Ezra Ochshorn

Recovery orientation of treatment, consumer empowerment, and satisfaction with services: a mediational model.

OBJECTIVE This study explores the relationship between the recovery orientation of treatment and subjective experiences of consumer empowerment and satisfaction with services for individuals with severe and persistent mental illness. METHODS Instruments measuring perceptions of empowerment, recovery orientation of treatment, and satisfaction with services were administered to 45 participants enrolled in two demographically similar mental health treatment programs in Tampa, Florida - a community mental health center and an Assertive Community Treatment team. Analyses were conducted according to traditional mediation models. Empowerment was expected to mediate the relationship between the recovery orientation of treatment and consumer satisfaction with services. RESULTS A recovery-based treatment orientation significantly predicted both consumer empowerment and satisfaction with services. Empowerment mediated the relationship between treatment orientation and consumer satisfaction. CONCLUSIONS These preliminary findings highlight the impact of the recovery orientation of treatment on empowerment and satisfaction with services among individuals with severe and persistent mental illness.

Implementing the Comprehensive, Continuous, Integrated System of Care Model for Individuals with Co-Occurring Disorders: Preliminary Findings from a Residential Facility Serving Homeless Individuals

ABSTRACT This study assessed the effectiveness of an evidence-based treatment model for homeless individuals with co-occurring diagnosed mental health and substance use disorders. The model, Comprehensive, Continuous, Integrated System of Care (CCISC), has been recognized by the Substance Abuse and Mental Health Services Administration as one of the best treatment protocols in the United States (Minkoff & Cline, 2004). During residential treatment, clients received medical care, counseling, psychiatric/psychological evaluation, recreational and vocational services, as well as comprehensive discharge planning. All 76 participants were administered measures assessing housing and employment status, as well as mental health symptomatology and levels of substance use at both baseline and six-month follow-up. Analyses revealed significant improvement in all assessment categories at six-month follow-up as well as client satisfaction with the program. The Comorbidity Program Audit and Self-Survey for Behavioral Health Services (COMPASS), a standardized measure to assess fidelity to the CCISC model, was utilized annually and indicated that the CCISC principles of care were being implemented as intended. These results underscore the effectiveness of an evidence-based model for treating clients with co-occurring mental health and substance use disorders.

Relationship between Trauma and Risky Behavior in Substance-Abusing Parents Involved in a Family Dependency Treatment Court

This exploratory study examined participants in a Family Dependency Treatment Court (FDTC), designed for substance-abusing parents whose children were removed from the home. Twenty-five participants were interviewed one year after FDTC enrollment to assess retrospectively the relationship between trauma history and risky behaviors. Treatment compliance rates were found to be high, and most participants had negative urinalysis results. Qualitative analyses revealed that approximately half of the participants attributed decreases in risky behaviors to the FDTC program. This study increases understanding of the effect of substance abuse and trauma on high-risk behaviors and might help to improve services for substance-abusing parents involved in the child welfare system. Finally, the future success of reducing child abuse and neglect and parental substance use could hinge on the partnership between judicial and substance abuse treatment through FDTCs. Findings from this exploratory pilot study should be replicated with more representative and larger samples.

A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders

ABSTRACT This study examined the effectiveness of the Comprehensive, Continuous, Integrated System of Care (CCISC) model in addressing co-occurring mental health and substance use disorders. Clients were eligible for participation if they had co-occurring disorders and were homeless or at risk of homelessness. Forty-eight clients received a comprehensive array of services consistent with the CCISC model. Measures assessing housing, employment, mental health, and substance use were completed at baseline, 6-month, and 12-month follow-up. Results demonstrated significant improvements in housing, employment, mental health, and substance use at 12-month follow-up. These results underscore the effectiveness of implementing evidence-based care.

An Alcohol Policy Evaluation of Drinking and Driving in Hillsborough County, Florida

Driving under the influence (DUI) is a serious crime that contributes to approximately 9% of traffic-related crashes, injuries, and fatalities in the state of Florida. Specifically, Hillsborough County, which includes Tampa, has the highest rate of DUI-related occurrences in the state of Florida. There are several gaps in policy, enforcement, and treatment that need to be addressed before Hillsborough County can shed this dubious distinction. To this end, 15 key stakeholders involved in alcohol policy were interviewed about law enforcement, judicial, and treatment issues. Several obstacles to reducing DUI crime emerged: inadequate case preparation time, case overload, prosecution challenges such as leniency and inconsistency in sentencing, and the need for more collaboration between law enforcement, the judicial system, and treatment providers. Suggested recommendations included the addition of a DUI court, stricter legal and treatment requirements, and mandatory blood testing.

Risk for Suicide among Medicaid Beneficiaries

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high mental health service use. Among Medicaid enrollees not receiving SSI, strongest suicide predictors were mental health hospitalization, high expenditures for physical health medications, and involuntary psychiatric examination. Findings suggest reducing involuntary psychiatric examinations and mental health hospitalizations while improving physical health may reduce suicide in the Medicaid population. Comprehensive hospital discharge planning, adherence monitoring with follow-up care, training mental health providers in assessing suicide lethality, and providing adequate assessment time are all crucial to achieve these objectives.