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Meisel SN, Pielech M, Magill M, Sawyer K, Miranda R. Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:154-173. [PMID: 38883554 PMCID: PMC11178260 DOI: 10.1037/cps0000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines.
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Affiliation(s)
- Samuel N. Meisel
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
| | | | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University
| | - Kelsey Sawyer
- Center for Alcohol and Addiction Studies, Brown University
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
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Joudrey PJ, Wang M, DeRycke E, Williams EC, Edelman EJ. Alcohol-Related Care Among Veterans With Unhealthy Alcohol Use: The Role of Long-Term Opioid Therapy Receipt. J Addict Med 2024; 18:293-299. [PMID: 38533996 PMCID: PMC11150097 DOI: 10.1097/adm.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Long-term opioid therapy (LTOT) is potentially dangerous among patients with unhealthy alcohol use because of possible adverse interactions. We examined receipt of alcohol-related care among patients with unhealthy alcohol use receiving LTOT and without opioid receipt. METHODS We use data collected from 2009 to 2017 in the Women Veterans Cohort Study, a national cohort of Veterans engaged in Veterans Health Administration care. We included patients who screened positive for unhealthy alcohol use (score ≥5) using the Alcohol Use Disorder Identification Consumption questionnaire. Our primary exposure was LTOT (receipt of prescribed opioids for ≥90 days) versus no opioid receipt at the time of the first positive Alcohol Use Disorder Identification Consumption. Our primary outcome was receipt of brief intervention within 14 days of positive alcohol screen. Unadjusted and 4 adjusted modified Poisson regression models assessed prevalence and relative rates (RRs) of outcomes. RESULTS Among eligible veterans, 6222 of 113,628 (5.5%) received LTOT at screening. Among patients receiving LTOT, 67.5% (95% confidence interval [CI], 66.3%-68.6%) had a documented brief intervention within 14 days of positive screen, compared with 70.1% (95% CI, 69.8%-70.4%) among patients without opioid receipt (RR, 0.96; 95% CI, 0.95-0.98; P < 0.001). Within adjusted models, the rate of brief intervention among patients receiving LTOT remained lower than patients without opioid receipt. CONCLUSIONS Among patients with unhealthy alcohol use, patients receiving LTOT had significantly lower rates of brief intervention receipt compared with those without opioid receipt, and they should be a focus for interventions to improve alcohol-related care and safer opioid prescribing.
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Affiliation(s)
- Paul J Joudrey
- From the Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA (PJJ); Department of Medicine, UCSF School of Medicine, San Francisco, CA (MW); VA Connecticut Healthcare System, West Haven, CT (ED); Pain Research, Informatics, Multi-morbidities, and Education Center, Department of Veterans Affairs, West Haven, CT (ED); Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound, Seattle, WA (ECW); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (ECW); Department of Internal Medicine, Yale School of Medicine, New Haven, CT (EJE); and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE)
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Quinton ML, Tidmarsh G, Parry BJ, Cumming J. A Kirkpatrick Model Process Evaluation of Reactions and Learning from My Strengths Training for Life™. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11320. [PMID: 36141592 PMCID: PMC9517080 DOI: 10.3390/ijerph191811320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Underpinned by the New World Kirkpatrick model, and in the context of a community-based sport psychology programme (My Strengths Training for Life™) for young people experiencing homelessness, this process evaluation investigated (1) young peoples' reactions (i.e., program and facilitator evaluation, enjoyment, attendance, and engagement) and learning (i.e., mental skills and transfer intention), (2) the relationship between reaction and learning variables, and (3) the mediators underpinning this relationship. A total of 301 young people living in a West Midlands housing service completed questionnaires on demographics and reaction and learning variables. Higher levels of programme engagement were positively associated with more favourable reactions to the programme. Enjoyment positively predicted learning outcomes, which was mediated by transfer intention. Recommendations are made for (1) a balance between rigor and flexibility for evaluation methods with disadvantaged youth, (2) including engagement as well as attendance as indicators of meaningful programme participation, (3) measuring programme experiences (e.g., enjoyment) to understand programme effectiveness, and (4) providing opportunities for skill transfer during and after programme participation. Our findings have implications for researchers, programme commissioners, and policymakers designing and evaluating programmes in community-based settings.
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Affiliation(s)
- Mary L. Quinton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Grace Tidmarsh
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Benjamin J. Parry
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Jennifer Cumming
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK
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Chavez LJ, Steelesmith DL, Bridge JA, Fontanella CA. Predictors of substance use disorder treatment initiation and engagement among adolescents enrolled in Medicaid. Subst Abus 2022; 43:1260-1267. [PMID: 35670769 DOI: 10.1080/08897077.2022.2074603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies. The present study reports the rates and predictors of IET among adolescents with SUD, as well as receipt of any mental health services. Methods: The sample included adolescents enrolled in Medicaid in 14 states who had a qualifying diagnosis for SUD (2009-2013) and met HEDIS IET performance measure eligibility criteria. Three outcomes were assessed, including initiation of SUD treatment within 14 days of qualifying diagnosis, engagement in SUD treatment (2 or more encounters) within 30 days of initiation, and receipt of any mental health services (1 or more encounters) within 30 days of initiation. Logistic regression was used to identify demographic and clinical characteristics associated with outcomes. Results: Among 20,602 adolescents who met eligibility criteria, 49.5% initiated SUD treatment, 48.5% engaged in SUD treatment, and 70% received any mental health service. Adolescents with higher levels of clinical need (e.g., medical complexity, mental health comorbidity, and multiple SUD diagnoses) had significantly higher odds of initiating, but lower odds of engaging in treatment or receiving any mental health service. Conclusions: To increase the delivery of SUD treatment, efforts should target adolescents with co-occurring mental health needs, many of whom are receiving mental health services after SUD diagnosis. Integrating addiction and mental health services could address these missed opportunities.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey A Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Treatment completion among justice-involved youth engaged in behavioral health treatment studies in the United States: A systematic review and meta-analysis. J Clin Transl Sci 2022; 6:e86. [PMID: 36003208 PMCID: PMC9389282 DOI: 10.1017/cts.2022.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Justice-involved youth (JIY) have high rates of behavioral health disorders, but few can access, much less complete, treatment in the community. Behavioral health treatment completion among JIY is poorly understood, even within treatment studies. Measurement, reporting, and rates of treatment completion vary across studies. This systematic review and meta-analysis synthesizes the literature on rates of treatment completion among JIY enrolled in research studies and identifies potential moderators. After systematically searching 6 electronic databases, data from 13 studies of 20 individual treatment groups were abstracted and coded. A meta-analysis examined individual prevalence estimates of treatment completion in research studies as well as moderator analyses. Prevalence effect sizes revealed high rates of treatment completion (pr = 82.6). However, analysis suggests a high likelihood that publication bias affected the results. Treatment groups that utilized family- or group-based treatment (pr = 87.8) were associated with higher rates of treatment completion compared to treatment groups utilizing individual treatment (pr = 61.1). Findings suggest that it is possible to achieve high rates of treatment completion for JIY, particularly within the context of family- and group-based interventions. However, these findings are limited by concerns about reporting of treatment completion and publication bias.
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Dalton K, Bishop L, Darcy S. Investigating interventions that lead to the highest treatment retention for emerging adults with substance use disorder: A systematic review. Addict Behav 2021; 122:107005. [PMID: 34119856 DOI: 10.1016/j.addbeh.2021.107005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Emerging adults (age 18-25) have the highest rate of substance use disorders (SUD) and often drop out of treatment earlier than those age twenty six or older. In order to increase treatment retention in emerging adults, there needs to be a better understanding of which SUD treatment interventions work best for this population. The purpose of this systematic review was to evaluate treatment interventions for emerging adults with SUD and identify which interventions show promise for retention in treatment. METHODS Following the PRISMA guidelines, Medline, PsycInfo, CINAHL (all via EBSCO), and Embase were systematically searched for articles that evaluated treatment interventions for emerging adults with SUD. From here, the authors identified treatment interventions that showed promise for retention in treatment. RESULTS Nine studies were included. The main findings indicate (1) behavioral therapy such as cognitive behavioral therapy and contingency management for cannabis and alcohol use disorders, or (2) cognitive behavioral therapy paired with opioid-agonist-therapy for opioid use disorder demonstrate the most promise for retention in treatment. CONCLUSION The interventions identified that show promise for emerging adults was similar to studies evaluating interventions for all ages. Given that retention rates are often lower in emerging adults despite the application of the full range of effective adult treatments, this review suggests they may require something different. While further studies are warranted to determine with more certainty what works best to keep emerging adults in treatment, some tentative suggestions are included.
