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CORK Bibliography: Program Administration

35 citations. January 2009 to present

Prepared: September 2011

Amodeo M; Storti SA; Larson MJ. Moving empirically supported practices to addiction treatment rograms: Recruiting supervisors to help in technology transfer. Substance Use & Misuse 45(6): 968-982, 2009. (33 refs.)

Federal and state funding agencies are encouraging or mandating the use of empirically supported treatments in addiction programs, yet many programs have not moved in this direction (Forman, Bovasso, and Woody, 2001; Roman and Johnson, 2002; Willenbring et al., 2004). To improve the skills of counselors in community addiction programs, the authors developed an innovative Web-based course on Cognitive Behavioral Therapy (CBT), a widely accepted empirically-supported practice (ESP) for addiction. Federal funding supports this Web course and a randomized controlled trial to evaluate its effectiveness. Since supervisors often play a pivotal role in helping clinicians transfer learned skills from training courses to the workplace, the authors recruited supervisor-counselor teams, engaging 54 supervisors and 120 counselors. Lessons learned focus on supervisor recruitment and involvement, supervisors' perceptions of CBT, their own CBT skills and their roles in the study, and implications for technology transfer for the addiction field as a whole. Recruiting supervisors proved difficult because programs lacked clinical supervisors. Recruiting counselors was also difficult because programs were concerned about loss of third-party reimbursement. Across the addiction field, technology transfer will be severely hampered unless such infrastructure problems can be solved. Areas for further investigation are identified.

Arnull E. Drug policy and performance management: A necessary evil? Drugs: Education, Prevention and Policy 16(4): 298-310, 2009. (23 refs.)

This paper considers the impact of a culture of performance management on the UK drug strategies since 1995. It discusses the background to the emergence of this policy direction and explores the reality of the culture through interviews with those responsible for making and implementing drug policy. Within the UK drug policy has been made centrally, but is implemented at a local government level and this is an important feature. The paper considers the interaction of performance management with other policy features, such as devolved power, New Labour, regionalization, partnership, and an emphasis on evidencing implementation. The findings indicate that the performance management of the strategies by the centre has developed and increased over time, but that this is perceived as a necessary evil; without it the drug strategy would not be so well understood or supported at the centre. Thus, the implication is that drug services would not have been so well funded and drug treatment would not have improved.

Borrelli B. Smoking cessation: Next steps for special populations research and innovative treatments. (review). Journal of Consulting and Clinical Psychology 78(1): 1-12, 2010. (115 refs.)

Objective: The current introductory article provides the rationale for the special section on understudied smokers and innovative treatments. This article proposes a definition of "special populations" of smokers, outlines a priori criteria by which to judge whether an intervention should be adapted for these smokers, and delineates a process by which cultural adaptation of an intervention can be achieved. Next steps for innovative, theory-based treatments with special populations and with general populations of smokers are discussed. Method: Special populations of smokers are defined as having (a) >10% higher smoking prevalence than the general population of smokers, (b) disproportionate tobacco-related health disparities, (c) less access to treatments, and (d) a lack of prospective, longitudinal treatment trials. Results: Cultural adaptation of evidenced-based treatments (EBTs) for underserved smokers should be applied more widely, outside the bounds of race and ethnicity, but also judiciously, following several a priori criteria. Cultural adaptation may be justified if the target population differs from the general population in (a) rates and patterns of smoking, (b) burden of tobacco-related health diseases, (c) predictors of smoking behavior, (d) risk factors for treatment failure, (e) protective factors that facilitate quitting, (f) treatment engagement, (g) treatment response, and (h) perceived social validity of the EBT. Once these criteria are met, four phases of cultural adaptation of an EBT for the target population are proposed. Innovative treatments need to be developed that use novel channels and linkages between channels; test novel theories or build on mechanisms research to more accurately pinpoint targets of change; and increase consumer demand for EBTs. Conclusion: The process of cultural adaptation should be thoughtfully conducted with a priori definitions and criteria as well as standardized processes. Coupled with innovative, theory-based treatments, these considerations could help to jump-start stalled smoking cessation rates.

Colon RM; Deren S; Guarino H; Mino M; Kang SY. Challenges in recruiting and training drug treatment patients as peer outreach workers: A perspective from the field18. Substance Use & Misuse 45(12): 1892-1908, 2010. (18 refs.)

Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.

Corredoira RA; Chilingerian JA; Kimberly JR. Analyzing performance in addiction treatment: An application of data envelopment analysis to the state of Maryland system. Journal of Substance Abuse Treatment 41(1): 1-13, 2011. (45 refs.)

The pressure is on to measure performance and to increase accountability in health care in general and in addiction treatment in particular. The pressure in the world of addiction treatment comes in large measure from the limited resources that are available in relation to the very large numbers of potential patients. Using data on 161 clinics in the state of Maryland, this article illustrates how data envelopment analysis (DEA), a methodology used widely in other settings, can be used to measure the performance of addiction treatment clinics and can help to identify appropriate benchmarks for clinics wishing to improve their performance. The potential utility of DEA is not only limited to the analysis of state networks but extends to analyses of organizations that have a number of treatment locations. However, its full potential at the national and state levels will only be realized when state-level uniform data sets become available.

Crevecoeur-MacPhail D; Bellows A; Rutkowski BA; Ransom L; Myers AC; Rawson RA. "I've been NIATxed": Participants' experience with process improvement. Journal of Psychoactive Drugs Supplement 6: 249-259, 2010. (12 refs.)

Process improvement strategies provide industries with a method for improving outcomes and performance at a low cost and with minimal training. In Los Angeles County, two process improvement projects were implemented as a way to improve access to, and engagement and retention in, alcohol and other drug abuse treatment. A qualitative evaluation was completed after the Phase 11 pilot project to assess how the providers felt about the project, what worked, what did not work, what was learned, and the degree to which process improvements changed program operations. Semistructured interviews were conducted with 33 individuals, representing every level of staff participation in the project. Overall, comments indicated a positive experience for staff, administrators, and clients. Providers noted the relative ease of implementation and how quickly changes resulted in impressive improvements. Challenging issues included resistant staff or a lack of additional resources to pay for the project; however, most noted that these issues were resolved. Interview participants also requested more training on data collection and a reduction in the frequency of the project conference calls. This study gives support to the idea of process improvement being a tool that dramatically improves services to consumers of addiction treatment services.

Dryden E; Hyde J; Livny A; Tula M. Phoenix Rising: Use of a participatory approach to evaluate a federally funded HIV, Hepatitis and substance abuse prevention program. Evaluation and Program Planning 33(4): 386-393, 2010. (25 refs.)

This paper highlights the value of utilizing a participatory evaluation approach when working with community agencies receiving federal funding for prevention and intervention services. Drawing from our experience as evaluators of a SAMHSA-funded substance abuse, HIV and Hepatitis prevention program targeting homeless young adults, we describe the importance of and strategies for creating a participatory evaluation partnership with program implementers. By participatory evaluation we mean the active involvement of program implementers in defining the evaluation, developing instruments, collecting data, discussing findings, and disseminating results. There are a number of challenges faced when using this approach with federally funded programs that require the use of standardized measurement tools and data collection procedures. Strategies we used to strike a balance between federal requirements and local needs are presented. By increasing the understanding of and participation in the evaluation process, program implementers have greater support for data collection requirements and are appreciably more interested in learning from the evaluation data. This approach has helped to build the capacity of a program and stimulated new possibilities for learning, growing, and ultimately improving the services offered to those the program strives to reach.

Edwards JR; Knight DK; Broome KM; Flynn PM. The development and validation of a transformational leadership survey for substance use treatment programs. Substance Use & Misuse 45(9): 1279-1302, 2010. (70 refs.)

Directors in substance use treatment programs are increasingly required to respond to external economic and socio-political pressures. Leadership practices that promote innovation can help offset these challenges. Using focus groups, factor analysis, and validation instruments, the current study developed and established psychometrics for the Survey of Transformational Leadership. In 2008, clinical directors were evaluated on leadership practices by 214 counselors within 57 programs in four U. S. regions. Nine themes emerged: integrity, sensible risk, demonstrates innovation, encourages innovation, inspirational motivation, supports others, develops others, delegates tasks, and expects excellence. Study implications, limitations, and suggested future directions are discussed.

