Ivy Krull

The Affordable Care Act: New Opportunities for Social Work to Take Leadership in Behavioral Health and Addiction Treatment

An estimated 23 million individuals in the United States meet criteria for a diagnosis of substance abuse or dependence; however, only about 4 million people enter treatment each year. The Patient Protection and Affordable Care Act (ACA) is likely to increase access to addiction treatment through the integration of behavioral health and health care services. However, this integration effort is at risk of excluding the most vulnerable population groups with substance use disorders. Further, key health and government agencies report an urgent need for more health professionals to be trained in empirically supported methods for screening and treating patients for abuse and dependence of alcohol and other drugs. The implementation of an integrated care model is threatened by the shortage of social workers who are sufficiently trained in these methods. This article argues that in this era of implementing the ACA, it is key that social workers not only become leaders in the addiction health services research field but also translate their knowledge to social work practice. Further, the article presents research on the Swedish addiction treatment system as a model of an alternative system in which social workers fill a central role in implementing a coordinated care model.

Organizational readiness for change in community-based addiction treatment programs and adherence in implementing evidence-based practices: a national study

UNLABELLED Prior studies by the authors identified that clinical staff who reported that their treatment unit had lower levels of organizational readiness to change experienced higher levels of barriers in implementing an evidence-based practice (EBP). The current study examined whether clinical staff perceptions of their treatment units organizational readiness to change were also associated with their adherence to EBP protocols during EBP implementation. Adherence was examined through a variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Multivariate regression analyses identified that clinical staff who had five or more years of addiction counseling experience, who rated staff in their organization as having higher levels of influence, who less frequently implemented new counseling interventions and who reported higher levels of barriers when implementing a newly funded EBP also reported that their program made more modifications to the EBP in the implementation process. Finally, staff who implemented MI compared to any other EBP reported lower levels of EBP modifications. IMPLICATIONS Continued federal funding is needed to enhance treatment unit organizational resources in order to reduce barriers and promote adherence to EBPs. Also, funders of treatment need to continue to provide ongoing technical assistance and training opportunities to promote implementation of EBPs with fidelity.

Attitudes Toward Evidence-Based Pharmacological Treatments Among Community-Based Addiction Treatment Programs Targeting Vulnerable Patient Groups

ABSTRACT A national sample of addiction treatment Program Directors (N = 296) were assessed regarding their attitudes about pharmacological treatment for addiction disorders. Multivariable analyses indicate that directors who worked in organizations affiliated with research institutions and who had more professional experience had significantly more positive attitudes about a range of pharmacological therapies. Also, directors in organizations serving higher percentage homeless clients and clients with severe and persistent mental illness had more negative attitudes toward use of buprenorphine. Community-based organizations providing addiction treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological evidence-based practices and may underutilize those practices.

Association Between Addiction Treatment Staff Professional and Educational Levels and Perceptions of Organizational Climate and Resources

BACKGROUND Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. METHODS The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associates degree, bachelors degree, masters degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. RESULTS Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their units organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. CONCLUSION It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.