Martha A. Jessup

A Randomized Trial of Probation Case Management for Drug-Involved Women Offenders

This article reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to PCM (n = 92) or standard probation (n = 91) and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support, and service utilization. Arrest data were collected from administrative data sets. The sample included mostly African American and White women (age M = 34.7, education M = 11.6 years). Cocaine and heroin were the most frequently reported drugs of abuse, 86% reported history of incarceration, and 74% had children. Women assigned to both PCM and standard probation showed clinical improvement change over time on 7 of 10 measured outcomes. However, PCM group changes were no different than those observed for the standard probation group. Higher levels of case management, drug abuse treatment, and probationary supervision may be required to achieve improved outcomes in this population.

Unmet mental health and substance abuse treatment needs of sexual minority elders.

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55–64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Issues in Reproductive Health and Empowerment in Perinatal Women with Substance Use Disorders

&NA; This article describes perinatal drug dependent womens perspectives on pregnancy, contraception, knowledge of reproductive health, and communication with sexual partners. In this qualitative study, semi‐structured interviews were conducted with perinatal residential substance abuse treatment participants (n = 36) regarding their life experiences in the time just prior to drug treatment. Using an analytic framework to examine life dimensions, analysis of the biological and socio‐cultural dimensions and their effects was conducted and indicated that pregnancy and motherhood were motivational for women to enter treatment and to seek prenatal care. In addition, the data showed that the women were poorly informed about their reproductive health status and contraception, and experienced difficulty communicating about these issues with male partners. Recommendations for drug treatment and health care systems include strategies for: 1) expansion of womens “empowerment” in recovery to include knowledge and decision‐making skills regarding their reproductive health status and 2) development of cross‐disciplinary activities aimed at outreach, screening, and assessment of drug dependent women.

Smoking and Behavioral Health of Women

BACKGROUND Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. METHODS Using a convenience sample (n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. RESULTS One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. CONCLUSIONS Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for womens health.

Multi-Level Assessment Protocol (MAP) for Adoption in Multisite Clinical Trials

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is intended to test promising drug abuse treatment models in multisite clinical trials and to support adoption of new interventions into clinical practice. Using qualitative research methods we asked the following question: how might the technology of multisite clinical trials be modified to better support adoption of tested interventions? A total of 42 participants, representing eight organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and intervention adoption. Among eight clinics participating in the clinical trial, we found adoption of the tested intervention in one clinic only. Analysis of interview data revealed four conceptual themes likely to affect adoption and may be informative in future multisite clinical trials. Planning for adoption in the early stages of protocol development will better serve the aim of integrating new interventions into practice.

Evaluation of Probation Case Management (PCM) for Drug-Involved Women Offenders:

Based on availability of case management services, drug-involved women offenders entered either a probation case management (PCM) intervention(n = 65) or standard probation(n = 44). Participants were placed in the case management condition until all slots were filled, then placed in standard probation until case management slots opened. Participants were interviewed at program entry and at 6- and 12-month follow-up using measures of substance abuse, psychiatric symptoms, and social support. Results showed modest change over time in both conditions, but PCM did not result in more services or treatment, or better outcomes than standard probation. These findings are discussed in the context of study limitations and in the context of state initiatives like those in Arizona and California designed to apply treatment as an alternative to incarceration.

Organizational Change in a Perinatal Treatment Setting : Integration of Clinical Practice and Policies on Tobacco and Smoking Cessation

Abstract Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women. This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the programs clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-model ing for children.

The Place of Adoption in the NIDA Clinical Trials Network

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) was established in 1999 to determine effectiveness of drug abuse treatment interventions among diverse client populations and settings. To address dissemination of research findings, the CTN also has as its mission the transfer of research findings to treatment providers. In a qualitative study of adoption of evidence-based practice in the context of two CTN clinical trials, we interviewed 29 participants from seven organizational levels of the multisite study organization about post-trial adoption, their role in the clinical trial, and interactions between the research initiative and clinic staff and setting. Analysis of interview data revealed a range of opinion among participants on the place of adoption within the CTN. Innovation within the CTN to support adoption and further observational research on dynamics of adoption within the CTN can increase dissemination of evidence-based drug abuse treatment interventions in the future.

Validity and Reliability of the COJAC Screening Tool for Co‐occurring Disorders

This study explored the reliability and validity of a nine-item screening tool (Co-Occurring Joint Action Council [COJAC] Screening Tool [CST]) for co-occurring disorders (COD). Using a convenience sample (n=1,951), an online survey was conducted in multiple settings and included demographic questions, the CST, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), and the Posttraumatic Stress Disorder Checklist-Civilian version. The CST substance abuse (SA) scale performed well with a Cronbachs alpha of .84 and a correlation of .71 with GAIN-SS SA (past year). The CST mental health and trauma items did not perform well as scales with Cronbachs alphas of .64 and .56, respectively. The CST-SA is a short, reliable, and valid measure of SA. Further study is needed to determine the best evaluation tool for the mental health portion of the COD screening instrument.