Fields D; Blum TC; Roman PM. An exploratory study of alternative configurations of governing boards of substance abuse treatment centers. Journal of Substance Abuse Treatment 41(2): 156-168, 2011. (43 refs.)

Boards of directors are the ultimate governing authorities for most organizations providing substance abuse treatment. A governing board may establish policies, monitor and improve operations, and represent a treatment organization to the public. This article explores alternative configurations of governing boards in a national sample of 500 substance abuse treatment centers. The study proceeds from the premise that boards may be configured with varying levels of engagement in five aspects of internal management and external connections in treatment center operating environments. Based on interviews with treatment center administrative directors, four clusters emerge, describing boards that are (a) active and balanced across internal and external domains, (b) active boundary spanners concentrating primarily on external relationships, (c) focused primarily on internal organizational management, and (d) relatively inactive. In post hoc analysis, we found that placement in these clusters is associated with treatment center attributes such as rate of growth and financial results, use of evidence-based practices, and provision of integrated care.

Fields D; Roman PM. Total quality management and performance in substance abuse treatment centers. Health Services Research 45(6, Part 1): 1630-1650, 2010. (42 refs.)

Objective: To examine the relationship of organizational characteristics of substance abuse treatment centers with their use of quality management practices (total quality management [TQM]) and the contribution of TQM use to a center's provision of comprehensive care and to use of evidence-based treatment practices. Data Sources: Data were collected from a national sample of over 700 private and public substance abuse treatment centers in the National Treatment Center Study. Study Design: The design was a cross-sectional field study. The key variables were three TQM practices, the provision of comprehensive treatment services, and the implementation of evidence-based treatment practices. Numerous organizational characteristics were controlled. Data Collection: The data were obtained through interviews with administrative directors and clinical directors of the treatment centers in 2002-2004. Principal Findings: In multivariate models, TQM practices were positively related to provision of comprehensive care and use of evidence-based practices. A limited set of organizational characteristics predicted the use of TQM practices. Conclusions: Substance abuse treatment centers' implementation of TQM processes may be positively related to the quality and cost-effectiveness of care provided.

Fujimoto K; Valente TW; Pentz MA. Network structural influences on the adoption of evidence-based prevention in communities. Journal of Community Psychology 37(7): 830-845, 2009. (47 refs.)

This study examined the impact of key variables in coalition communication networks, centralization and density, on the adoption of evidence-based substance abuse prevention. Data were drawn from a network survey and a corresponding community leader survey that measured leader attitudes and practices toward substance abuse prevention programs. Two types of coalition networks were measured: advice-seeking and discussion relations. For each community, we computed network-level measurements (n = 20), and then used multiple linear regression. Results showed that adoption outcomes were associated with a decrease in centralization for the advice network and an increase in centralization for the discussion network, controlling for density. This suggests that community coalitions might consider decreasing their network density in such a manner that distributes power and influence among a broader base of coalition members to seek advice about programs while simultaneously discussing these programs in a more concentrated group to facilitate decisions about which programs to adopt.

Guerrero EG. Managerial capacity and adoption of culturally competent practices in outpatient substance abuse treatment organizations. Journal of Substance Abuse Treatment 39(4): 329-339, 2010. (51 refs.)

The field of cultural competence is shifting its primary emphasis from enhancement of counselors skills to management organizational policy and processes of care This study examined managers' characteristics associated with adoption of culturally competent practices in the nation's outpatient substance abuse treatment field Findings indicate that in 1995, supervisors cultural sensitivity played the most significant role in adopting practices, such as matching counselors and clients based on race and offering bilingual services Staff's exposure to cross-cultural training increased from 1995 to 2005. In this period positive associations were found between managers cultural sensitivity and connection with the community and staff receiving cross-cultural training and the number of training hours completed. However, exposure to and investment in this training were negatively correlated with managers' formal education. Health administration policy should consider the extent to which the decision makers education, community involvement and cultural sensitivity contribute to building culturally responsive systems of care.

Henggeler SW. Efficacy studies to large-scale transport: The development and validation of multisystemic therapy programs. Annual Review of Clinical Psychology 7(351-381), 2011. (103 refs.)