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Mark TL, Hinde JM, Barnosky A, Joshi V, Padwa H, Treiman K. Is implementation of ASAM-based addiction treatment assessments associated with improved 30-day retention and substance use? Drug Alcohol Depend 2021; 226:108868. [PMID: 34237614 DOI: 10.1016/j.drugalcdep.2021.108868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Addiction Medicine (ASAM) criteria were developed to provide a systematic, evidence-based, and transparent approach to addiction treatment assessment and level-of-care recommendations. In 2017, California began a Medicaid demonstration that required that providers in participating counties to adopt ASAM-based intake assessments and level-of-care criteria. We hypothesized that ASAM implementation would increase the proportion of patients retained in addiction treatment and successfully completing their treatment plan. METHODS We implemented a comparative interrupted time series analysis with 407,792 treatment episodes by Medicaid beneficiaries in specialty addiction treatment settings from 2015 to mid-2019. We compared the change in retention rates and successful completion rates in counties that adopted ASAM-based assessments relative to counties that did not adopt ASAM-based assessments and used only clinical judgment for level-of-care decisions. Treatment retention was defined as staying in addiction treatment for at least 30 days. Successful completion of the treatment plan was determined by the patient's clinician. RESULTS After one year, ASAM implementation was associated with a 9% increase in 30-day retention among treatment episodes that started in a residential setting, but no change in retention among episodes starting in outpatient settings. We found no statistically significant association between ASAM adoption and successful treatment completion. CONCLUSIONS Implementation of ASAM-based assessment may lead to improved retention for individuals who begin treatment in residential treatment, which may be encouraging to the many state Medicaid programs that are adopting ASAM-based criteria. More research is needed to clarify the mechanism by which ASAM leads to improved outcomes and to clarify how to maximize the potential benefits of ASAM, such as through patient-centered implementation.
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Affiliation(s)
- Tami L Mark
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States.
| | - Jesse M Hinde
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States
| | - Alan Barnosky
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States
| | - Vandana Joshi
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Los Angeles, CA, 90095-1759, United States
| | - Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Los Angeles, CA, 90095-1759, United States
| | - Katherine Treiman
- RTI International, 6110 Executive Blvd, #900, Rockville, MD, 20852, United States
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Piecing Together the Puzzle of Success: Attending to the Developmental Needs of Emerging Adults in Substance Use Disorder Programming. CANADIAN JOURNAL OF ADDICTION 2020. [DOI: 10.1097/cxa.0000000000000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Does the Addition of Naloxone in Buprenorphine/Naloxone Affect Retention in Treatment in Opioid Replacement Therapy?: A Systematic Review and Meta-Analysis. J Addict Nurs 2019; 30:254-260. [PMID: 31800516 DOI: 10.1097/jan.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Opioid maintenance therapy is an evidence-based first-line treatment approach to reduce the problems associated with opioid use disorders. Buprenorphine and methadone are the two most commonly recommended pharmacotherapies. Individuals who remain in treatment longer tend to have a reduced drug use, a higher social functioning, and a higher quality of life. The addition of naloxone to buprenorphine (bup/nx) was developed, in part, to help increase retention in treatment. However, this has not been shown in research. The objective of this review was to examine whether bup/nx is more effective than buprenorphine and methadone, to ultimately determine whether the addition of naloxone shows a clinical difference. METHODS The literature search was conducted using the electronic databases PubMed, Embase, and Cochrane. Search strategies were thoroughly developed and modified for each database by combining relevant MeSH and Emtree terms as well as keywords such as "bup/nx," "buprenorphine," and "naloxone." The outcome measure was treatment retention, as determined by the number of days a participant remains in a treatment program. RESULTS There were four studies included in the review. The data were analyzed with Review Manager software. There was no statistically significant result for bup/nx compared with methadone or buprenorphine. CONCLUSION Bup/nx may be an alternative to standard treatments such as buprenorphine and methadone as the addition of naloxone does not affect retention in treatment.
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Tolou-Shams M, Yonek J, Galbraith K, Bath E. Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study. JMIR Mhealth Uhealth 2019; 7:e10904. [PMID: 30950808 PMCID: PMC6473210 DOI: 10.2196/10904] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/16/2018] [Accepted: 01/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. OBJECTIVE This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth's behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. METHODS CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. RESULTS Overall, 28 individuals participated in focus groups and interviews-8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. CONCLUSIONS Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step.
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Affiliation(s)
- Marina Tolou-Shams
- Division of Infant, Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Juliet Yonek
- Division of Infant, Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katharine Galbraith
- Division of Infant, Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Eraka Bath
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Joe GW, Lehman WEK, Rowan GA, Knight K, Flynn PM. The role of physical and psychological health problems in the drug use treatment process. J Subst Abuse Treat 2019; 102:23-32. [PMID: 31202285 DOI: 10.1016/j.jsat.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/28/2022]
Abstract
The role of physical and psychological health is examined as a predictor of client engagement in prison-based drug treatment. A treatment process model was expanded to include physical and mental health issues. The sample included 6009 offenders in prison-based drug treatment, comprised of 67% male, 26% African American, 51% white, and 22% Hispanic; average age was 34.6. Half reported "some physical health concerns" and mentioned a variety of ailments. A fifth reported moderate stress on the Kessler Psychological Distress Scale (K10) and 15% reported PTSD based on the PTSD Check List (PCL). Structural equation modeling was used to model treatment engagement in terms of demographics, physical health concerns, psychological distress, HIV risky behaviors, self-esteem, decision making, and treatment motivation. Two random samples were created, with one used for estimation and the other for cross-validation. The findings suggested physical health and HIV risky behaviors have effects on client engagement through psychological functioning, and that psychological functioning has direct effects on treatment engagement.
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Affiliation(s)
- George W Joe
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Wayne E K Lehman
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Grace A Rowan
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Kevin Knight
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
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Garnick D, Horgan C, Mark TL, Lee M, Acevedo A, Neager S, O'Brien P, Hashmi A, Marder B, Miller K. The importance of identification when measuring performance in addiction treatment. Subst Abus 2019; 40:263-267. [PMID: 30913002 DOI: 10.1080/08897077.2019.1580240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Identifying and effectively treating individuals with substance use disorders (SUDs) is an important priority for state Medicaid programs, given the enormous toll that SUDs take on individuals, their families, and their communities. In this paper, we describe how the Healthcare Effectiveness Data and Information Set (HEDIS) measure "Identification of Alcohol and Other Drug Services" can be used, along with eligible population prevalence rates, to expand states' ability to track how well their Medicaid programs identify enrollees with SUDs and link them with treatment (measured by initiation and engagement performance measures). Methods: We use the 2009 Medicaid MAX data on utilization and enrollment along with information from the National Survey of Drug Use and Health (NSDUH) to obtain state-level estimates of alcohol and drug abuse and dependence among Medicaid beneficiaries for 7 illustrative states. We calculate identification, initiation, and engagement measures using specifications from the National Committee on Quality Assurance (NCQA). Results: NSDUH data showed that the eligible population prevalence rate (the average rate of alcohol or drug abuse or dependence) among the 7 states was 10.0%, whereas the average identification rate was 2.9%. The gap between the prevalence and identification rates ranged from 5.1% to 11.0% among the 7 states. The initiation rates ranged from 36.9% to 57.1%. The states' engagement rates ranged from 11.8% to 31.1%, although rates differ by age, gender, and race/ethnicity in some states. Conclusion: Including identification along with initiation and engagement measures allows states to determine how well they are performing in a more complete spectrum from need, to recognition and documentation of enrollees with SUDs, to initiation of treatment, to continuation of early treatment.
