Mary R. Haack

Medication adherence among homeless patients: A pilot study of cell phone effectiveness

Purpose: We examined the feasibility of using cell phones to monitor medication adherence among homeless participants and collected data for research purposes. Data sources: Ten homeless individuals with a co‐occurring substance use and psychiatric disorders who were receiving psychopharmacologic treatment participated in the study. All psychopharmacologic treatment was provided by a psychiatric mental health nurse practitioner. Cell phones were provided to participants with unlimited phone service for 45 days. An automated telephone system was programmed to call participants daily for 30 days. All participant responses were reported to a computer and reviewed by study staff on a daily basis. Conclusions: The automated calls reached study participants 93% of days and, when reached, participants reported 100% adherence with the prescribed medication regimen. Exit interviews indicated strong support for the usefulness of the phone and the value of the call and survey as reminders to take their medication. No patients dropped out of this study. Implications for practice: This pilot study establishes the feasibility of using cell phones to monitor and manage medication regimens for hard‐to‐reach populations, such as the homeless with co‐occurring disorders. It also establishes that this technology would work for research data collection. Disclaimer The views expressed in this article do not represent the views of the Veterans Administration or the United States Government.

Impact of online counseling on drug use: a pilot study.

Purpose To examine the effect of online counseling abuse counseling on drug use among underserved patients. Methods Subjects were recruited from an Indian Reservation in Eagle Butte, South Dakota; a family court in Newark, New Jersey; a probation office in Alexandria, Virginia; and a co-occurring disorders treatment clinic in Washington, District of Columbia. Subjects were predominantly poor, undereducated, unemployed, court involved, or diagnosed with co-occurring psychiatric disorders. A total of 79 subjects volunteered to participate in the project. Subjects were randomly assigned to either a control group or an experimental group. The control and experimental groups were both issued an Internet-ready computer and 1 year of Internet service. Only the experimental group had access to online counseling intervention. Drug use was measured using a combination of self-usage reporting and supervised urine tests. Results Urine tests were available for 37% of subjects. Exit surveys containing self-reported usage were obtained from 54% of the subjects. Self-usage reports or urine test results were available from 70% of subjects. The difference of the rates of drug use in the control and experimental groups (as calculated from urine tests or through self-report) was not significantly different from zero, suggesting that online counseling had not led to a reduction in substance use. It is possible that the study lacked sufficient power to detect small differences in the rate of drug use in the experimental and control groups. Conclusions Additional research is needed to establish the efficacy of online counseling in hard-to-reach populations.

Promoting Early Intervention for Substance Use Disorders Through Interdisciplinary Education for Health Professionals

Substance use disorders (SUDs) impose enormous costs on individuals, families and public resources. Illegal drugs and alcohol are responsible for thousands of deaths each year, and contribute to the spread of communicable diseases such HIV and Hepatitis C, as well as some of the worst social problems in the United States, including child abuse, domestic violence and sexual assault. It is evident that in all areas of health care, untreated SUDs elevate the risk of complications and poor outcomes, and drive up the cost of health care.Despite a general agreement that SUDs are a leading cause of death, disability and disease, front-line health professionals are not trained to identify individuals with SUDs, assess their condition, intervene on their behalf, or refer them to treatment. Numerous studies demonstrate the effectiveness and cost effectiveness of activities intended to detect and intervene early with individuals with SUDs in health care settings (; ; ). Several forces either facilitate or inhibit ef...

Engaging Client's Family and Friends in Online Counseling

This paper describes how online counseling can be used to engage family members in the recovery of clients. The counselor guides the client and the family member separately through the stages of change, helping them commit to joint action. Each participant thinks through his/her concerns and the advantages of getting involved, each makes a specific commitment to working together under the guidance of the counselor. Finally each celebrates, with specific rituals, their decision to work together. Once the client and the family members commit to working together, the counselor guides them through the stages of change as a group. In the pre-contemplation stage, the family members are taught the goals of working together and the procedures to avoid dysfunctional conflict. In the contemplation phase, the client and the family members examine the shared environment and its links to target behavior. In the commitment to action stage, the client and the family members decide on specific changes in their shared environment. In the maintenance phase, the client and the family members analyze if the change has led to improvements. They analyze relapses and make additional cycles of improvement.

Facilitating Self-Management of Substance Use Disorders with Online Counseling: The Intervention and Study Design.

This paper describes a pilot study using online counseling for court-involved parents who have been charged with child abuse and neglect related to substance use. All families resided in the medically underserved area of Newark, New Jersey and were recruited from halfway houses and the Family Court. The sample consisted of 30 participants randomly assigned to control (n=15) and experimental (n=15) groups. Of the participants, 83% were Black, 13% were White, and 3% were Hispanic. The control group had access to usual face-to-face treatment at a local treatment center where typical court-ordered offenders were referred. Usual face-to-face treatment often involved being wait-listed for periods of months even for a detox bed. The experimental group had immediate access to the online counseling intervention. The online counseling software and the live counseling components of the intervention were developed with a stages of change theoretical framework. Preliminary findings show promise for the feasibility of online interventions for underserved populations.

Part II—Center for Health Policy and

Those programs that successfully navigate the funding maze and piece together exemplary programs do so with impressive ingenuity, sophistication, and financial and administrative resources. Model programs identified through case studies by the Center for Health Policy Research (CHPR) include Operation PAR (Parental Awareness and Responsibility) in St. Petersburg, Florida, and CSTAR (Comprehensive Substance Treatment and Rehabilitation Program), a Missouri state program. The funding of both programs is unique to the communities they serve. The CHPR presents its funding not as an example of treatment that should be replicated nationwide, as that may not be feasible, but as an example of creative uses of available financial resources (Tables 1 and 2).

New Funding Proposal Seeks to Study Substance Dependence Among Nurses

The issue of impaired nursing practice has been researched in a limited manner. Although recovering nurses participate in research studies, they represent only a limited population of those who have recovered and are willing volunteers. Factors studied in the few published investigations are highly variable by study; predisposing factors are difficult to identify in retrospect. Now the National Council of State Boards of Nursing and the George Washington University have entered into a collaborative agreement to submit a funding proposal to the National Institute of Drug Abuse (NIDA) for a 5-year study of regulatory models for managing substance dependence among registered and licensed practical nurses. The study, entitled Nurse Drug Abuse: Risk Factors, Co-morbidity, Recovery, is described as follows: