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Buchholz A, Berner M, Dams J, Rosahl A, Hempleman J, König HH, Konnopka A, Kriston L, Piontek D, Reimer J, Röhrig J, Scherbaum N, Silkens A, Kraus L. Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial. BMC Psychiatry 2022; 22:60. [PMID: 35086501 PMCID: PMC8793210 DOI: 10.1186/s12888-022-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. METHODS The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. RESULTS Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. CONCLUSIONS While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. TRIAL REGISTRATION German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.
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Affiliation(s)
- Angela Buchholz
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre of Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Michael Berner
- Municipal Clinical Center of Karlsruhe, Karlsruhe, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Rosahl
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre of Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jochen Hempleman
- Outpatient Department for Addiction, LWL-Hospital Muenster, Muenster, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre of Hamburg-Eppendorf, 20246, Hamburg, Germany
| | | | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Centre for Psychosocial Medicine, Health North, Bremen, Germany
| | - Jeanette Röhrig
- Clinic for Addiction Medicine and Addictive Behaviour, Institute for Clinical Psychology, Klinikum Stuttgart, Stuttgart, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behavior and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Anna Silkens
- LVR-Hospital Essen, Department of Addictive Behavior and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany
- Department for Public Health Sciences, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Mei X, van Wormer JG, Lu R, Abboud MJ, Lutze FE. Validating Drug Court Collaboration Instrument: Differences in Model Adherence Between Adult and Juvenile Drug Courts. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:1990-2017. [PMID: 30938214 DOI: 10.1177/0306624x19836547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Drug courts aim to significantly address drug abuse and drug-related criminality. However, the effectiveness of drug courts varies from court to court. The variation of success demands insights regarding what is going on inside the "black box" of drug court practices. Therefore, it is necessary to evaluate to what extent drug courts are operated in adherence with guiding principles and strategies. Using a national sample and validated measures, the current article examines the "black boxes" of adult and juvenile drug courts across the country. We found that, in general, adult drug courts face less model adherence challenges in comparison with juvenile courts, which may, in part, explain why adult drug courts perform better than juvenile drug courts overall.
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Affiliation(s)
- Xiaohan Mei
- 1 California State University, Los Angeles, USA
| | | | - Ruibin Lu
- 3 Stockton University, Galloway, NJ, USA
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Mei X, van Wormer JG, Lu R, Abboud MJ, Lutze FE. Collaboration: A Mechanism of Drug Court Model Adherence. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042618821196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug courts solve problems, namely, reducing drug use and recidivism. The current research attempts to answer the question of how to ensure program fidelity and therefore optimize the efficacy of drug courts. Justice professionals and scholars have recognized that there are multiple internal and external threats that could undermine the drug court operation. At this point, the mechanism(s) by which threaten factors affect drug court program fidelity has been neither theoretically modeled nor empirically tested. In the present study, using a national sample and the Structural Regression Analysis (SRA), we found collaboration and judicial decision making are the most important factors for maintaining drug court program fidelity. This is because collaboration and judicial decision making can mediate the threats and challenges from many quarters, including the lack of information sharing and evaluation, treatment, operational support, and community and political support.
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Affiliation(s)
- Xiaohan Mei
- California State University, Los Angles, USA
| | | | - Ruibin Lu
- Stockton University, Galloway, NJ, USA
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Stallvik M, Gastfriend DR, Nordahl HM. Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.934305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units. J Addict Med 2013; 3:139-50. [PMID: 21769010 DOI: 10.1097/adm.0b013e31818ebb6f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standardized patient placement criteria such as those developed by the American Society of Addiction Medicine are increasingly common in substance abuse treatment, but it is unclear what factors are associated with their use or with treatment units' provision of related services. This study examined these issues in the context of a national survey of outpatient substance abuse treatment units. Regressions using 2005 data revealed that both public and private managed care were associated with a greater likelihood of using American Society of Addiction Medicine criteria to develop client treatment plans. However, only public managed care was associated with a greater likelihood of offering more resource-intensive services. Associations between client population severity and resource-intensive service provision were sparse but positive.