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Affiliation(s)
- Deborah Garnick
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Constance Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | | | - Margaret Lee
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Andrea Acevedo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Sarah Neager
- Truven Health Analytics Inc., IBM Watson Health, Cambridge, Massachusetts, USA
| | - Peggy O'Brien
- Truven Health Analytics Inc., IBM Watson Health, Cambridge, Massachusetts, USA
| | - Ali Hashmi
- Truven Health Analytics Inc., IBM Watson Health, Cambridge, Massachusetts, USA
| | - Bill Marder
- Truven Health Analytics Inc., IBM Watson Health, Cambridge, Massachusetts, USA
| | - Kay Miller
- Truven Health Analytics Inc., IBM Watson Health, Cambridge, Massachusetts, USA
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Hadland SE, Bagley SM, Rodean J, Silverstein M, Levy S, Larochelle MR, Samet JH, Zima BT. Receipt of Timely Addiction Treatment and Association of Early Medication Treatment With Retention in Care Among Youths With Opioid Use Disorder. JAMA Pediatr 2018; 172:1029-1037. [PMID: 30208470 PMCID: PMC6218311 DOI: 10.1001/jamapediatrics.2018.2143] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 12/21/2022]
Abstract
Importance Retention in addiction treatment is associated with reduced mortality for individuals with opioid use disorder (OUD). Although clinical trials support use of OUD medications among youths (adolescents and young adults), data on timely receipt of buprenorphine hydrochloride, naltrexone hydrochloride, and methadone hydrochloride and its association with retention in care in real-world treatment settings are lacking. Objectives To identify the proportion of youths who received treatment for addiction after diagnosis and to determine whether timely receipt of OUD medications is associated with retention in care. Design, Setting, and Participants This retrospective cohort study used enrollment data and complete health insurance claims of 2.4 million youths aged 13 to 22 years from 11 states enrolled in Medicaid from January 1, 2014, to December 31, 2015. Data analysis was performed from August 1, 2017, to March 15, 2018. Exposures Receipt of OUD medication (buprenorphine, naltrexone, or methadone) within 3 months of diagnosis of OUD compared with receipt of behavioral health services alone. Main Outcomes and Measures Retention in care, with attrition defined as 60 days or more without any treatment-related claims. Results Among 4837 youths diagnosed with OUD, 2752 (56.9%) were female and 3677 (76.0%) were non-Hispanic white. Median age was 20 years (interquartile range [IQR], 19-21 years). Overall, 3654 youths (75.5%) received any treatment within 3 months of diagnosis of OUD. Most youths received only behavioral health services (2515 [52.0%]), with fewer receiving OUD medications (1139 [23.5%]). Only 34 of 728 adolescents younger than 18 years (4.7%; 95% CI, 3.1%-6.2%) and 1105 of 4109 young adults age 18 years or older (26.9%; 95% CI, 25.5%-28.2%) received timely OUD medications. Median retention in care among youths who received timely buprenorphine was 123 days (IQR, 33-434 days); naltrexone, 150 days (IQR, 50-670 days); and methadone, 324 days (IQR, 115-670 days) compared with 67 days (IQR, 14-206 days) among youths who received only behavioral health services. Timely receipt of buprenorphine (adjusted hazard ratio, 0.58; 95% CI, 0.52-0.64), naltrexone (adjusted hazard ratio, 0.54; 95% CI, 0.43-0.69), and methadone (adjusted hazard ratio, 0.32; 95% CI, 0.22-0.47) were each independently associated with lower attrition from treatment compared with receipt of behavioral health services alone. Conclusions and Relevance Timely receipt of buprenorphine, naltrexone, or methadone was associated with greater retention in care among youths with OUD compared with behavioral treatment only. Strategies to address the underuse of evidence-based medications for youths with OUD are urgently needed.
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Affiliation(s)
- Scott E. Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Sarah M. Bagley
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - Michael Silverstein
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Sharon Levy
- Adolescent Substance Use and Addictions Program, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Marc R. Larochelle
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey H. Samet
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Bonnie T. Zima
- Semel Institute for Neuroscience and Human Behavior, UCLA (University of California, Los Angeles), Los Angeles
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Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders. Drug Alcohol Depend 2018; 192:67-73. [PMID: 30223190 PMCID: PMC6334843 DOI: 10.1016/j.drugalcdep.2018.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND To assess the mechanism by which a collaborative care (CC) intervention improves self-reported abstinence among primary care patients with opioid and alcohol use disorders (OAUD) compared to treatment as usual. METHODS Secondary data analysis of SUMMIT, a randomized controlled trial of CC for OAUD. Participants were 258 patients with OAUD receiving primary care at a multi-site Federally Qualified Health Center. Using a mediation analysis decomposition of a total effect into a mediated and a direct effect, we examined the effect of CC on abstinence at six months, attributable to the HEDIS treatment initiation and engagement measures for the total sample, for individuals with alcohol use disorders alone, and for those with a co-morbid opioid use disorder. RESULTS Although the CC intervention led to an increase in both initiation and engagement, among the full sample, only initiation mediated the effect of the intervention on abstinence (3.8%, CI=[0.4%, 8.3%]; 32% proportion of the total effect). In subgroup analyses, among individuals with comorbid alcohol and opioid use disorders, almost 100% of the total effect was mediated by engagement, but the effect was not significant. This was not observed among the alcohol use disorder only group. CONCLUSIONS Among primary care patients with OAUDs, treatment initiation partially mediated the effect of CC on abstinence at 6-months. The current study emphasizes the importance of primary care patients returning for a second substance-use related visit after identification. CC may work differently for people with co-morbid opioid use disorders vs. alcohol use disorders alone.
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Hogue A, Henderson CE, Becker SJ, Knight DK. Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014-2017: Outcomes, Treatment Delivery, and Promising Horizons. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:499-526. [PMID: 29893607 PMCID: PMC7192024 DOI: 10.1080/15374416.2018.1466307] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.
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Affiliation(s)
| | | | - Sara J Becker
- c Center for Alcohol and Addictions Studies , Brown University School of Public Health
| | - Danica K Knight
- d Institute of Behavioral Research , Texas Christian University
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Lee MT, Acevedo A, Garnick DW, Horgan CM, Panas L, Ritter GA, Campbell KM. Impact of Agency Receipt of Incentives and Reminders on Engagement and Continuity of Care for Clients With Co-Occurring Disorders. Psychiatr Serv 2018; 69:804-811. [PMID: 29695226 PMCID: PMC6193487 DOI: 10.1176/appi.ps.201700465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined whether having co-occurring substance use and mental disorders influenced treatment engagement or continuity of care and whether offering financial incentives, client-specific electronic reminders, or a combination to treatment agencies improved treatment engagement and continuity of care among clients with co-occurring disorders. METHODS The study used a randomized cluster design to assign agencies (N=196) providing publicly funded substance use disorder treatment in Washington State to a research arm: incentives only, reminders only, incentives and reminders, and a control condition. Data were analyzed for 76,044 outpatient, 32,797 residential, and 39,006 detoxification admissions from Washington's treatment data system. Multilevel logistic regressions were conducted, with clients nested within agencies, to examine the effect of the interventions on treatment engagement and continuity of care. RESULTS Compared with clients with a substance use disorder only, clients with co-occurring disorders were less likely to engage in outpatient treatment or have continuity of care after discharge from residential treatment, but they were more likely to have continuity of care after discharge from detoxification. The interventions did not influence treatment engagement or continuity of care, except the reminders had a positive impact on continuity of care after residential treatment among clients with co-occurring disorders. CONCLUSIONS In general, the interventions did not result in improved treatment engagement or continuity of care. The limited number of significant results supporting the influence of incentives and alerts on treatment engagement and continuity of care add to the mixed findings reported by previous research. Multiple interventions may be needed for performance improvement.
