Jeanne C. Marsh

Female Clients in Substance Abuse Treatment

This paper reviews recent research on sex differences in the nature of alcohol and drug problems, use of treatment services, and the role of treatment and extratreatment factors in influencing these problems. Although patterns of use are different for men and women, responses to traditional treatment programs have not been different. Research suggests that programs providing ancillary services designed to meet the particular needs of women, such as child care, and those involving other family members and significant others hold the greatest promise for women with drug and alcohol problems.

Need-service matching in substance abuse treatment: Racial/ethnic differences

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.

Practitioner Expertise in Evidence-Based Practice Decision Making

Evidence-based practice (EBP) is an orientation to practice that values evidence as a resource for clinical decision making while recognizing that evidence alone is never sufficient to make a clinical decision. Critics of EBP typically ignore, negate, or misrepresent the role of practitioner thinking processes and expertise in clinical settings. The authors believe that, far from being a mechanistic process that ignores practitioner expertise, reflection and critical thinking are essential to implementing EBP in real-world clinical practice. The purpose of this article is to provide guidance for how practitioners bring their expertise to bear when engaging in the process of EBP. The authors use a social work practice scenario to illustrate the application of practitioner expertise in each of the five steps of EBP.

Client-Provider Relationship and Treatment Outcome: A Systematic Review of Substance Abuse, Child Welfare, and Mental Health Services Research

This systematic review reports on the association of the client-provider relationship with service outcomes across 3 service sectors: substance abuse, child welfare, and mental health. The review includes 60 research reports meeting inclusion criteria: 25 in substance abuse, 7 in child welfare, and 28 in mental health. For each social service sector, we analyze the association of the client-provider relationship to intermediate and ultimate outcomes. In addition, we examine potential moderating mechanisms of rater type (i.e., client, provider, and observer) and treatment setting (i.e., inpatient, outpatient, other). Social services research increasingly seeks to identify the active elements that affect outcomes common to all interventions. Results suggest the client-provider relationship is a consistent predictor of client retention in treatment and a somewhat less-consistent predictor of ultimate outcome across the 3 service sectors. These results contrast with recent findings from the psychotherapeutic literature in which the client-provider relationship demonstrated a weaker association with treatment retention (measured as drop out) than with other outcome measures. Findings indicate a clear need to refine the conceptualization and measurement of key service mechanisms and outcomes, particularly in the area of child welfare given that services research is less developed in that sector. The discussion includes recommendations for future research, including the use of selection criteria to enable researchers to conduct formal meta-analyses and expand the moderational framework with additional moderator variables relevant to social service delivery.

A Sex-Roles Perspective on Drug and Alcohol Use by Women

Patterns of use and misuse of drugs and alcohol consistently have differed by gender. Men have exceeded women in the use of alcohol and illicit substances to such a degree that substance abuse has been seen as a male problem. Until recently, the meaning of these differential patterns and the problems of substance use and misuse by women has been virtually ignored. A decade ago, Hochschild (1973) noted that “most research in the social sciences is on male subjects; yet there are significantly different findings on males and females ... which are often ignored. As a corrective, most sex role research is on women.” This chapter offers another corrective. We believe that research in substance use and abuse has progressed so that we can go beyond describing women or describing differences between men and women to exploring what those differences tell us about substance abuse, about sex roles, and about the relationship between the two.

Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups.

This study examined gender differences within Black, Latino, and White subgroups in the utilization of comprehensive services and their relation to posttreatment substance use. Survey data were collected during the National Treatment Improvement Evaluation Study (NTIES), a prospective, longitudinal, multisite study of substance abuse treatment programs and their clients in the United States. The analytic sample consisted of 1,812 blacks (734 women and 1,078 men), 486 Latinos (147 women and 339 men), and 844 whites (147 women and 339 men) from 59 service delivery organizations. Results related to service utilization indicated that compared to men, women in all racial and ethnic groups needed and received more services targeted to their needs and reported more positive relations with service providers. Gender was a significant moderator of the relationship between service receipt and treatment outcomes for all racial and ethnic groups, but especially for the Latino subsample. Findings point to the need to consider race-specific gender differences in the development of culturally competent, comprehensive substance abuse treatment.

Gender Differences in Client-provider Relationship as Active Ingredient in Substance Abuse Treatment

The client-provider relationship is increasingly evaluated as an active ingredient in the delivery of substance abuse treatment services. This study examines gender differences in client-provider relationship as an important treatment ingredient affecting retention in treatment and reduced post-treatment substance use. The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of U.S. substance abuse treatment programs and their clients. Data on individual characteristics were collected at the pre-treatment interview; on client-provider relationship and services received at treatment exit; and on post-treatment drug use at 12 months post-treatment. The analytic sample consists of 3027 clients from 59 service delivery units (1922 men and 1105 women). Structural equation modeling (SEM) was used to assess the structural relations and causal connections between relationship and service variables and treatment outcome variables. Results indicate that a positive client-provider relationship is related directly to longer duration and reduced post-treatment drug use for the total sample and for men analyzed separately. For women, a positive client-provider relationship was related directly to treatment duration and only indirectly to reduced post-treatment drug use. The findings point to the significance of including client-provider relationship in service delivery models--both as a therapeutic element as well as an element facilitative of matching services to specific client needs.

EVALUATION OF HULL HOUSE TEEN PREGNANCY AND PARENTING PROGRAM

Abstract An institutional cohort design was used in the evaluation of the Hull House Adolescent Family Life Project, a program for pregnant and parenting teenagers located in two public housing projects in Chicago. In 4 years, 335 teenagers, extremely disadvantaged in terms of income and opportunities, participated in the program. Services were characterized by an emphasis on the acquisition of knowledge of parenting and child development. Services also emphasized health care and assistance with practical life problems. Study findings reveal the program achieved some of the gains found by other programs: Knowledge increases in the areas of sexuality, contraception, child development, and parenting. Although there was no detectable change in clientssexual activity, there was a significant increase in the numbers using birth control. The findings reveal change in the direction of more clients in-school and employed post program, but these changes were not statistically significant. Further, the fertility measure, number of repeat pregnancies in 1 year, was completely unaffected by the intervention. In considering which aspects of the program were most effective, counseling was the most important in influencing young women to avoid subsequent pregnancies. Assistance with health problems was particularly important for enabling young people to stay in school, employed, or in the labor force. Counseling and health services were strengths of the program, measured in terms of services most frequently delivered. Program participants expressed greatest dissatisfaction with the lack of job training, one of the weakest aspects of the program. Overall, the gains documented in this study are consistent with those found in evaluations of similar programs, and although modest, provide the basis for continued support and evaluation of programs for teenage parents.

The Impact of Comprehensive Services in Substance Abuse Treatment for Women With a History of Intimate Partner Violence

This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete ( p = .016) and family services (p = .023) in predicting substance use.

Response: From Fish and Bicycles to a Science of Social Work:

John Brekke challenges the field and profession of social work to define and develop the “science of social work”. This response to Brekkes paper identifies the premises undergirding a discussion of the science of social work related to (1) a definition of “science”; (2 ) an organizing principle for social work; (3) a recognition that the task is a dynamic and evolving one; and, (4) an understanding that the science of social work is a reflection on what we study and how we study it. The paper identifies a tripartite conceptual framework to guide the discussion of the science of social work, one that focuses on semantics, syntactics, and pragmatics. The paper asserts that critical reflection on the science of social work, disciplined by a framework such as the one proposed, is needed to advance the science of social work.