An exploratory analysis of treatment completion and client and organizational factors using hierarchical linear modeling

Methodological issues in the design and analyses of neonatal research studies: Experience of the NICHD Neonatal Research Network

Impressive advances in neonatology have occurred over the 30 years of life of The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN). However, substantial room for improvement remains in investigating and further developing the evidence base for improving outcomes among the extremely premature. We discuss some of the specific methodological challenges in the statistical design and analysis of randomized trials and observational studies in this population. Challenges faced by the NRN include designing trials for unusual or rare outcomes, accounting for and explaining center variations, identifying other subgroup differences, and balancing safety and efficacy concerns between short-term hospital outcomes and longer-term neurodevelopmental outcomes. In conclusion, the constellation of unique patient characteristics in neonates calls for broad understanding and careful consideration of the issues identified in this article for conducting rigorous studies in this population.

Factors associated with substance use treatment completion in residential facilities

PURPOSE

Individuals in residential treatment often face many challenges, which can include limited education, unstable housing, difficulty participating in the workforce, and severe substance use problems. We analyzed factors associated with substance use treatment completion. We focused on factors that can be influenced by health care system changes resulting from the Affordable Care Act (ACA).

DATA AND METHODS

We used the 2010 Treatment Episode Data Set - Discharges (TEDS-D), which is made available by the Substance Abuse and Mental Health Services Administration (SAMHSA). We analyzed factors associated with substance use treatment completion using logistic regression.

RESULTS

Individuals in residential treatment were often unemployed or not in the labor force, had prior substance use treatment episodes, used more than one substance, and were uninsured. Factors associated with treatment completion included older age, greater education, employment, criminal justice referral, not being homeless, and private insurance.

CONCLUSION

The expansion in private insurance coverage as a result of the ACA may result in more treatment completion in residential settings. Changes to the Medicaid program resulting from the ACA, including coverage of substance use treatment as an essential health benefit and greater support for housing, education, and employment, may also contribute to more residential discharges ending in treatment completion.

Program structure and counselor-client contact in outpatient substance abuse treatment

OBJECTIVES

To examine organizational structural attributes associated with counselor-client contact.

DATA SOURCES

Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs.

STUDY DESIGN

The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predictors of time in counseling and case management, and caseload size, controlling for geographic differences.

DATA COLLECTION

Directors at 116 outpatient drug-free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure.

PRIMARY FINDINGS

Clients received more counseling hours in programs that were "intensive," publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in "intensive," private-for-profit or publicly owned (versus private-nonprofit) programs, serving a lower proportion of dual-diagnosis clients, and providing more on-site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients.

CONCLUSIONS

Organizational attributes are related to counselor-client contact and may have implications for staff turnover and service quality.

Program structure and counselor-client contact in outpatient substance abuse treatment

OBJECTIVES

To examine organizational structural attributes associated with counselor-client contact.

DATA SOURCES

Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs.

STUDY DESIGN

The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predictors of time in counseling and case management, and caseload size, controlling for geographic differences.

DATA COLLECTION

Directors at 116 outpatient drug-free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure.

PRIMARY FINDINGS

Clients received more counseling hours in programs that were "intensive," publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in "intensive," private-for-profit or publicly owned (versus private-nonprofit) programs, serving a lower proportion of dual-diagnosis clients, and providing more on-site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients.

CONCLUSIONS

Organizational attributes are related to counselor-client contact and may have implications for staff turnover and service quality.