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Affiliation(s)
- Margaret T Lee
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Andrea Acevedo
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Deborah W Garnick
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Constance M Horgan
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Lee Panas
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Grant A Ritter
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Kevin M Campbell
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
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Williams AR, Nunes EV, Bisaga A, Pincus HA, Johnson KA, Campbell AN, Remien RH, Crystal S, Friedmann PD, Levin FR, Olfson M. Developing an opioid use disorder treatment cascade: A review of quality measures. J Subst Abuse Treat 2018; 91:57-68. [PMID: 29910015 DOI: 10.1016/j.jsat.2018.06.001] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 06/01/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice. METHODS Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes. RESULTS Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose. CONCLUSION Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.
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Affiliation(s)
- Arthur Robin Williams
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States.
| | - Edward V Nunes
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Adam Bisaga
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Harold A Pincus
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States; New York-Presbyterian Hospital, United States
| | - Kimberly A Johnson
- University of South Florida Department of Mental Health Law and Policy, United States
| | - Aimee N Campbell
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Remien H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University, United States
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers, United States
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts-Baystate and Baystate Health, United States
| | - Frances R Levin
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Mark Olfson
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
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Garner BR, Hunter SB, Slaughter ME, Han B, Godley SH. Factors associated with an evidence-based measure of implementation for the Adolescent Community Reinforcement Approach. Drug Alcohol Depend 2017; 180:144-150. [PMID: 28888154 PMCID: PMC6757189 DOI: 10.1016/j.drugalcdep.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND An evidence-based measure of implementation (EBMI) is an implementation outcome measure shown to have predictive validity with one or more future-measured constructs of importance. The current study sought to identify correlates and predictors of an EBMI called procedure exposure. Garner et al. (2016) found procedure exposure to be an EBMI for the Adolescent Community Reinforcement Approach (A-CRA). METHODS The dataset included 76 community-based substance use treatment organizations located across the United States. Organizational-level regression analyses, which were framed within the context of Chaudoir et al. (2013) framework for predicting implementation outcomes, were used to examine predictors of A-CRA procedure exposure RESULTS: The Washington Circle's treatment initiation performance measure (B=5.05 [SE=1.60], p=0.002), as well as session exposure (B=0.18 [SE=0.06], p=0.003), were significant predictors of A-CRA procedure exposure in the backward stepwise regression analysis (Adjusted R-square=0.55). The Washington Circle's treatment engagement performance measure (B=7.93 [SE=0.77], p<0.001), as well as time-to-proficiency (B=-0.04 [SE=0.02], p=0.02), each had significant bivariate relationships with A-CRA procedure exposure but were not retained in the final model. CONCLUSIONS Organizations implementing A-CRA are encouraged to make the following high priorities: (a) scheduling and completing a subsequent treatment session within 14days of their index session (treatment initiation) and (b) providing a targeted number of treatment sessions to each client (session exposure). To the extent organizations do this, they may be more likely to achieve higher levels of A-CRA procedure exposure.
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Affiliation(s)
- Bryan R. Garner
- RTI International, P. O. Box 12194, Research Triangle Park, NC 27709, USA,Corresponding author. (B.R. Garner)
| | | | | | - Bing Han
- RAND Corp, P.O. Box 2138, Santa Monica, CA 90407, USA.
| | - Susan H. Godley
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA
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Garnick DW, Horgan CM, Acevedo A, Lee MT, Panas L, Ritter GA, Campbell K, Bean-Mortinson J. Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State. J Subst Abuse Treat 2017; 82:93-101. [PMID: 29021122 PMCID: PMC5653287 DOI: 10.1016/j.jsat.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 12/18/2022]
Abstract
Financial incentives for quality improvement and feedback on specific clients are two approaches to improving the quality of treatment for individuals with substance use disorders. We examined the impacts of these interventions in Washington State by randomizing outpatient substance use treatment agencies into intervention and control groups. From October 2013 through December 2015, agencies could earn financial incentives for meeting performance goals incorporating both achievement relative to a benchmark and improvement from agencies' own baselines. Weekly feedback was e-mailed to agencies in the alert or alert plus incentives arms. Difference-in difference regressions controlling for client and agency characteristics showed that none of the interventions significantly affected client engagement after outpatient admissions, overall or for sub-groups based on race/ethnicity, age, rural residence, or agency baseline performance. Treatment agencies offered insights related to several themes: delivery system context (e.g., agency time and resources needed during transition to a managed behavioral healthcare system), implementation (e.g., data lag), agency issues (e.g., staff turnover), and client factors (e.g., motivation). Interventions took place during a time of Medicaid expansion and planning for statewide integration of mental health and substance use disorder treatment into a managed care model, which may have resulted in agencies not responding to the interventions. Moreover, incentives and alerts at the agency-level may not be effective when factors are at play beyond the agency's control.
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Affiliation(s)
- Deborah W Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States.
| | - Constance M Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States; Department of Community Health, Tufts University, United States
| | - Margaret T Lee
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Grant A Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Kevin Campbell
- The Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, United States
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Dunne T, Bishop L, Avery S, Darcy S. A Review of Effective Youth Engagement Strategies for Mental Health and Substance Use Interventions. J Adolesc Health 2017; 60:487-512. [PMID: 28087268 DOI: 10.1016/j.jadohealth.2016.11.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 11/18/2022]
Abstract
The majority of adult mental health and substance use (MH&SU) conditions emerge in adolescence. Prevention, diagnosis, and treatment programs targeting this age group have a unique opportunity to significantly impact the well-being of the future generation of adults. At the same time, youth are reluctant to seek treatment and have high rates of dropout from interventions. An emphasis on youth engagement in prevention and treatment interventions for MH&SU results in better health outcomes for those youth. This literature review was undertaken to evaluate opportunities to improve youth engagement in MH&SU programs. The intent was to determine best practices in the field that combined community-level improvement in clinical outcomes with proven strategies in engagement enhancement to inform program development at a local level. The results discuss 40 studies, reviews, and program reports demonstrating effective youth engagement. These have been grouped into six themes based on the underlying engagement mechanism: youth participation in program development, parental relationships, technology, the health clinic, school, and social marketing. A broad range of tools are discussed that intervention developers can leverage to improve youth engagement in prevention or treatment programs.
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Affiliation(s)
- Tom Dunne
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Lisa Bishop
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada; School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Susan Avery
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Stephen Darcy
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Sloas LB, Caudy MS, Taxman FS. Is Treatment Readiness Associated With Substance Use Treatment Engagement? An Exploratory Study. JOURNAL OF DRUG EDUCATION 2017; 47:51-67. [PMID: 29482378 DOI: 10.1177/0047237918759955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With nearly 8.2% of Americans experiencing substance use disorders (SUDs), a need exists for effective SUD treatment and for strategies to assist treatment participants to complete treatment programs (Chandler, Fletcher, & Volkow, 2009). The purpose of the current research is to contribute to an emerging knowledge base about treatment readiness and its utility for predicting substance use treatment process performance measures. The study examines the relative salience of treatment readiness as a predictor of treatment engagement. Data are derived from adult cases included in the 2012 Global Appraisal of Individual Needs-Intake data set ( n = 5,443). Binary logistic regression was used to identify if treatment readiness predicts substance use treatment engagement. The findings of this study do not provide support for treatment readiness significantly predicting substance use treatment engagement. Further research is needed to better understand treatment engagement.