The 35-year progression of multisystemic therapy (MST) from modest university-based efficacy studies to large-scale transport to community practice settings is described in this review. The success of early efficacy research led to effectiveness trials, and their success in decreasing rates of youth rearrest and incarceration led to multisite transportability trials and adaptations of the MST model for treating youth presenting other types of challenging clinical problems. To support the transport of MST programs to community settings, an intensive quality improvement system modeled after that used in clinical trials has been implemented in community-based MST programs for the past 15 years. With the association between therapist treatment fidelity and youth outcomes well established, transportability research has demonstrated the significant roles played by clinical supervisors, expert consultants, and provider organizations in supporting therapist adherence and youth outcomes. This body of work has been facilitated by federal and state initiatives to support evidence-based services.

Herbeck DM; Gonzales R; Rawson RA. Performance improvement in addiction treatment: Efforts in California. Journal of Psychoactive Drugs Supplement 6: 261-268, 2010. (12 refs.)

This article examines performance data improvement efforts among alcohol and other drug (AOD) county and program stakeholders within California's publicly-funded treatment system. County AOD system administrators from approximately two-thirds of California counties (N = 37) and a random sample of treatment program managers (N = 63) were surveyed about practices and priorities related to using performance data to improve service delivery. Survey results showed that over half (56.8%) of the county administrators reported using performance and/or outcome measures to guide decision-making about the treatment programs with which they contract. Measures of treatment engagement and retention were most frequently reported as high priorities for performance data collection. Treatment providers reported considerable variation with their use of performance measures to improve practices. Overall, findings from this study suggest that many programs and counties are taking steps toward adopting practices of performance measurement and management for treatment improvement, although they still require assistance and support in establishing, collecting, and using performance data.

Knight DK; Broome KM; Edwards JR; Flynn PM. Supervisory turnover in outpatient substance abuse treatment. Journal of Behavioral Health Services & Research 38(1): 80-90, 2011. (43 refs.)

Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the word missing. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover.

Lin CQ; Wu ZY; Rou KM; Yin WY; Wang CH; Shoptaw S et al. Structural-level factors affecting implementation of the methadone maintenance therapy program in China. Journal of Substance Abuse Treatment 38(2): 119-127, 2010. (47 refs.)

This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented.

MacCoun RJ. The implicit rules of evidence-based policy analysis, updated. (editorial). Addiction 105(8): 1335-1336, 2010. (4 refs.)

Matthews H; Kelly PJ; Deane FP. The dual diagnosis capability of residential addiction treatment centres: Priorities and confidence to improve capability following a review process. Drug and Alcohol Review 30(2): 195-199, 2011. (8 refs.)

Introduction and Aims. The Dual Diagnosis Capability of Addiction Treatment (DDCAT) index is used to assess the capacity of substance abuse services to work with individuals with co-occurring mental health problems. The current study aimed to: (i) examine the dual diagnosis capability of residential substance abuse programs in Australia; (ii) identify managers' perceptions regarding both priorities and confidence for change following the completion of the DDCAT; and (iii) to examine the usefulness of the DDCAT to residential substance abuse programs. Design and Methods. The DDCAT was completed across 16 residential substance abuse units. An external researcher administered and scored the DDCAT. A Unit Manager from each site completed the Comorbidity Priorities and Confidence Survey following the completion of the DDCAT review. This survey examined the usefulness of the DDCAT, and the unit's priorities to improve its capability, and confidence to improve its DDCAT score. Results. Across the services, program structure and staff training were the DDCAT domains that required the most improvement. While training was the highest endorsed priority area for improvement, program structure was the lowest priority. Overall the Unit Managers reported positive attitudes towards use of the DDCAT and were confident that their unit could improve their DDCAT scores. Discussion and Conclusions. DDCAT scores of Australian residential substance abuse programs are comparable with previous published results. However, there is still substantial work required to improve the capability of these programs. Future research should examine strategies to promote sustained improvements in the capability of residential substance abuse programs.

McConnell KJ; Hoffman KA; Quanbeck A; McCarty D. Management practices in substance abuse treatment programs. Journal of Substance Abuse Treatment 37(1): 79-89, 2009. (26 refs.)

Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the "business of addiction treatment." This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of "good" management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.

Olivet J; McGraw S; Grandin M; Bassuk E. Staffing challenges and strategies for organizations serving individuals who have experienced chronic homelessness. Journal of Behavioral Health Services & Research 37(2): 226-238, 2010. (43 refs.)

Hiring and retaining appropriate staff is essential for programs serving those who have experienced chronic homelessness. This paper describes specific staffing challenges and strategies from the Collaborative Initiative to Help End Chronic Homelessness (CICH), an 11-site, multi-agency Federal program designed to serve people experiencing chronic homelessness who also have a disabling condition such as substance use or mental health problems. This paper addresses approaches to staffing including team structures, staff supervision, and training. Challenges identified include low pay, high rates of burnout and turnover, limited time for supervision, and multiple staff training needs. This paper also explores specific staffing strategies based on the experience of the CICH sites, and concludes with implications for practice, research, and policy, including recommendations for ongoing staff training, suggestions for future mixed-methods research, and a call for an enhanced focus on strengthening the homeless services workforce.

Pedersen MU; Hesse M; Bloomfield K. Abstinence-orientated residential rehabilitation of opioid users in Denmark: Do changes in national treatment policies affect treatment outcome? Scandinavian Journal of Public Health 39(6): 582-589, 2011. (24 refs.)

Aims: Significant changes in the Danish drug-abuse treatment system occurred from 1998 to 2008, allowing the opportunity to study their impact on outcomes for opiate dependent patients. This paper examines whether such changes are related to possible changes in abstinence rates of two cohorts of drug users. Methods: We compared survival curves and the month-by-month probability of abstinence between cohorts of drug abusers who were followed for one year after treatment for opioid dependence in 1998 (n = 305) and in 2008 (n = 204). Of the 1998 cohort, 192 were interviewed face-to-face and 61 were found through national drug-abuse treatment registers. Of the 2008 cohort 112 were interviewed face-to-face and 42 were found through national drug-abuse treatment registers. Results: Survival curves did not differ between the two cohorts. After controlling for age and gender, people from the 2008 cohort had a higher frequency of month-to-month rates of abstinence. A higher proportion of clients received new treatment after their index treatment in 2008. Clients from the 1998 cohort who did not receive new treatment used drugs more often than clients who did not receive treatment in 2008. At the same time, the proportion of clients who received residential rehabilitation treatment for opiate dependence increased substantially by 2008. Conclusions: Total abstinence rates are highly consistent over time and seem to change little with changes in systems of care. However, changes in care that improve access to treatment may reduce the overall burden of opioid addiction to both individuals and society.

Rawson RA; Gonzales R; Crevecoeur-MacPhail D; Urada D; Brecht ML; Chalk M et al. Improving the accountability of California's public substance abuse treatment system through the implementation of performance models. Journal of Psychoactive Drugs Supplement 6: 211-214, 2010. (15 refs.)

Improving the care for individuals with substance use disorders is a national health policy priority. Like other parts of the health care system, the addiction field is under pressure for higher accountability-more efficient use of treatment resources, the delivery of quality services, and the production of positive client outcomes. This introductory article highlights the importance of the collection of articles being published in this special issue as they describe California's efforts toward making the alcohol and drug (AOD) treatment system more accountable and effective.

Rieckmann TR; Kovas AE; Cassidy EF; McCarty D. Employing policy and purchasing levers to increase the use of evidence-based practices in community-based substance abuse treatment settings: Reports from single state authorities. Evaluation and Program Planning 34(4): 366-374, 2011. (53 refs.)

State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical state-to-provider strategies aimed at accelerating use of evidence-based practices: purchasing levers (financial incentives and mechanisms) and policy or regulatory levers. A sample of 51 state representatives was interviewed. Single State Authorities for substance abuse treatment (SSAs) that fund providers directly or through managed care were significantly more likely to have contracts that required or encouraged evidence-based interventions, as compared to SSAs that fund providers indirectly through sub-state entities. Policy levers included EBP-related legislation, language in rules and regulations, and evidence-based criteria in state plans and standards. These differences in state policy are likely to result in significant state level variations regarding both the extent to which EBPs are implemented by community-based treatment providers and the quality of implementation.

