James R. Ciesla

Relapse Patterns among Adolescents Treated for Chemical Dependency

This study examined levels, timing, and patterns of posttreatment alcohol and drug use in adolescents (n = 113) during the 12 months following completion of primary treatment. Data were collected from clinical records, random urine screens, and interviews with the adolescents and their parents. In all, 61.1% relapsed to pretreatment levels of use during the 12 months after treatment, 79.6% of the males and 59.3% of the females. Of those with alcohol as the drug of dependence, 45.9% relapsed to pretreatment levels of use in 12 months. Likewise, 75.0% marijuana users, 70.6% combined alcohol and marijuana users, and 50.2% other drug users relapsed to pretreatment levels of use in the 12 months. Relapse curves are presented to demonstrate the specific timing and patterns of relapse. Implications for primary treatment and aftercare are discussed.

Nonresponse Bias in Adolescent Substance Abuse Treatment Outcomes Research: Implications for Evaluating Care.

ABSTRACT Nonresponse bias was investigated in an outcomes study of adolescent substance abuse treatment. Treatment-related characteristics of respondents (n = 53) were compared with those of non respondents (n = 61). Statistical analysis showed that few differences were seen between respondents and nonrespondents. The results indicate that outcomes data can be collected in this treatment population that are relatively unaffected by nonresponse bias. Missing responses are shown to be very likely missing at random.

Rasch Analysis of the Lubben Social Network Scale–6 (LSNS-6)

The purposes of this article are to review the psychometric properties of the Lubben Social Network Scale–6 (LSNS-6) and to determine its utility in assessing social networks of an older adult community sample. We tested the LSNS-6 with Rasch methodology using a sample of 196 older adults, aged 55 and above who live in public and subsidized housing facilities. Rasch analysis showed unidimensionality of the overall scale, high person and item reliability, and good fit of individual items with one exception. Principal component analysis (PCA) of Rasch model residuals suggested family and friend subdimensions. Response categories demonstrated improvement when six categories were collapsed to four. A person-threshold map indicated ceiling and floor effects due to lack of items measuring less and more developed social networks. Recommendations provided in this article can make the LSNS-6 more psychometrically sound and useful in research and practical contexts.

Validation of a Targeted Peer Relations Scale for Adolescents Treated for Substance Use Disorder: An Application of Rasch Modeling

The objective of this research is to use item response theory (IRT) to validate a 14-item peer relations scale for use in the adolescent treatment population. Subjects are 509 adolescents discharged from substance abuse treatment from 2004–2009. The person reliability is 0.76 and the Cronbachs alpha person raw score reliability is 0.93 both indicating the scale is a strong metric. The item reliability of 0.99 is high showing the model is reliable. The real separation (8.49) meaning items are placed on the Rasch “ruler” with about eight levels of importance identified. The mean-square statistics of the infit and outfit values were between 0.5 and 1.5 for the items indicating a low level of randomness and thus unidimensionality of the scale. Inspection of a Wright Item Map shows the hierarchical structure of the scale with a moderate degree of inter-item spread. The analysis shows the scale is a reliable unidimensional metric.

Findings from a Demonstration Outreach Project at a Community Health Center

Outreach using personal contact was a cornerstone of the federally funded Community Health Center (CHC) movement of the 1960s. Funding cuts and changes in federal policy have led to the discontinuation of this activity in most CHCs. This paper assesses aspects of a demonstration outreach project designed to encourage use of a CHC in Orangeburg, South Carolina. The evaluation shows that this type of outreach effort, which includes door-to-door canvassing, can identify specific needs for primary health care services in a poor under served community, and can enhance community access to Medicaid, although the financial impact of bringing poor patients into CHCs by means of this type of outreach is relatively low.

Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

PURPOSE The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. METHODS The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. RESULTS A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of

Peer relations scale for adolescents treated for substance use disorder: a factor analytic presentation

2.675 million, or

Hypertension in Community-Dwelling Elders from a Statewide Study: Implications for Nonpharmacologic Therapy

5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. CONCLUSIONS Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more.

The Role of the Medical Care Advisory Committee in the Administration of State Medicaid Programs A TWenty-Year Perspective

BackgroundThe literature indicates that peer relations are an important aspect of the treatment and recovery of adolescents with substance use disorder (SUD). Unfortunately, no standard measure of peer relations exists. The objective of this research is to use exploratory factor analysis to examine the underlying factor structure of a 14-item peer relations scale for use in this treatment population.MethodsParticipants are 509 adolescents discharged from primary substance abuse treatment from 2003–2010. The data are from research conducted between six and twelve months post discharge via a 230-item questionnaire that included the 14-item peer relations scale. The scale has questions that assess the degree to which the adolescents social contacts conform to norms of positive behavior and therefore foster non-use and recovery. The response rate was 62%.ResultsThe scale was decomposed by principal component factor analysis. When the matrix was rotated by varimax a three factor solution explaining 99.99% of the common variance emerged. The first factor yielded ten items that measure association with peers who engage in positive versus delinquent social behavior (positive versus negative social behavior). The three items in the second factor specify association with peers who use versus those who don’t use drugs, and thereby encourage recovery and discourage drug use (drug use). The third and factor contained two items measuring the degree to which the recovering adolescent associates with new or previous friends (post treatment peer association).ConclusionsThis scale is useful as a standard measure in that it begins to identify the measurable dimensions of peer relations that influence sustaining post treatment recovery.

A Peer Support Scale for Adults Treated for Psychoactive Substance–Use Disorder: A Rasch Analysis

This study used multivariate analysis to determine the sociodemographic variables that predict whether hypertensive elders who are aware of their disease deliberately make lifestyle modifications aimed at controlling their hypertension. The data are from the 1990 Panel Study of Older South Carolinians (n = 6,473). The researchers performed five separate logistic regressions, each to predict the odds that the elders made specific lifestyle changes to reduce their hypertension. The dependent variable in the first regression was 1 = quit smoking to reduce hypertension and 0 = did not quit smoking to reduce hypertension. Changing diet, exercising, taking medication, and using stress management techniques were the dependent variables in the second, third, fourth, and fifth regressions, respectively. Significant determinants included age, gender, marital status, socioeconomic status, previous medical history, and social participation. This paper discussed implications for prevention programs.