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Affiliation(s)
- Lincoln B Sloas
- 1 School of Criminology and Criminal Justice, 1782 Florida Atlantic University , Florida Atlantic University, Boca Raton, FL, USA
| | - Michael S Caudy
- 2 Department of Criminal Justice, University of Central Florida, Orlando, FL, USA
| | - Faye S Taxman
- 3 Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
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Belenko S, Knight D, Wasserman GA, Dennis ML, Wiley T, Taxman FS, Oser C, Dembo R, Robertson AA, Sales J. The Juvenile Justice Behavioral Health Services Cascade: A new framework for measuring unmet substance use treatment services needs among adolescent offenders. J Subst Abuse Treat 2016; 74:80-91. [PMID: 28132705 DOI: 10.1016/j.jsat.2016.12.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 12/15/2016] [Accepted: 12/28/2016] [Indexed: 11/26/2022]
Abstract
OVERVIEW Substance use and substance use disorders are highly prevalent among youth under juvenile justice (JJ) supervision, and related to delinquency, psychopathology, social problems, risky sex and sexually transmitted infections, and health problems. However, numerous gaps exist in the identification of behavioral health (BH) problems and in the subsequent referral, initiation and retention in treatment for youth in community justice settings. This reflects both organizational and systems factors, including coordination between justice and BH agencies. METHODS AND RESULTS This paper presents a new framework, the Juvenile Justice Behavioral Health Services Cascade ("Cascade"), for measuring unmet substance use treatment needs to illustrate how the cascade approach can be useful in understanding service delivery issues and identifying strategies to improve treatment engagement and outcomes for youth under community JJ supervision. We discuss the organizational and systems barriers for linking delinquent youth to BH services, and explain how the Cascade can help understand and address these barriers. We provide a detailed description of the sequential steps and measures of the Cascade, and then offer an example of its application from the Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System project (JJ-TRIALS), a multi-site research cooperative funded by the National Institute on Drug Abuse. CONCLUSION As illustrated with substance abuse treatment, the Cascade has potential for informing and guiding efforts to improve behavioral health service linkages for adolescent offenders, developing and testing interventions and policies to improve interagency and cross-systems coordination, and informing the development of measures and interventions for improving the implementation of treatment in complex multisystem service settings. Clinical Trials Registration number - NCT02672150.
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Affiliation(s)
- Steven Belenko
- Temple University, 1115 Polett Walk, Philadelphia, PA 19122, United States.
| | - Danica Knight
- Texas Christian University, 3034 Sandage Avenue, Fort Worth, TX 76129, United States.
| | - Gail A Wasserman
- Columbia University, 1051 Riverside Drive, Unit 78, New York City, NY 10032, United States.
| | - Michael L Dennis
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61701, United States.
| | - Tisha Wiley
- National Institute on Drug Abuse, 6001 Executive Boulevard, Room 5191, Bethesda, MD 20892, United States.
| | - Faye S Taxman
- George Mason University, 4087 University Drive, 4100, MSN 6D3, Fairfax, VA 22030, United States.
| | - Carrie Oser
- University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, United States.
| | - Richard Dembo
- University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Angela A Robertson
- Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
| | - Jessica Sales
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Room 570, Atlanta, GA 30322, United States.
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Smith DC, Ureche DJ, Davis JP, Walters ST. Motivational Interviewing With and Without Normative Feedback for Adolescents With Substance Use Problems: A Preliminary Study. Subst Abus 2016; 36:350-8. [PMID: 25551562 DOI: 10.1080/08897077.2014.988838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Many adolescents in need of substance use disorder treatments never engage in treatment. Further, the most promising interventions that could be adapted to target treatment engagement often use normative feedback (NF) despite concerns about its appropriateness for adolescents. This preliminary study will inform a larger trial designed to isolate whether NF is an inert, helpful, or harmful active ingredient within pretreatment motivational interviewing (MI) interventions designed to increase treatment engagement. METHODS Adolescents (N = 48) presenting for treatment intake assessments were randomized to receive MI (n = 22) or MI+NF (n = 26) immediately following their assessments. Three-month outcomes included the percentage of youth engaged in treatment, the percentage of youth reporting past-month binge drinking, and the percentage of days of abstinence. RESULTS Treatments were delivered with high fidelity, and a high proportion of eligible participants were recruited and retained in this study. Participants significantly increased their percentage of days of abstinence by approximately 10% at follow-up (d = .32, P =.03), with no significant differences between groups. Fifty-five percent of youth in MI and 41.7% of youth in MI+NF engaged in treatment (odds ratio [OR] = .60, nonsignificant; 95% confidence interval, CI [0.136-2.68]). CONCLUSIONS Larger trials should test whether NF is an active ingredient in adolescent MI interventions, and should also determine the mechanisms through which MI+NF may produce effects.
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Affiliation(s)
- Douglas C Smith
- a School of Social Work , University of Illinois at Urbana-Champaign , Urbana , Illinois , USA
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Schmidt EM, Gupta S, Bowe T, Ellerbe LS, Phelps TE, Finney JW, Asch SM, Humphreys K, Trafton J, Vanneman M, Harris AHS. Predictive validity of a quality measure for intensive substance use disorder treatment. Subst Abus 2016; 38:317-323. [PMID: 27435754 DOI: 10.1080/08897077.2016.1212779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measures of substance use disorder (SUD) treatment quality are essential tools for performance improvement. The Veterans Health Administration (VHA) developed a measure of access to and engagement in intensive outpatient programs (IOPs) for SUD. However, predictive validity, or associations between this measure and treatment outcomes, has not been examined. METHODS Data on veterans with SUD came from 3 samples: the Outcomes Monitoring Project (N = 5436), a national evaluation of VHA mental health services (N = 339,887), and patients receiving detoxification services (N = 23,572). Propensity score-weighted mixed-effects regressions modeled associations between receiving at least 1 week of IOP treatment and patient outcomes, controlling for facility-level performance and a random effect for facility. RESULTS Propensity score weighting reduced or eliminated observable baseline differences between patient groups. Patients who accessed IOPs versus those who did not reported significantly reduced alcohol- and drug-related symptom severity, with significantly fewer past-month days drinking alcohol (b = 1.83, P < .001) and fewer past-month days intoxicated (b = 1.55, P < .001). Patients who received IOP after detoxification services had higher 6-month utilization of SUD outpatient visits (b = 2.09, P < .001), more subsequent detoxification episodes (b = 0.25, P < .001), and lower odds of 2-year mortality (odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.61-0.75; P < .001). CONCLUSIONS Receiving at least 1 week of SUD treatment in an IOP was associated with higher follow-up utilization, improved health outcomes, and reduced mortality. These associations lend support to the predictive validity of VHA's IOP quality measure. Future research should focus on measure feasibility and validity outside of VHA, and whether predictive validity is maintained once this quality measure is tied to performance incentives.
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Affiliation(s)
- Eric M Schmidt
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.,b Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR) and the Division of General Medical Disciplines , Stanford , California , USA
| | - Shalini Gupta
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Thomas Bowe
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Laura S Ellerbe
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Tyler E Phelps
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - John W Finney
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Steven M Asch
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Keith Humphreys
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Jodie Trafton
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.,c Program Evaluation and Resource Center , Office of Mental Health Operations, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Megan Vanneman
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA.,b Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR) and the Division of General Medical Disciplines , Stanford , California , USA
| | - Alex H S Harris
- a Center for Innovation to Implementation (Ci2i) , VA Palo Alto Health Care System , Menlo Park , California , USA
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Watkins KE, Paddock SM, Hudson TJ, Ounpraseuth S, Schrader AM, Hepner KA, Sullivan G. Association Between Quality Measures and Mortality in Individuals With Co-Occurring Mental Health and Substance Use Disorders. J Subst Abuse Treat 2016; 69:1-8. [PMID: 27568504 DOI: 10.1016/j.jsat.2016.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/11/2016] [Accepted: 06/03/2016] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Individuals with co-occurring mental and substance use disorders have increased rates of mortality relative to the general population. The relationship between measures of treatment quality and mortality for these individuals is unknown. OBJECTIVE To examine the association between 5 quality measures and 12- and 24-month mortality. DESIGN, SETTING AND PARTICIPANTS Retrospective cohort study of patients with co-occurring mental illness (schizophrenia, bipolar disorder, post-traumatic stress disorder and major depression) and substance use disorders who received care for these disorders paid for by the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 5 patient-level quality measures, while risk-adjusting for patient characteristics. Quality measures included receipt of psychosocial treatment, receipt of psychotherapy, treatment initiation and engagement, and a measure of continuity of care. We also examined the relationship between number of diagnosis-related outpatient visits and mortality, and conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. MAIN OUTCOMES MEASURE Mortality 12 and 24 months after the end of the observation period. RESULTS All measures except for treatment engagement at 24 months were significantly associated with lower mortality at both 12 and 24 months. At 12 months, receiving any psychosocial treatment was associated with a 21% decrease in mortality; psychotherapy, a 22% decrease; treatment initiation, a 15% decrease, treatment engagement, a 31% decrease; and quarterly, diagnosis-related visits a 28% decrease. Increasing numbers of visits were associated with decreasing mortality. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of an unobserved confounder, to render these findings non-significant. CONCLUSIONS AND RELEVANCE This is the first study to show an association between process-based quality measures and mortality in patients with co-occurring mental and substance use disorders, and provides initial support for the predictive validity of the measures. By devising strategies to improve performance on these measures, health care systems may be able to decrease the mortality of this vulnerable population.