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Orwat J, Saitz R, Tompkins CP, Cheng DM, Dentato MP, Samet JH. Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems. J Subst Abuse Treat 2011; 41:233-42. [PMID: 21700412 PMCID: PMC3634563 DOI: 10.1016/j.jsat.2011.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/15/2011] [Accepted: 04/15/2011] [Indexed: 01/06/2023]
Abstract
This is a prospective cohort study to identify factors associated with receipt of substance abuse treatment (SAT) among adults with alcohol problems and HIV/AIDS. Data from the HIV Longitudinal Interrelationships of Viruses and Ethanol study were analyzed. Generalized estimating equation logistic regression models were fit to identify factors associated with any service utilization. An alcohol dependence diagnosis had a negative association with SAT (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [95% CI] = 0.19-0.67), as did identifying sexual orientation other than heterosexual (AOR = 0.46, CI = 0.29-0.72) and having social supports that use alcohol/drugs (AOR = 0.62, CI = 0.45-0.83). Positive associations with SAT include presence of hepatitis C antibody (AOR = 3.37, CI = 2.24-5.06), physical or sexual abuse (AOR = 2.12, CI = 1.22-3.69), social supports that help with sobriety (AOR = 1.92, CI = 1.28-2.87), homelessness (AOR = 2.40, CI = 1.60-3.62), drug dependence diagnosis (AOR = 2.64, CI = 1.88-3.70), and clinically important depressive symptoms (AOR = 1.52, CI = 1.08-2.15). While reassuring that factors indicating need for SAT among people with HIV and alcohol problems (e.g., drug dependence) are associated with receipt, nonneed factors (e.g., sexual orientation, age) that should not decrease likelihood of receipt of treatment were identified.
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Affiliation(s)
- John Orwat
- Loyola University Chicago, Chicago, IL 60611, USA.
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De Leon G, Melnick G, Cleland CM. Matching to Sufficient Treatment: Some Characteristics of Undertreated (Mismatched) Clients. J Addict Dis 2010; 29:59-67. [DOI: 10.1080/10550880903436051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Timko C, Chen S, Sempel J, Barnett P. Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs. J Ment Health 2009. [DOI: 10.1080/09638230600559631] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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De Leon G, Melnick G, Cleland CM. Client Matching: A Severity-Treatment Intensity Paradigm. J Addict Dis 2008; 27:99-113. [DOI: 10.1080/10550880802122703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- George De Leon
- a Center for Therapeutic Community Research , National Development and Research Institutes, Inc. , New York, NY
| | - Gerald Melnick
- b Center for the Integration of Research and Practice , National Development and Research Institutes, Inc. , New York, NY
| | - Charles M. Cleland
- c Center for Drug/Use and HIV Research, Institute for AIDS Research , National Development and Research Institutes, Inc. , New York, NY
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No-Show for Treatment in Substance Abuse Patients with Comorbid Symptomatology: Validity Results from a Controlled Trial of the ASAM Patient Placement Criteria. J Addict Med 2007; 1:79-87. [DOI: 10.1097/adm.0b013e3180634c1d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Magura S, Fong C, Staines GL, Cleland C, Foote J, Rosenblum A, Kosanke N, DeLuca A. The combined effects of treatment intensity, self-help groups and patient attributes on drinking outcomes. J Psychoactive Drugs 2005; 37:85-92. [PMID: 15916254 DOI: 10.1080/02791072.2005.10399751] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Better understanding of the diverse factors that predict alcoholism treatment outcomes is essential to improving treatment strategies. Patients accepted for treatment at a multimodality program were interviewed and followed-up at three months and one year after admission. The study tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, modality matching, treatment retention, aftercare, self-help group participation and patient attributes at admission. Drinking frequency diminished substantially between baseline and the two follow-ups. Outcomes for inpatient were better than for outpatient treatment in bivariate analysis, but outcomes for these modalities were equal after adjusting for the effect of patient-treatment mismatching. Aftercare treatment, time in treatment for outpatients, community 12-Step group participation, and several patient attributes such as motivation for change and psychiatric severity significantly predicted drinking outcomes at one or both follow-ups. Clinical implications of the results are discussed.
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Affiliation(s)
- Stephen Magura
- National Development and Research Institutes, 71 West 23rd Street, New York, New York 10010, USA.
