Karen McKendrick

Modified therapeutic community for homeless mentally ill chemical abusers: treatment outcomes.

This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified therapeutic community programs (TC1 and TC2) and to a treatment-as-usual (TAU) control group. Follow-up interviews were obtained at 12 months postbaseline and at time F (on average more than 2 years postbaseline) on a retrieved sample of 232 (68%) clients and 281 (82%) clients, respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychological symptoms, and employment. Individuals in both modified TC groups showed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified TC2, with lower demands and more staff guidance, was superior to modified TC1. Completers of both TC programs showed significantly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients.

Benefit-cost analysis of a modified therapeutic community for mentally ill chemical abusers

Abstract This paper estimates and compares the economic benefits and costs of modified therapeutic community (modified TC) treatment for homeless mentally ill chemical abusers (MICAs) relative to a ‘treatment-as-usual’ (TAU) comparison group. Data from the period 12 months pre-admission to the modified TC were compared to data from 12 months post-admission across three outcome categories: employment, criminal activity, and utilization of health care services. The economic cost of the average modified TC treatment episode was

Modified therapeutic community for mentally ill chemical abusers: outcomes and costs.

20,361. The economic benefit generated by the average modified TC client was

Modified Therapeutic Community Treatment for Offenders with MICA Disorders: Substance Use Outcomes

305,273. The incremental economic benefit per modified TC client (relative to TAU) was

A Randomized Clinical Trial of a Therapeutic Community Treatment for Female Inmates: Outcomes at 6 and 12 Months After Prison Release

273,698, resulting in a net benefit per modified TC client of

Prison Therapeutic Community Treatment for Female Offenders: Profiles and Preliminary Findings for Mental Health and Other Variables (Crime, Substance Use and HIV Risk)

253,337 and a benefit–cost ratio of 13:1. Adjusting for extreme outlier observations, the incremental economic benefit estimate was

Randomized trial of a reentry modified therapeutic community for offenders with co-occurring disorders: Crime outcomes

105,618, net benefit was

SEQUENTIAL ASSIGNMENT AND TREATMENT-AS-USUAL Alternatives to Standard Experimental Designs in Field Studies of Treatment Efficacy

85,257, and the benefit–cost ratio was 5.2. These results quantify the potential economic and social advantages of the modified TC approach and highlight the policy implications of modified TC programs for homeless MICAs. This study is the first comprehensive economic evaluation of TC treatment for homeless MICAs; future research can draw from the economic analysis methods outlined here to apply to larger samples, longer follow-up periods, and other treatment settings.

Modified Therapeutic Community for Homeless Mentally Ill Chemical Abusers: Emerging Subtypes*

Several studies have established that the personal and social consequences of substance abuse are extensive and costly. These consequences are frequently compounded by mental illness. Although interventions that target mentally ill chemical abusers (MICAs) present several challenges, the potential benefits of successful interventions are significant. This article presents outcomes and costs of a modified therapeutic community (TC) intervention for homeless MICAs. Outcomes at follow-up are compared with those for a control group of homeless MICAs receiving standard services in a “treatment-as-usual” (TAU) condition. Annual economic costs for the modified TC and the average weekly cost of treating a single client are estimated. Treatment and other health service costs at 12 months postbaseline are compared for modified TC and TAU clients. The results of this study indicate that, suitably modified, the TC approach is an effective treatment alternative for homeless MICAs, with the potential to be highly cost-effective relative to standard services.

Outcomes from a therapeutic community for homeless addicted mothers and their children.

Correctional systems nationwide have increasingly turned to therapeutic community (TC) programs for the treatment of addiction in prisons. TC treatment, with modifications, has shown considerable promise in treating offenders who have co-occurring mental and substance use disorders, a group that has a mounting prevalence in prison populations. This article reports data from a study that randomly assigned male inmates with mental illness and chemical abuse (MICA) disorders (n = 139) to either a Modified TC (MTC) or a comparison group. Analyses revealed that the MTC group had significantly greater declines in alcohol and drug use at 12-months post-prison release. Additional analysis related positive substance use outcomes to reduced contact with the justice system and self-reported criminal activity. Implications for treatment and policy are discussed.