Rutkowski BA; Rawson RA; Freese TE. Improving the addiction treatment system in California through the use of data and evidence-based practices California Substance Abuse Research Consortium (SARC) Meetings, 2009 Introduction. (editorial). Journal of Psychoactive Drugs Supplement 6: 207-210, 2010. (0 refs.)

Schoenwald SK; Hoagwood KE; Atkins MS; Evans ME; Ringeisen H. Workforce development and the organization of work: The science we need. Administration and Policy in Mental Health and Mental Health Services Research 37(1-2, special issue): 71-80, 2010. (40 refs.)

The industrialization of health care, underway for several decades, offers instructive guidance and models for speeding access of children and families to clinically and cost effective preventive, treatment, and palliative interventions. This industrialization --i.e., the systematized production of goods or services in large-scale enterprises --has the potential to increase the value and effects of care for consumers, providers, and payers (Hayes and Gregg in Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. Academic Press, San Diego, 2001), and to generate efficiencies in care delivery, in part because workforce responsibilities become more functional and differentiated such that individuals with diverse educational and professional backgrounds can effectively execute substantive clinical roles (Rees in Clin Exp Dermatol, 33, 39-393, 2008). To date, however, the models suggested by this industrialization have not been applied to children's mental health services. A combination of policy, regulatory, fiscal, systemic, and organizational changes will be needed to fully penetrate the mental health and substance abuse service sectors. In addition, problems with the availability, preparation, functioning, and status of the mental health workforce decried for over a decade will need to be addressed if consumers and payers are to gain access to effective interventions irrespective of geographic location, ethnic background, or financial status. This paper suggests that critical knowledge gaps exist regarding (a) the knowledge, skills, and competencies of a workforce prepared to deliver effective interventions; (b) the efficient and effective organization of work; and (c) the development and replication of effective workforce training and support strategies to sustain effective services. Three sets of questions are identified for which evidence-based answers are needed. Suggestions are provided to inform the development of a scientific agenda to answer these questions.

Sosin MR; Smith SR; Hilton T; Jordan LP. Temporary crises and priority changes: The case of state substance abuse systems. Journal of Public Administration Research and Theory 20(3): 539-575, 2010. (85 refs.)

Many doubts have been expressed about the capacity of states to administer federally supported social service programs. This article relies on institutional theory, punctuated equilibrium theory, and evidence from two states to analyze the way states administer the programs in times of fiscal crisis. The particular context is the fiscal crisis of the early 2000s in substance abuse programs. The analysis suggest that, during the crisis, state administrative authorities and the providers they funded refocused services on federal rather than local priorities. The states and providers also further integrated substance abuse services with the services of other programs and promoted managerial practices that seemed to loosen the match between services and clients. The findings point to some of the ways in which the states' capacities to respond to crises can be undermined by the national trend toward encouraging state discretion. Findings also reveal challenges for state-level crisis management.

Taxman FS; Henderson CE; Belenko S. Organizational context, systems change, and adopting treatment delivery systems in the criminal justice system. (editorial). Drug and Alcohol Dependence 103(Supplement 1): S1-S6, 2009. (46 refs.)

The correctional system does not include service provision as a primary goal, even though individuals in prison, jail, and on probation/parole have large unmet Substance abuse treatment needs. In response to mandates in the U.S. Constitution for basic health care, services are provided for incarcerated offenders, but generally do not include substance abuse treatment. The system does little to extend any type of health care service to individuals in community settings. This leaves the majority of offenders (6 million under community Supervision in the U.S.) basically unattended, even with substance abuse disorders that are four times greater than the general public. The challenge of adapting the correctional system to be part of all integrated service provision system - working in conjunction with the public and private community-based service delivery sector- has intrigued researchers and policy makers over the last two decades. A series of articles using data from the National Criminal Justice Treatment Practices Survey have examined factors that influence the adoption of a myriad of substance abuse treatment services for offender Populations in various settings. These articles explore the factors that affect adoption and implementation, and provide guidance on issues relevant to Organizational change and a dual mission Of correctional agencies to advance public safety and public health. This special issue of Drug and Alcohol Dependence is devoted to understanding organizational constructs and factors to improve health outcomes for offenders.

