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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TL;DR: Results indicate the ORC can contribute to the study of organizational change and technology transfer by identifying functional barriers involved and has acceptable psychometric properties.
817 citations
TL;DR: Preliminary studies by the authors and other applicable studies show that providers' perception of need, and their knowledge of resources, and the environment are related to the decision to offer or refer to services, supporting key aspects of the Model.
Abstract: Enhancing the functioning of parents, teachers, juvenile justice authorities, and other health and mental heal professionals who direct children and adolescents to services is a major mental health services concern. The Gateway Provider Model is an elaborated testable subset of the Network-Episode Model (NEM; B. A. Pescosolido & C. A. Boyer, 1999) that synthesizes it with Decision (D. H. Gustafson, et al., 1999) and organizational theory (C. Glisson, 2002; C. Glisson & L. James, 1992, 2002). The Gateway Provider Model focuses on central influences that affect youth’s access to treatment, i.e., the individual who first identifies a problem and sends a youth to treatment (the “gateway provider”); and the need those individuals have for information on youth problems and relevant potential resources. Preliminary studies by the authors and other applicable studies (D. Carise & O. Gurel, 2003) show that providers’ perception of need, and their knowledge of resources, and their environment are related to the decision to offer or refer to services, supporting key aspects of the Model.
345 citations
Cites background from "The staff workplace and the quality..."
...Although relatively few also include a study of provider behavior, the articles have consistently commented on the role of structural and psychological climate variables in influencing provider behavior (Brown & Leigh, 1996; Glisson & Hemmelgarn, 1998; Moos & Moos, 1998)....
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...way providers in mental health services. The New Freedom Commission on Mental Health (2003), the National Research Council (1995), and others (Glisson & Hemmelgarn, 1998) identified research...
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01 Mar 2003
TL;DR: A model of patient safety is developed to help frame the key questions and provide a way to synthesize data reported in studies on the effects of health care working conditions on patient safety.
146 citations
TL;DR: In this article, a 2-year follow-up analysis of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB) treatment programs was conducted.
Abstract: Background: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients' health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.
Methods: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step–based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step–based programs placed substantially more emphasis on 12-step concepts, had more staff members “in recovery,” had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients' substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.
Results: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).
Conclusions: Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.
131 citations
TL;DR: To consider key issues in understanding effective treatment and recovery, the author reviews selected principles and unresolved puzzles about the context of addictive disorders and the structure, process, and outcome of treatment.
Abstract: To consider key issues in understanding effective treatment and recovery, the author reviews selected principles and unresolved puzzles about the context of addictive disorders and the structure, process, and outcome of treatment. The principles focus on the process of problem resolution, the duration and continuity of care, treatment provided by specialist versus nonspecialist providers, alliance and the goals and structure of treatment, characteristics of effective interventions, and the outcome of treatment versus remaining untreated. The unresolved puzzles involve how to conceptualize service episodes and treatment careers, connections between the theory and process of treatment, effective patient–treatment matching strategies, integration of treatment and self-help, and the development of unified models to encompass life context factors and treatment within a common framework. There has been an expanding cornucopia of research on addictive behaviors in the past 30 years. We have formulated conceptual models, measured key constructs, examined salient theoretical issues, and made substantial progress in understanding the ebb and flow of addictive disorders. An integrated biopsychosocial orientation and a theoretical paradigm of evaluation research have supplanted earlier adherence to an oversimplified biomedical model and reliance on a restrictive methodological approach to treatment evaluation. And yet, in an ironic way, more remains to be done than before, in part because of our increased knowledge and in part because of new clinical perspectives and treatment procedures and the evolving social context in which we ply our trade. Here, I set out seven principles that exemplify advances in our effort to understand the processes involved in effective treatment and recovery. I then describe some unresolved puzzles and important questions for future research. Principles: What We Know or Think We Know
121 citations
Cites background from "The staff workplace and the quality..."
...In a study that addressed these issues, Moos and Moos (1998) found that staff members in supportive and goal-directed work environments were more likely to espouse disease model beliefs and a 12-step orientation toward substance abuse treatment....
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...Patients in these settings received more services, were more involved in self-help groups, were more satisfied with treatment, improved more during treatment, and were more likely to participate in continuing outpatient care (Moos & Moos, 1998)....
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References
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TL;DR: The comparative effectiveness of 12-step and cognitive-behavioral models of substance abuse treatment was examined among 3,018 patients from 15 programs at U.S. Department of Veterans Affairs Medical Centers, and the finding of equal effectiveness was consistent over several treatment subgroups.
Abstract: The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at U.S. Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step-C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistent over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment.
300 citations
TL;DR: Investigation of the efficacy-outcome expectancy relationship in a population of alcoholic clients as they moved through a traditional treatment program and were contacted following a three-month aftercare period indicated that outcome expectancies did not predict consumption at follow-up, but self-efficacy, defined as confidence in being able to resist the urge to drink heavily, was strongly associated with the level of consumption on drinking occasions at follow up.
Abstract: A recent controversy in research on self-efficacy theory has been directed at the role of outcome and efficacy expectancies in the prediction of behaviour. While Bandura maintains that outcome expectancies add little information to prediction beyond that explained by efficacy expectations, others disagree. The present study explored the efficacy-outcome expectancy relationship in a population of alcoholic clients as they moved through a traditional treatment program and were contacted following a three-month aftercare period. Results indicated that outcome expectancies (defined as the costs and benefits expected to result from a change in drinking) did not predict consumption at follow-up. However, self-efficacy (defined as confidence in being able to resist the urge to drink heavily) assessed at intake of treatment, was strongly associated with the level of consumption on drinking occasions at follow-up. These findings are discussed in relation to the relevance of self-efficacy theory to research and treatment of alcoholic patients.
188 citations
186 citations
TL;DR: Initial work stressors predicted poorer functioning, and coworker cohesion predicted more intent to stay in the job at follow-up, and more positive work climates were linked to higher job morale.
Abstract: Relationships between work stressors and work climate, and job morale and functioning were examined. Initial and 8-month follow-up data were obtained from 405 staff in 14 long-term care facilities. Relationship and workload stressors were related to less job satisfaction and intent to stay in the job, and more job-related distress, depression, and physical symptoms. Patient care task stressors were associated with better outcomes. More positive work climates were linked to higher job morale. Initial work stressors predicted poorer functioning, and coworker cohesion predicted more intent to stay in the job at follow-up.
180 citations
TL;DR: The purpose of this project was to examine occupational stress in a specified area of psychiatric nursing and the conceptual basis was Lazarus's cognitive theory of stress and coping and Maslach's model of burnout.
Abstract: Psychiatric nursing is invariably assumed to be a stressful area of nursing practice. Empirical evidence to support this proposition is limited, however, due to the lack of research in this field. The purpose of this project was to examine occupational stress in a specified area of psychiatric nursing. The research was exploratory and therefore the concern was discovery and description rather than the testing of clear hypotheses and the development of causal relationships. The study has four main objectives. First, to describe the various stressors present in the work of the psychiatric nurse in the acute admission wards of two district health authorities. Secondly, to measure the effects of stress using a recognized and well-validated instrument for recording levels of burnout. Thirdly, through the use of a particular theoretical framework to identify the types of coping strategy used by the participants in the study. Fourthly, to note any clear associations between the stressors, the effects of stress and the ways of coping identified in the study. The conceptual basis for the project was Lazarus's cognitive theory of stress and coping and Maslach's model of burnout.
162 citations