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Sharon E, Krebs C, Turner W, Desai N, Binus G, Penk W, Gastfriend DR. Predictive validity of the ASAM Patient Placement Criteria for hospital utilization. J Addict Dis 2005; 22 Suppl 1:79-93. [PMID: 15991591 DOI: 10.1300/j069v22s01_06] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We tested the validity of the ASAM Patient Placement Criteria (PPC) using the first complete and reliable computerized implementation of these criteria. Adult U.S. veterans (N = 95) seeking substance abuse treatment were blindly assessed for level of care need according to the PPC but were naturalistically assigned by counselors to residential rehabilitation (Level III) without knowledge of the PPC recommendation. Analyses compared subjects across three levels of recommended care, based on the algorithm, for utilization outcomes of VA hospital admissions and bed days of care. Subjects who were mismatched to lesser level of care than recommended utilized nearly twice as many hospital bed-days over the subsequent year (F (2;92) = 3.88; p < .05); this was unrelated to differential pre-assessment chronicity. The computerized algorithm is a promising new tool for facilitating field trials of the validity of the ASAM Criteria. A comprehensive implementation is an important methodologic requirement. These preliminary results support predictive validity for the ASAM Criteria, in that mismatching may be associated with excessive hospital utilization.
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Affiliation(s)
- Estee Sharon
- Addiction Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
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13
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Pirard S, Sharon E, Kang SK, Angarita GA, Gastfriend DR. Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes. Drug Alcohol Depend 2005; 78:57-64. [PMID: 15769558 DOI: 10.1016/j.drugalcdep.2004.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 09/20/2004] [Accepted: 09/20/2004] [Indexed: 11/28/2022]
Abstract
More than half of substance abusers entering addiction treatment report a history of physical or sexual abuse. It is unclear if such a history impacts treatment outcomes. This one-year follow-up study of 700 substance abusers sought to clarify the relationship between lifetime physical and/or sexual abuse and addiction treatment outcome to help address the specific needs of this population. To achieve this goal, baseline characteristics, no-show for treatment status, post-treatment clinical outcomes, and treatment history were studied for subjects with lifetime history of abuse (47.3%) versus without. Abused subjects, predominantly women, were significantly more impaired at baseline on clinical dimensions including family/social severity and psychiatric severity as measured by the Addiction Severity Index (ASI), and general level of functioning. The two groups endorsed different drugs as primary, with the abused group less frequently endorsing heroin and cocaine in favor of alcohol and polydrug use. Abused subjects reported more prior medical and psychiatric treatments. Abuse history was not a predictor of no-show for treatment. Over the 1-year follow-up, lifetime physical and/or sexual abuse was significantly associated with worse psychiatric status and more psychiatric hospitalizations and outpatient treatment despite receiving similar intensive addiction treatment.
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Affiliation(s)
- Sandrine Pirard
- Addiction Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 388 Commonwealth Avenue, Boston, MA 02115, USA.
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Fletcher BW, Broome KM, Delany PJ, Shields J, Flynn PM. Patient and program factors in obtaining supportive services in DATOS. J Subst Abuse Treat 2004; 25:165-75. [PMID: 14670522 DOI: 10.1016/s0740-5472(03)00126-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients (N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.
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Affiliation(s)
- Bennett W Fletcher
- National Institute on Drug Abuse National Institutes of Health, 6001 Executive Boulevard, Room 5159, Bethesda, MD 20892, USA.
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Levine HJ, Turner W, Reif S, Janas D, Gastfriend DR. Determining Service Variations Between and Within ASAM Levels of Care. J Addict Dis 2004; 22 Suppl 1:9-25. [PMID: 15991587 DOI: 10.1300/j069v22s01_02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The American Society of Addiction Medicine (ASAM) Criteria Validity Study at Massachusetts General Hospital and Harvard Medical School randomized patients between programs in two levels of care. It therefore became critical to determine the extent to which programs met ASAM level of care (LOC) descriptions. Quantitative surveys (checklist) and qualitative case studies (field observation, key informant interviews) documented care variation within and between two ASAM LOCs in 12 substance abuse treatment units. These LOCs were: Level II (Intensive Outpatient Treatment) and Level III (Medically Monitored Residential Treatment). The Level II and Level III programs, as a group, met ASAM LOC criteria, but data showed major within-level variation by hours per day and number and type of skilled treatment services. Observational data suggest considerable within-level variation due to managed care and staff training. In multi-site PPC validity studies, it will be crucial to examine within-LOC variation and take into account payment sources and staff training when assessing patient outcomes.