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Affiliation(s)
| | - Susan M Paddock
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,.
| | - Teresa J Hudson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,; Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR, 72205, USA.
| | - Songthip Ounpraseuth
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA,.
| | - Amy M Schrader
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA,.
| | | | - Greer Sullivan
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,; University of California, Riverside, School of Medicine, 2608 School of Medicine Education Building, 900 University Ave., Riverside, CA 92521, USA.
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Knight DK, Joe GW, Crawley RD, Becan JE, Dansereau DF, Flynn PM. The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes. J Subst Abuse Treat 2015; 62:20-7. [PMID: 26742724 DOI: 10.1016/j.jsat.2015.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
Treatment engagement is a primary pathway to change. Because motivation consistently predicts engagement and sustained recovery following treatment, targeted efforts at improving problem recognition (i.e., a significant ingredient in motivation) during early weeks of treatment are critical. The purpose of this study is to compare the effectiveness of Standard Operating Practice (SOP) versus SOP plus an 8-session Treatment Readiness and Induction Program (TRIP; delivered in the first weeks of treatment) on cognitive indicators and treatment engagement among youth in 5 residential substance use treatment settings. Structural Equation Modeling (SEM) documented higher problem recognition, decision making, and treatment engagement (participation, satisfaction, counselor rapport) among youth receiving TRIP (compared to SOP only), even when controlling for background characteristics such as age, race-ethnicity, gender, baseline drug use severity, etc. Findings suggest that TRIP is an effective induction tool that directly impacts targeted constructs (i.e., problem recognition, decision making), and also directly affects indicators of engagement.
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Affiliation(s)
- Danica K Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA.
| | - George W Joe
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA
| | - Rachel D Crawley
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA
| | - Jennifer E Becan
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA
| | - Donald F Dansereau
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA
| | - Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA
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Myers B, Govender R, Koch JR, Manderscheid R, Johnson K, Parry CDH. Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa. Subst Abuse Treat Prev Policy 2015; 10:44. [PMID: 26545736 PMCID: PMC4636825 DOI: 10.1186/s13011-015-0040-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA). METHODS First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach's measure of internal consistency. RESULTS The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients' perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach's α ranging from 0.72 to 0.89. CONCLUSION A lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients' perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington DC, USA.
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
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Harris AHS, Gupta S, Bowe T, Ellerbe LS, Phelps TE, Rubinsky AD, Finney JW, Asch SM, Humphreys K, Trafton J. Predictive validity of two process-of-care quality measures for residential substance use disorder treatment. Addict Sci Clin Pract 2015; 10:22. [PMID: 26520402 PMCID: PMC4672518 DOI: 10.1186/s13722-015-0042-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to monitor and ultimately improve the quality of addiction treatment, professional societies, health care systems, and addiction treatment programs must establish clinical practice standards and then operationalize these standards into reliable, valid, and feasible quality measures. Before being implemented, quality measures should undergo tests of validity, including predictive validity. Predictive validity refers to the association between process-of-care quality measures and subsequent patient outcomes. This study evaluated the predictive validity of two process quality measures of residential substance use disorder (SUD) treatment. METHODS Washington Circle (WC) Continuity of Care quality measure is the proportion of patients having an outpatient SUD treatment encounter within 14 days after discharge from residential SUD treatment. The Early Discharge measure is the proportion of patients admitted to residential SUD treatment who discharged within 1 week of admission. The predictive validity of these process measures was evaluated in US Veterans Health Administration patients for whom utilization-based outcome and 2-year mortality data were available. Propensity score-weighted, mixed effects regression adjusted for pre-index imbalances between patients who did and did not meet the measures' criteria and clustering of patients within facilities. RESULTS For the WC Continuity of Care measure, 76 % of 10,064 patients had a follow-up visit within 14 days of discharge. In propensity score-weighted models, patients who had a follow-up visit had a lower 2-year mortality rate [odds ratio (OR) = 0.77, p = 0.008], but no difference in subsequent detoxification episodes relative to patients without a follow-up visit. For the Early Discharge measure, 9.6 % of 10,176 discharged early and had significantly higher 2-year mortality (OR = 1.49, p < 0.001) and more subsequent detoxification episodes. CONCLUSIONS These two measures of residential SUD treatment quality have strong associations with 2-year mortality and the Early Discharge measure is also associated with more subsequent detoxification episodes. These results provide initial support for the predictive validity of residential SUD treatment quality measures and represent the first time that any SUD quality measure has been shown to predict subsequent mortality.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Shalini Gupta
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Thomas Bowe
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Laura S Ellerbe
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Tyler E Phelps
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Anna D Rubinsky
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - John W Finney
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA. A
| | - Steven M Asch
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Keith Humphreys
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Jodie Trafton
- Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, CA, USA.
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Acevedo A, Garnick D, Ritter G, Lundgren L, Horgan C. Admissions to detoxification after treatment: Does engagement make a difference? Subst Abus 2015; 37:364-71. [PMID: 26308604 DOI: 10.1080/08897077.2015.1080784] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment engagement is a well-established performance measure for the treatment of substance use disorders. This study examined whether outpatient treatment engagement is associated with a reduced likelihood of subsequent detoxification admissions. METHODS This study used administrative data on treatment services received by clients in specialty treatment facilities licensed in Massachusetts. The sample consisted of 11,591 adult clients who began an outpatient treatment episode in 2006. Treatment engagement was defined as receipt of at least 1 treatment service within 14 days of beginning a new outpatient treatment episode and receipt of at least 2 additional treatment services in the next 30 days. The outcome was a subsequent detoxification admission. Multilevel survival models examined the relationship between engagement and outcomes, with time to detoxification admission as the dependent variable censored at 365 days. RESULTS Only 35% of clients met the outpatient engagement criteria, and 15% of clients had a detoxification admission within a year after beginning their outpatient treatment episode. Controlling for client demographics, insurance type, and substance use severity, clients who met the engagement criteria had a lower hazard of having a detoxification admission during the year following the index outpatient visit than those who did not engage (hazard ratio = 0.87, P < .01). CONCLUSIONS Treatment engagement is a useful measure for monitoring quality of care. The findings from this study could help inform providers and policy makers on ways to target care and reduce the likelihood of more intensive services.
