Molly Engle

Sufficient conditions for effective treatment of substance abusing homeless persons.

Treatment efficacy for homeless substance abusers (primarily crack cocaine) was studied in a randomized control design with subjects (n = 176) assigned to usual care (UC) or an enhanced day treatment program plus abstinent contingent work therapy and housing (EC). Subjects met DSM-III-R criteria for Substance Use Disorder and McKinny Act criteria for homelessness. UC involved weekly individual and group counseling. EC involved a day treatment program consisting of daily attendance, transportation, lunch, manualized psychoeducational groups, and individual counseling. A total of 131 (74.4%) subjects (62 UC and 69 EC) were treated and followed. UC subjects attended 28.5% and EC attended 48.4% of expected treatment during the first 2 months. After 2 months, EC subjects experienced up to 4 months of abstinent contingent work therapy (44.9% of EC subjects) and housing (37.7% of EC subjects), with day treatment available two afternoons per week. Longitudinal Wei-Lachin analyses of medians (reported alcohol use, days homeless and employed) and proportions (cocaine toxicologies) were conducted across 2-, 6-, and 12-month follow-up points. EC had 36% fewer positive cocaine toxicologies at 2-months and 18% fewer at 6-months than UC with regression toward baseline at 12-months. EC had 8 days fewer days of reported alcohol use in the past 30 days, 52 fewer days homeless in the past 60 days, and 10 more days employed in the past 30 days from baseline to the 12-months. UC showed no changes except a temporary increase in employment at 6-months. This is one of the first demonstrations that homeless cocaine abusers can be retained and effectively treated.

A Randomized Control Study to Determine the Effects of Unlimited Oral Intake of Water in Patients with Identified Aspiration

No statistical differences were found in the moderator variables of age, gender, eth nicity, stroke location, amount of initial aspiration, or presence/absence of a cough reflex. Using a t-test for independent means, a significant difference (p = 0.03) oc curred between groups on average intake of thickened liquids. Conclusion : Until further larger scale research utilizing water intake with known aspirators is conducted, it is recommended that water (and ice chips) be given presently only in instances of patient refusal to drink thickened liquids or when hydration is sues cause medical concern.

Validity of Self-Reported Crack Cocaine Use Among Homeless Persons in Treatment

The validity of self-reported crack cocaine use among 131 homeless persons participating in an outpatient substance abuse treatment research demonstration project was assessed by comparing the concordance of self-report and urinalysis results. The subjects were participants in either a Usual Care outpatient program or an Enhanced Care day treatment program that included drug free contingent work therapy and housing. For all subjects across four evaluation points, the false negative classification by self-report (i.e., denied verified use) rate for crack cocaine use was 32.0%. Denied verified use was greater in Usual Care (34.9%) than in Enhanced Care clients (23.7%) and greater at follow-up as compared to treatment entry for all clients. The findings are explained in terms of social desirability and the influence of treatment contingencies and greater accountability specific to the Enhanced Care program. The need for validation of self-reported cocaine use data among homeless persons in settings where contingencies are present and in other drug treatment or research settings is recommended.

Investing in Oregon's Expanded Food and Nutrition Education Program (EFNEP): Documenting Costs and Benefits

OBJECTIVES To apply Virginias cost-benefit analysis (CBA) model developed for a large Expanded Food and Nutrition Education Program (EFNEP) to Oregons small EFNEP. To estimate a cost-benefit ratio for Oregons EFNEP based on retrospective analysis of program costs and optimal nutrition behaviors (ONBs) in relation to potential health-related savings for diet-related chronic diseases/conditions. DESIGN Standard components of a CBA. SUBJECTS/SETTINGS 368 adult graduates of Oregon State Universitys Extension Service EFNEP during the 1999-2000 program year. INTERVENTION Prior participation in the EFNEP with a mean of 10.4 lessons. MAIN OUTCOME MEASURES Cost-benefit ratio and several sensitivity analyses. ANALYSIS EFNEP program graduates practicing ONBs related to prevention/delay of diet-related chronic diseases/conditions were determined using SPSS (Base 10 computer program). Cost-benefit ratios were computed using Microsoft Excel. RESULTS CBA determined a 1:3.63 cost-benefit ratio (in 1999 dollars). CONCLUSIONS AND IMPLICATIONS Virginias CBA model was useful in the retrospective evaluation of Oregons small EFNEP. With Oregons benefits exceeding costs, CBA provides evidence for resource allocation and justification for program continuation.

2002 Survey of Evaluation Preparation Programs in Universities: An Update of the 1992 American Evaluation Association--Sponsored Study.

Entry into professions, such as medicine, law, and the clergy, is typically controlled. In contrast, evaluation has multiple pathways leading into the field. For evaluators, a graduate degree from a university program is one of several ways to become an evaluator. What university programs exist to prepare evaluators and what is their nature? In 2002, we undertook a survey of university-based evaluation preparation programs to answer this question and to update findings from prior surveys of university preparation programs for evaluators. In this article, we briefly review the results of previous surveys, discuss the methods for collecting the current data, and present the results and implications of the 2002 survey.