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Gastfriend DR, Rubin A, Sharon E, Turner WM, Anton RF, Donovan DM, Gorski T, Marlatt GA, Maisto S, Schultz TK, Shulman GD. New Constructs and Assessments for Relapse and Continued Use Potential in the ASAM Patient Placement Criteria. J Addict Dis 2004; 22 Suppl 1:95-111. [PMID: 15991592 DOI: 10.1300/j069v22s01_07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
One area of intensive study in recent years in addiction research is the characterization and prediction of relapse risk. Given the growing list of findings and assessment tools in this area, in preparation for the second edition, revised volume of the Patient Placement Criteria (PPC) of the American Society of Addiction Medicine (ASAM), a workgroup of the Coalition for National Criteria was assigned the task of creating a revised conceptual organization for Dimension 5: Relapse/Continued Use Potential. The workgroup conducted a review of the previous Dimension 5 constructs and criteria, including a decision analysis of the previous Dimension 5 decision rules. Following that analysis, field data from the ASAM Criteria Validity Study at Massachusetts General Hospital and Harvard Medical School were analyzed from a large cohort of public and indigent patients in eastern Massachusetts. After determining the concurrent validity of the Dimension 5 decision rules and their limitations, the decision rules were rewritten to gain improved validity. This exercise revealed techniques that can and should be used to improve the discrimination of levels of care among all Dimensions. Finally, the workgroup expanded and refined the constructs that should comprise a revised Dimension 5. This revised list of constructs is sequential and hierarchical. It offers face validity on several levels of current basic and clinical research knowledge: behavioral pharmacology, behavioral psychology, learning theory and psychopathology. While the Second Edition-Revised volume of the ASAM PPC (PPC-2R) does not go so far as to propose final decision rules for Dimension 5 based on these new constructs, it does recommend pilot adoption of several new assessment tools for this dimension and provides the framework incorporating those constructs and assessments in the next complete PPC edition.
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Affiliation(s)
- David R Gastfriend
- Addiction Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA.
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Mattson ME. The search for a rational basis for treatment selection. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 2003; 16:97-113. [PMID: 12638633 DOI: 10.1007/0-306-47939-7_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Margaret E Mattson
- Treatment Research Branch, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892, USA
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Magura S, Schildhaus S, Rosenblum A, Gastfriend D. Substance user treatment program quality: selected topics. Subst Use Misuse 2002; 37:1185-214. [PMID: 12180561 DOI: 10.1081/ja-120004179] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This panel explores the "state of the art" in conceptualization and research pertinent to program quality in substance user treatment. First, seven critical questions for program quality are identified and discussed. Second, a recent national evaluation of treatment examines the implications of long-term patient outcomes for treatment quality. Third, a large number of clinical trials of behavioral and pharmacological treatments for cocaine dependence were conducted during the 1990s; this research is synthesized and interpreted. Fourth, progress is reported in improving the quality of treatment through standardized criteria for patient placement matching.
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Affiliation(s)
- Stephen Magura
- National Development and Research Institutes, New York, NY 10010, USA.
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Harrison PA, Asche SE. Outcomes monitoring in Minnesota: treatment implications, practical limitations. J Subst Abuse Treat 2001; 21:173-83. [PMID: 11777666 DOI: 10.1016/s0740-5472(01)00199-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Minnesota developed its treatment outcomes monitoring system to evaluate its service delivery system and to identify specific ways to enhance treatment outcomes. Standardized patient and treatment data were collected for all outpatient and inpatient admissions, and an assessment interview and weekly treatment services records were completed for 4953 adults and 387 adolescents who consented to participate in the outcomes study. Six-month follow-up interviews were completed for 64.4% of these adults and 83.5% of these adolescents. The study identified predictors of treatment completion and outcome for adults and adolescents, and predictors of outcome by setting for adults. The study also examined results for programs designed especially for adolescents, women, and culturally specific populations, as well as the relationships to outcomes of ancillary services and continuing care activities. Anticipated policy and program design changes resulting from the findings are discussed, along with the practical limitations of conducting a state outcomes monitoring system.
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Affiliation(s)
- P A Harrison
- Minnesota Department of Human Services, 444 Lafayette Road, St. Paul, MN 55155-3865, USA.
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