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Affiliation(s)
- Andrea Acevedo
- a Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University , Waltham , Massachusetts , USA
| | - Deborah Garnick
- a Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University , Waltham , Massachusetts , USA
| | - Grant Ritter
- a Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University , Waltham , Massachusetts , USA
| | - Lena Lundgren
- b School of Social Work, Boston University , Boston , Massachusetts , USA
| | - Constance Horgan
- a Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University , Waltham , Massachusetts , USA
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Walley AY, Palmisano J, Sorensen-Alawad A, Chaisson C, Raj A, Samet JH, Drainoni ML. Engagement and Substance Dependence in a Primary Care-Based Addiction Treatment Program for People Infected with HIV and People at High-Risk for HIV Infection. J Subst Abuse Treat 2015; 59:59-66. [PMID: 26298399 DOI: 10.1016/j.jsat.2015.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
To improve outcomes for people with substance dependence and HIV infection or at risk for HIV infection, patients were enrolled in a primary care-based addiction treatment program from 2008-2012 that included a comprehensive substance use assessment, individual and group counseling, addiction pharmacotherapy and case management. We examined whether predisposing characteristics (depression, housing status, polysubstance use) and an enabling resource (buprenorphine treatment) were associated with engagement in the program and persistent substance dependence at 6 months. At program enrollment 61% were HIV-infected, 53% reported heroin use, 46% reported alcohol use, 37% reported cocaine use, and 28% reported marijuana use in the past 30 days, 72% reported depression, 19% were homeless, and 53% had polysubstance use. Within 6-months 60% had been treated with buprenorphine. Engagement (defined as 2 visits in first 14 days and 2 additional visits in next 30 days) occurred in 64%; 49% had substance dependence at 6-months. Receipt of buprenorphine treatment was associated with engagement (Adjusted Odds Ratio (AOR) 8.32 95% CI: 4.13-16.77). Self-reported depression at baseline was associated with substance dependence at 6-months (AOR 3.30 95% CI: 1.65-6.61). Neither housing status nor polysubstance use was associated with engagement or substance dependence. The FAST PATH program successfully engaged and treated patients in a primary care-based addiction treatment program. Buprenorphine, a partial opioid agonist, was a major driver of addiction treatment engagement. Given depression's association with adverse outcomes in this clinical population, including mental health treatment as part of integrated care holds potential to improve addiction treatment outcomes.
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Affiliation(s)
- Alexander Y Walley
- Boston Medical Center, General Internal Medicine; Boston University School of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States.
| | - Joseph Palmisano
- Boston University School of Public Health, Data Coordinating Center, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118 United States
| | - Amy Sorensen-Alawad
- Boston University School of Medicine, Geriatrics Section, Boston, MA 02118 United States
| | - Christine Chaisson
- Boston University School of Public Health, Data Coordinating Center, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118 United States
| | - Anita Raj
- University of California, San Diego, La Jolla, CA United States
| | - Jeffrey H Samet
- Boston Medical Center, General Internal Medicine; Boston University School of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States
| | - Mari-Lynn Drainoni
- Boston University School of Public Health, Department of Health Policy and Management, 715 Albany Street T3W, Boston, MA 02118 United States; Boston University School of Medicine, Infectious Diseases Section, Boston, MA 02118 United States; Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA 01730, United States
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Acevedo A, Garnick D, Ritter G, Horgan C, Lundgren L. Race/ethnicity and quality indicators for outpatient treatment for substance use disorders. Am J Addict 2015; 24:523-31. [PMID: 26179892 DOI: 10.1111/ajad.12256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/16/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Initiation and engagement, performance measures that focus on the frequency and timely receipt of services in the early stages of substance use disorders (SUD) treatment, are useful tools for assessing treatment quality differences across racial/ethnic groups. The purpose of this study was to examine whether there are racial/ethnic disparities in these quality indicators and to explore whether predictors of treatment initiation and engagement differ by clients' race/ethnicity. METHODS This study used administrative data from outpatient treatment facilities licensed by the state of Massachusetts that receive public funding. The sample consisted of 10,666 adult clients (76% White, 13% Latino, 11% Black) who began an outpatient treatment episode in 2006. Client data were linked with facility data from the National Survey on Substance Abuse Treatment Services. Multilevel regressions were used to examine racial/ethnic disparities and to explore whether predictors for initiation and engagement differed by client's race/ethnicity. RESULTS We did not find evidence of racial/ethnic disparities in treatment initiation or engagement. However, we found that predictors of initiation and engagement differed by client's race/ethnicity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Disparities may be context specific, and thus it is important that they be examined at state or local levels. Our results point to the importance of examining predictors of quality indicators separately by group to better understand and address the needs of diverse client populations.
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Affiliation(s)
- Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Deborah Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Grant Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Constance Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Lena Lundgren
- Boston University School of Social Work, Boston, Massachusetts
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Martin RA, Stein LAR, Clair M, Cancilliere MK, Hurlbut W, Rohsenow DJ. Adolescent Substance Treatment Engagement Questionnaire for Incarcerated Teens. J Subst Abuse Treat 2015; 57:49-56. [PMID: 26021405 DOI: 10.1016/j.jsat.2015.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/14/2015] [Accepted: 04/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment engagement is often measured in terms of treatment retention and drop out, resource utilization, and missed appointments. Since persons may regularly attend treatment sessions but not pay close attention, actively participate, or comply with the program, attendance may not reflect the level of effort put into treatment. Teens in correctional settings may feel coerced to attend treatment, making it necessary to develop measures of treatment involvement beyond attendance. This study describes the development and validation of the Adolescent Substance Treatment Engagement Questionnaire (ASTEQ), Teen and Counselor versions. METHODS The psychometric properties of the ASTEQ were examined in a sample of incarcerated teens (N = 205) and their counselors. Principal component analysis was conducted on teen and counselor versions of the questionnaire. RESULTS Scales of positive and negative treatment engagement were found, reflecting both overt behaviors (joking around, talking to others) and attitudes (interest in change). Significant correlations with constructs related to treatment attitudes and behaviors, and misbehaviors (including substance use) demonstrate good concurrent and predictive validity. Teen and counselor ratings of engagement produced validity correlations in the medium effect size range. CONCLUSIONS These measures comprise a valid and reliable method for measuring treatment engagement for incarcerated teens.
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Affiliation(s)
- Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912.
| | - Lynda A R Stein
- The University of Rhode Island, Kingston, RI, 02881; The Rhode Island Training School, 40 Howard Avenue, Cranston, RI, 02920
| | - Mary Clair
- The University of Rhode Island, Kingston, RI, 02881; The Rhode Island Training School, 40 Howard Avenue, Cranston, RI, 02920
| | | | - Warren Hurlbut
- The Rhode Island Training School, 40 Howard Avenue, Cranston, RI, 02920
| | - Damaris J Rohsenow
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912; Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908
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Ramchand R, Griffin BA, Hunter SB, Booth MS, McCaffrey DF. Provision of mental health services as a quality indicator for adolescent substance abuse treatment facilities. Psychiatr Serv 2015; 66:41-8. [PMID: 25219932 PMCID: PMC4388191 DOI: 10.1176/appi.ps.201300517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study tested whether adolescents receiving substance abuse treatment at facilities offering full (can treat all psychiatric conditions) or partial (cannot treat severe or persistent mental illness) mental health services have better 12-month substance use and mental health outcomes than youths at facilities with no mental health services. METHODS Data were collected from 3,235 adolescents who were assessed at baseline and at 12 months at one of 50 adolescent treatment facilities. Propensity scores were applied to compare client outcomes from three types of facilities (full, partial, or no mental health services); weighted linear models were estimated to examine outcomes. RESULTS Youths attending facilities offering full or partial mental health services had better substance abuse treatment outcomes than youths attending facilities offering no such services. There was no evidence of a difference in substance use outcomes between facilities offering full versus partial services, nor was there evidence of differences in mental health outcomes. CONCLUSIONS These preliminary findings suggest that the availability of mental health services may be a useful quality indicator for adolescent substance abuse treatment facilities. More research is needed to examine specific types of mental health services offered at different facilities.
