dependency and mental health treatment, demonstrates that heterogeneous (multigenerational) treatment settings may be superior to homogeneous age group treatment.
Abstract: The treatment outcome from homogeneous age group substance abuse treatment centers, whose clientele consist of adolescent chemical dependents, has never clearly been demonstrated to be superior to heterogeneous age group treatment. An analysis of research in several disciplines concerning outcome studies related to adolescent chemical dependency and mental health treatment, demonstrates that heterogeneous (multigenerational) treatment settings may be superior to homogeneous age group treatment. Other adolescent issues in the family and society that directly affect treatment philosophies in centers directed toward youth are compared to the treatment philosophies of adult centers. It is suggested that multigenerational treatment facilities cost less, require less staff, are better received by the client, and produce higher abstinence rates than adolescent-specific centers.
References
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Journal ArticleDOI
TL;DR: An 18-item version of the Client Satisfaction Questionnaire (CSQ-18) was included in an experimental study of the effects of pretherapy orientation on psychotherapy outcome and demonstrated that a subset of items from the scale performed as well as the CSQ-8 and often better.

1,392 citations

Journal ArticleDOI
TL;DR: The analysis both confirmed the 10-process model and revealed two secondary factors, Experiential and Behavioral, which were composed of 5 processeseach and reflected hou.
Abstract: Subjects (A' = 970) representing five stages of smoking cessation (precontemplation, contemplation,action, maintenance, and relapse) were given a 65-item test measuring 10 basic processes of change.Subjects recorded the last time they quit smoking, their current use, the frequency of occurrence,and the degree of item helpfulness. A 40-item questionnaire provided highly reliable measures of 10processes of change, labeled (a)consciousness raising, (b) dramatic relief, (c) self-liberation, (d)socialliberation, (e) counterconditioning, (f) stimulus control, (g) self-reevaluation, (h) environmental re-evaluation, (i) reinforcement management, and (j) helping relationship. In a confirmatory analysis,770 subjects were assessed 6 months later. The analysis both confirmed the 10-process model andrevealed two secondary factors, Experiential and Behavioral, which were composed of 5 processeseach and reflected hou. individuals in particular stages use more lhan I process at a time. The trans-theoretical model of change and available external validity evidence are reviewed.

1,141 citations

Journal ArticleDOI
TL;DR: In this paper, the authors examined the factors associated with risk-adjusted mortality, risk adjusted average length of stay, nurse turnover, evaluated technical quality of care, and evaluated ability to meet family member needs.
Abstract: A significant portion of health care resources are spent in intensive care units with, historically, up to two-fold variation in risk-adjusted mortality. Technological, demographic, and social forces are likely to lead to an increased volume of intensive care in the future. Thus, it is important to identify ways of more efficiently managing intensive care units and reducing the variation in patient outcomes. Based on data collected from 17,440 patients across 42 ICUs, the present study examines the factors associated with risk-adjusted mortality, risk-adjusted average length of stay, nurse turnover, evaluated technical quality of care, and evaluated ability to meet family member needs. Using the Apache III methodology for risk-adjustment, findings reveal that: 1) technological availability is significantly associated with lower risk-adjusted mortality (beta = -.42); 2) diagnostic diversity is significantly associated with greater risk-adjusted mortality (beta = .46); and 3) caregiver interaction comprising the culture, leadership, coordination, communication, and conflict management abilities of the unit is significantly associated with lower risk-adjusted length of stay (beta = .34), lower nurse turnover (beta = -.36), higher evaluated technical quality of care (beta = .81), and greater evaluated ability to meet family member needs (beta = .74). Furthermore, units with greater technological availability are significantly more likely to be associated with hospitals that are more profitable, involved in teaching activities, and have unit leaders actively participating in hospital-wide quality improvement activities. The findings hold a number of important managerial and policy implications regarding technological adoption, specialization, and the quality of interaction among ICU team members. They suggest intervention "leverage points" for care givers, managers, and external policy makers in efforts to continuously improve the outcomes of intensive care.

766 citations

Journal Article
TL;DR: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation and was positively associated with greater perceived patient outcomes and human resource development.
Abstract: Objective This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. Data sources and study setting Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. Study design The study involved cross-sectional examination of the named relationships. Data collection/extraction methods Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. Principal findings A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. Conclusions What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.

703 citations

Book
21 Jun 1990
TL;DR: Evaluating and improving alcoholism treatment programsObjectives, methods, and assessment of treatment implementation Short-term outcome and patient prognosis Gender and marital status in treatment and outcome.
Abstract: PART I. A SYSTEMS EVALUATION OF ALCOHOLISM TREATMENT: Evaluating and improving alcoholism treatment programs Objectives, methods, and assessment of treatment implementation Short-term outcome and patient prognosis The process and effects of treatment Gender and marital status in treatment and outcome PART II. EXTRATREATMENT FACTORS AND THE RECOVERY PROCESS: Life stressors, social resources, and coping responses Context, coping, and treatment outcome The process of recovery and relapse PART III. ALCOHOLISM AND THE FAMILY: Spouses of alcoholic partners Children of alcoholic parents PART IV. PRACTICAL APPLICATIONS: Improving treatment, work, and family settings Implications for treatment and program evaluation Index.

462 citations

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The staff work environment is an important component of the substance abuse treatment system.