Reliability of the 3-Oz Water Swallow Test Utilizing Cough Reflex As Sole Indicator of Aspiration

Objective: Following the publication of the DePippo et al. research, many physicians are beginning to use the 3-oz water screen as a replacement for videofluoroscopic swallow evaluations. Decisions regarding oral intake are being made using the cough reflex as the sole indicator of aspiration. We replicated this procedure in one hundred patients scheduled for videofluoroscopic evaluation to determine its reliability as a screening method. Design: As part of routine videofluoroscopic swallow evaluations over a four-month period, we identified one hundred consecutive patients tested with the 3-oz water screen. Setting: The videofluoroscopic evaluations were conducted in an acute hospital set ting and a rehabilitation hospital. Participants: All patients had observed or suspected swallow difficulty that indicated the need for videofluoroscopic swallow evaluation. Half of the patients were evaluated at the acute hospital, the remaining at the rehabilitation hospital. Males comprised 52%. The mean age was 75.2 years (± 11.3), range 27 to 95. The diagnosis of CVA (left, bilateral, or right) had been made in 50% of the patients. Main Outcome Measures: Determine the proportion of patients who coughed on the 3-oz screen and aspirated on the videofluoroscopic swallow evaluation. Results : Fifty-four patients aspirated. Of these, only nineteen (35%) coughed, leaving thirty-five, or 65%, who were not identified by this screening method. Using the Fisher Exact Test, a statistically significant difference (p < 0.005) was identified between those patients who were identified by the 3-oz water screen and those who were iden tified by videofluoroscopic evaluation. Conclusions: The 3-oz water screen utilizing the cough reflex as the sole indica tor of aspiration is not a replacement for the precision and accuracy of a videofluoro scopic evaluation.

Comparing two substance abuse treatments for the homeless: The birmingham project

The Birmingham Comparative Substance Abuse Treatments for the Homeless is a cooperative effort between the Birmingham Health Care for the Homeless Coalition (BHCHC) and investigators at the University of Alabama at Birmingham (UAB). This treatment program provides and compares usual care with enhanced services to homeless persons with substance abuse disorders. The studys aims are to: (1) identify homeless persons with substance abuse problems; (2) provide medical evaluation, observation, and stabilization services; (3) randomly assign at least 150 homeless substance abusers to either a usual care or enhanced dav treatment intervention: and (4) evaluate the differential effectiveness of the interventions in reducina alcohol and/or drug use. increasing levels of shelter and residency, and enhancing economic and employment status.

A nutrition and physical fitness test for fifth and sixth graders

Abstract This paper reports the development of a written measure of nutrition and physical fitness knowledge for use with upper elementary school students. The objectives of the curriculum for which the test was developed derive from the basic concepts for nutrition education as proposed by the 1969 White House Conference on Food, Nutrition, and Health. Evaluation by a professional review committee of the adherence of the test to a table of specifications ensured content validity. Significantly greater gains by instructed students than by uninstructed students established criterion validity. Internal consistency reliability was 0.814 as measured by Cronbachs alpha. The authors believe the test should have wide application in assessing general knowledge in the area of nutrition and fitness education.

Linking Practice and Science in the Substance Abuse Treatment of Homeless Persons

The Homeless I Project represents the successful linking of practice and science in the development, delivery, and evaluation of innovative interventions for substance abuse and homelessness in a community-based setting. Several positive outcomes resulted from the collaboration between university investigators and providers of health care for the homeless. These included a productive research and service delivery collaboration, important project and community linkages, national research and service delivery linkages, service enhancements for homeless persons with substance abuse problems, development of an innovative abstinent-contingent work therapy and housing program, significant client participation rates, effective dissemination of method and results, and continued practice and research. Obstacles and solutions related to integrating science and practice, overcoming community resistance, and maintaining linkages are presented. Suggested applications for linking science and practice are offered.

Book Review: Qualitative Data Analysis: A Methods Sourcebook: The Coding Manual for Qualitative Researchers:

vation also poses certain challenges for evaluation: Things can happen suddenly or take years; it requires considerable knowledge of the innovation process; flexibility is key and perhaps there will be some difficult times with evaluation sponsors. Early in the piece, the authors distinguish between innovative organizations and innovation itself. The second half of the chapter is a case study that describes a framework used to evaluate the introduction of an innovative process. The framework is based on six criteria: relevance, effectiveness, influence, sustainability, impact, and risk management. The ‘‘innovation’’ evaluation questions that flow from these criteria certainly help ground what might otherwise have been a fairly conceptual part of the chapter. However, while the example is illuminating, it’s not clear whether these six criteria are supposed to be universally relevant to evaluating innovative practices or specific to the case study. The editors bookend the contributions with a precise and concise introduction and a longer concluding chapter. The stand-out feature of the concluding chapter is a superb appendix that lists the main points of each chapter according to four headings: guidance on definitions, guidance on methods, guidance on evaluation challenges, and guidance on possible solutions. It brings a welcome cross-chapter consistency, something that is notoriously difficult to achieve in multiauthored volumes. Overall, however, the final chapter opts for a ‘‘drawing the threads’’ style summary and consequently misses the opportunity to be a forward-looking set of reflections. After nearly 250 pages, I think readers—and certainly the contributors—could have hoped for more solid suggestions about necessary next steps than an expression of hope that the discussions raised in the book will continue and a call for more training of evaluators on the issues raised. In her preface to the book, Nancy MacPherson describes how the face of international development is changing and the not inconsiderable, perhaps even fundamental, challenges that this poses for evaluation to stay relevant. Evaluation has put its eggs firmly in a basket that may be fraying at the bottom. With the wealth of information contained in this volume, the concluding chapter could have addressed these challenges head on. However, if you are like me and tend to read the last part of a textbook first, then this chapter prepares you very well for the task ahead. And it is a task worth undertaking, whether or not you have an interest in international development.