Thomas D; Johnston V; Fitz J. Lessons for Aboriginal tobacco control in remote communities: An evaluation of the Northern Territory 'Tobacco Project'. Australian and New Zealand Journal of Public Health 34(1): 45-49, 2010. (18 refs.)

Objective: To evaluate a Northern Territory (NT) government-led pilot 'Tobacco Project' in six remote communities. Methods: Monthly surveys of staff, semi-structured interviews with staff and community members, observation of the delivery of tobacco control interventions, review of Project documents, and monitoring of tobacco consumption using sales (or wholesale orders) of tobacco. Results: There was a substantive amount of tobacco control activity delivered in three of the Project communities. In two of these locations, the majority of work was primarily driven and undertaken by resident staff. Overall, most of the Project's efforts related to community education and awareness-raising. There was variable impact of the Project on tobacco consumption across the six communities. More tobacco control activity was consistently associated with a greater reduction in tobacco consumption. An important predictor of local activity was the presence of strong community drivers. A significant obstacle to the Project was the lack of new resources. Conclusions: Despite the minimal impact of this Project on tobacco consumption overall, there was a consistent association between on-the-ground tobacco control activity and reductions in tobacco consumption. Implications: New initiatives will not only need to provide new funding, but identify and then support local staff, who are central to improving local tobacco control activity and so reducing smoking and smoking-related illnesses and deaths.

Tsai J; Salyers MP; Rollins AL; McKasson M; Litmer ML. Integrated dual disorders treatment. Journal of Community Psychology 37(6): 781-788, 2009. (21 refs.)

Mental health programs are increasingly combining evidence-based practices to provide comprehensive services. Individuals with complex services needs, such as those dually diagnosed with mental illness and substance use disorders, are at high risk for numerous negative outcomes and may benefit from such comprehensive programs. This report describes the process and, outcomes of a program, that, formally Integrated assertive community treatment, supported housing, and integrated dual disorders treatment for a sample of clients with dual diagnoses. Over a 2-year period, this pilot program targeted 14 clients with 12 clients successfully transitioned out of a state hospital into the community. Results showed large reductions in hospitalization, homelessness, and incarceration, and increases in employment and later stages of treatment for substance abuse. This study demonstrates the potential of such an integrated program and points to areas for further research in housing services.

Vahabzadeh M; Lin JL; Mezghanni M; Epstein DH; Preston KL. Automation in an addiction treatment research clinic: Computerised contingency management, ecological momentary assessment and a protocol workflow system. Drug and Alcohol Review 28(1): 3-11, 2009. (26 refs.)

Introduction and Aims. A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients' treatment needs and to accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with the provision of seamless methods for exporting, mining and querying the data. Design and Methods. We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialised applications: the Automated Contingency Management (ACM) system for the delivery of behavioural interventions, the transactional electronic diary (TED) system for the management of behavioural assessments and the Protocol Workflow System (PWS) for computerised workflow automation and guidance of each participant's daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorised staff. Results. ACM and the TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80 patient capacity, having an annual average of 18 000 patient visits and 7300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarise participant safety data for research oversight. Discussion and Conclusions. When developed in consultation with end users, automation in treatment research clinics can enable more efficient operations, better communication among staff and expansions in research methods. [Vahabzadeh M, Lin J-L, Mezghanni M, Epstein DH, Preston KL. Automation in an addiction treatment research clinic: Computerised contingency management, ecological momentary assessment and a protocol workflow system.

Vilardaga R; Luoma JB; Hayes SC; Pistorello J; Levin ME; Hildebrandt MJ et al. Burnout among the addiction counseling workforce: The differential roles of mindfulness and values-based processes and work-site factors. Journal of Substance Abuse Treatment 40(4): 323- 335, 2011. (97 refs.)

Although work-site factors have been shown to be a consistent predictor of burnout, the importance of mindfulness and values-based processes among addiction counselors has been little examined. In this study, we explored how strongly experiential avoidance, cognitive fusion, and values commitment related to burnout after controlling for well-established work-site factors (job control, coworker support, supervisor support, salary, workload, and tenure). We conducted a cross-sectional survey among 699 addiction counselors working for urban substance abuse treatment providers in six states of the United States. Results corroborated the importance of work-site factors for burnout reduction in this specific population, but we found that mindfulness and values-based processes had a stronger and more consistent relationship with burnout as compared with work-site factors. We conclude that interventions that target experiential avoidance, cognitive fusion, and values commitment may provide a possible new direction for the reduction of burnout among addiction counselors.

Wisdom JP; Ford JH; Wise M; Mackey D; Green CA. Substance abuse treatment programs' data management capacity: An exploratory study. Journal of Behavioral Health Services & Research 38(2): 249-264, 2011. (54 refs.)

Despite treatment improvement and performance management imperatives, little research describes the data management capacity of substance abuse treatment programs, and useful metrics are not available to gauge capacity. This exploratory study evaluates clinical and administrative data management at eight substance abuse treatment programs in four US states to identify factors for developing an appropriate metric. Findings indicate that programs tend to manage data inefficiently and have few protocols guiding information management. Barriers to better data management included lack of integrated information technology (IT) systems; limited funding, time, and staff for developing and implementing IT-related changes; and divergent staff skills in and attitudes toward IT. This snapshot of substance abuse treatment programs' data management capabilities suggests a need for a metric to examine data management capability in these settings. Infusion of expertise, training, and funding are needed to improve substance abuse treatment programs' IT-related systems and data management processes.

Woodruff SI; Candelaria JI; Elder JP. Recruitment, training outcomes, retention, and performance of community health advisors in two tobacco control interventions for Latinos. Journal of Community Health 35(2): 124-134, 2010. (25 refs.)

Community Health Advisors (CHAs) are indigenous lay health advisors who, with training, can create health awareness, disseminate health information and support behavior change in their communities. Little data are available that describe the characteristics, recruitment, training, retention, and performance of CHAs. The present study described the characteristics, recruitment process, training outcomes, retention activities, and performance of two sets of CHAs who delivered tobacco-related interventions in the local Latino community. The Tobacco Control in Latino Communities (TCLC) Center trained 35 CHAs to conduct either a smoking cessation program for Spanish-speaking adult smokers or a behavioral problem-solving intervention to reduce environmental tobacco smoke (ETS) exposure among low-income Latino children. Theoretical psychosocial constructs related to behavior change, general self-esteem, general self-efficacy, and demographics were collected from CHAs before and after training. Additional measures captured the level of professionalism exercised and effort undertaken by the CHAs, as well actual outcomes of their efforts. Of the 33 women and 2 men CHAs recruited, 86% were originally from Mexico, most had a high school education, most were married, and the average monthly household income was $1,100-$1,400. Mean participant age was 42 years, and level of acculturation was relatively low. There were changes in the desired direction pre-to-post training for both ETS and smoking cessation program CHAs for most of the psychosocial constructs. Expert ratings of CHA performance were good, and recipients of the CHAs' efforts showed positive changes in behavior. This information may aid in planning for recruitment and evaluation of CHAs for future tobacco control programs.

Wu F; Hser YI. Workforce professionalism in drug treatment services: Impact of California's Proposition 36. Journal of Substance Abuse Treatment 40(1): 44-55, 2011. (61 refs.)

This article investigates whether California's Proposition 36 has promoted the workforce professionalism of drug treatment services during its first 5 years of implementation. Program surveys inquiring about organizational information, Proposition 36 implementation, and staffing were conducted in 2003 and 2005 among all treatment providers serving Proposition 36 clients in five selected California counties (San Diego, Riverside, Kern, Sacramento, and San Francisco). A I-hour self-administered questionnaire was completed by 118 treatment providers representing 102 programs. This article examines five topics that are relevant to drug treatment workforce professionalism: resources and capability, standardized intake assessment and outcome evaluation, staff qualification, program accreditation, and information technology. Results suggest that Proposition 36 had a positive influence on the drug treatment workforce's professionalism. Improvements have been observed in program resources, client intake assessment and outcome evaluation databases, staff professionalization, program accreditation, and information technology system. However, some areas remain problematic, including, for example, the consistent lack of adequate resources serving women with children.

Zito R. Introduction: Moving forward to improve addiction treatment in California. (editorial). Journal of Psychoactive Drugs Supplement 6: 205-206, 2010. (0 refs.)