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Affiliation(s)
- Rajeev Ramchand
- The authors are with the RAND Corporation. Dr. Ramchand and Dr. Griffin are with the Arlington, Virginia, office, Dr. Hunter and Ms. Booth are in Santa Monica, California, and Dr. McCaffrey is in Pittsburgh. Send correspondence to Dr. Ramchand (e-mail: )
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Acevedo A, Garnick DW, Dunigan R, Horgan CM, Ritter GA, Lee MT, Panas L, Campbell K, Haberlin K, Lambert-Wacey D, Leeper T, Reynolds M, Wright D. Performance measures and racial/ethnic disparities in the treatment of substance use disorders. J Stud Alcohol Drugs 2015; 76:57-67. [PMID: 25486394 PMCID: PMC4263781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/09/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE A limited literature on racial/ethnic disparities in the treatment of substance use disorders suggests that quality of treatment may differ based on client's race/ethnicity. This study examined whether (a) disparities exist in the probability of treatment engagement, a performance measure for substance use disorders, and (b) treatment engagement is associated with similar reductions in likelihood of arrest for Whites, Blacks, Latinos, and American Indians. METHOD Adult clients who began an outpatient treatment episode in 2008 in public sector specialty treatment facilities in Connecticut, New York, Oklahoma, and Washington made up the sample (N = 108,654). Administrative treatment data were linked to criminal justice data. The criminal justice outcome was defined as an arrest within a year after beginning treatment. Engagement is defined as receiving a treatment service within 14 days of beginning a new outpatient treatment episode and at least two additional services within the next 30 days. Two-step Heckman probit models and hierarchical time-to-event models were used in the analyses. RESULTS Black clients in New York and American Indian clients in Washington had significantly lower likelihood of engagement than White clients. As moderators of engagement, race/ethnicity had inconsistent effects across states on the hazard of arrest. CONCLUSIONS Racial/ethnic minority groups may benefit from additional treatment support to reduce criminal justice involvement. States should examine whether disparities exist within their treatment system and incorporate disparities reduction in their quality improvement initiatives.
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Affiliation(s)
- Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Deborah W Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Robert Dunigan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Constance M Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Grant A Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Margaret T Lee
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kevin Campbell
- Washington State Department of Social and Health Services, The Division of Behavioral Health and Recovery, Olympia, Washington
| | - Karin Haberlin
- Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut
| | - Dawn Lambert-Wacey
- New York State Office of Alcoholism and Substance Abuse Services, Division of Outcome Management and System Information, Albany, New York
| | - Tracy Leeper
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, Oklahoma
| | - Mark Reynolds
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, Oklahoma
| | - David Wright
- Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City, Oklahoma
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Almirall D, Griffin BA, McCaffrey DF, Ramchand R, Yuen RA, Murphy SA. Time-varying effect moderation using the structural nested mean model: estimation using inverse-weighted regression with residuals. Stat Med 2014; 33:3466-87. [PMID: 23873437 PMCID: PMC4008726 DOI: 10.1002/sim.5892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 06/03/2013] [Indexed: 11/07/2022]
Abstract
This article considers the problem of examining time-varying causal effect moderation using observational, longitudinal data in which treatment, candidate moderators, and possible confounders are time varying. The structural nested mean model (SNMM) is used to specify the moderated time-varying causal effects of interest in a conditional mean model for a continuous response given time-varying treatments and moderators. We present an easy-to-use estimator of the SNMM that combines an existing regression-with-residuals (RR) approach with an inverse-probability-of-treatment weighting (IPTW) strategy. The RR approach has been shown to identify the moderated time-varying causal effects if the time-varying moderators are also the sole time-varying confounders. The proposed IPTW+RR approach provides estimators of the moderated time-varying causal effects in the SNMM in the presence of an additional, auxiliary set of known and measured time-varying confounders. We use a small simulation experiment to compare IPTW+RR versus the traditional regression approach and to compare small and large sample properties of asymptotic versus bootstrap estimators of the standard errors for the IPTW+RR approach. This article clarifies the distinction between time-varying moderators and time-varying confounders. We illustrate the methodology in a case study to assess if time-varying substance use moderates treatment effects on future substance use.
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Affiliation(s)
- Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, U.S.A
| | | | | | | | - Robert A. Yuen
- Department of Statistics, University of Michigan, Ann Arbor, MI 48104, U.S.A
| | - Susan A. Murphy
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, U.S.A
- Department of Statistics, University of Michigan, Ann Arbor, MI 48104, U.S.A
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, U.S.A
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Dunigan R, Acevedo A, Campbell K, Garnick DW, Horgan CM, Huber A, Lee MT, Panas L, Ritter GA. Engagement in outpatient substance abuse treatment and employment outcomes. J Behav Health Serv Res 2014; 41:20-36. [PMID: 23686216 PMCID: PMC3796147 DOI: 10.1007/s11414-013-9334-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study, a collaboration between an academic research center and Washington State's health, employment, and correction departments, investigates the extent to which treatment engagement, a widely adopted performance measure, is associated with employment, an important outcome for individuals receiving treatment for substance use disorders. Two-stage Heckman probit regressions were conducted using 2008 administrative data for 7,570 adults receiving publicly funded treatment. The first stage predicted employment in the year following the first treatment visit, and three separate second-stage models predicted the number of quarters employed, wages, and hours worked. Engagement as a main effect was not significant for any of the employment outcomes. However, for clients with prior criminal justice involvement, engagement was associated with both employment and higher wages following treatment. Clients with criminal justice involvement face greater challenge regarding employment, so the identification of any actionable step which increases the likelihood of employment or wages is an important result.
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Affiliation(s)
- Robert Dunigan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA,
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Pullmann MD, Ague S, Johnson T, Lane S, Beaver K, Jetton E, Rund E. Defining engagement in adolescent substance abuse treatment. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:347-58. [PMID: 24046184 DOI: 10.1007/s10464-013-9600-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Youth engagement in substance use treatment is an important construct for research and practice, but it has been thinly and inconsistently defined in the literature. Most research has measured engagement by initiation, attendance, and retention in treatment. Because youth generally enter substance use treatment as a result of compliance with external requirements, defining engagement in this way might be insufficient. This qualitative participatory research study describes five focus groups with 31 adults working with youth in substance use treatment. Focus groups were designed and conducted by youth researchers in collaboration with university-based partners. We categorized participants' descriptions of engagement into five domains, identified as "CARES": Conduct, Attitudes, Relationships, Empowerment, and Social Context. These domains represent a comprehensive and ecologically-based definition of engagement that situates engagement in the context and trajectory of youth development, has clear implications for assertive clinical practice, and provides a foundation for developing an operationalized measure.
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Affiliation(s)
- Michael D Pullmann
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 2815 Eastlake Avenue East, Seattle, WA, 98102, USA,
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Joe GW, Knight DK, Becan JE, Flynn PM. Recovery among adolescents: models for post-treatment gains in drug abuse treatments. J Subst Abuse Treat 2013; 46:362-73. [PMID: 24238715 DOI: 10.1016/j.jsat.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 09/20/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.
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Affiliation(s)
- George W Joe
- Texas Christian University, Fort Worth, TX 76129, USA.
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Criminal justice outcomes after engagement in outpatient substance abuse treatment. J Subst Abuse Treat 2013; 46:295-305. [PMID: 24238717 DOI: 10.1016/j.jsat.2013.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 09/20/2013] [Accepted: 10/04/2013] [Indexed: 11/22/2022]
Abstract
The relationship between engagement in outpatient treatment facilities in the public sector and subsequent arrest is examined for clients in Connecticut, New York, Oklahoma and Washington. Engagement is defined as receiving another treatment service within 14 days of beginning a new episode of specialty treatment and at least two additional services within the next 30 days. Data are from 2008 and survival analysis modeling is used. Survival analyses express the effects of model covariates in terms of "hazard ratios," which reflect a change in the likelihood of outcome because of the covariate. Engaged clients had a significantly lower hazard of any arrest than non-engaged in all four states. In NY and OK, engaged clients also had a lower hazard of arrest for substance-related crimes. In CT, NY, and OK engaged clients had a lower hazard of arrest for violent crime. Clients in facilities with higher engagement rates had a lower hazard of any arrest in NY and OK. Engaging clients in outpatient treatment is a promising approach to decrease their subsequent criminal justice involvement.
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