Natasha S. Mendoza

Early Attrition From Treatment Among Women With Cooccurring Substance Use Disorders and PTSD

Participant retention is one of the more challenging issues in the treatment of substance use disorders. Using data from the National Institute on Drug Abuse Clinical Trials Networks Women and Trauma Study (recruitment in 2004–2005), we examine prominent factors associated with early attrition among women with cooccurring substance use disorders and posttraumatic stress disorder (N = 340). Early treatment attrition is associated with a history of youth partner violence, perceived need for psychological treatment, and abuse of alcohol, opioids, and stimulants. Logistical barriers (e.g., transportation, having children) were not significantly associated with early attrition. Findings provide insight into characteristics of women who might need additional supports to engage in treatment.

Women Reentering the Community: Understanding Addiction and Trauma-Related Characteristics of Recidivism

Women represent 26% of those arrested for serious crimes; many have posttraumatic stress and co-occurring substance use disorders, which may influence recidivism. This study examined 57 women residing in a community re-entry program after exiting prison. Participants completed the Trauma Symptom Inventory and Substance Abuse Subtle Screening Inventory. A discriminant function analysis accounted for 34% of between-group variability and provided a profile of women who recidivated. Women who recidivated had greater alcohol dependence and lower rates of sexual dysfunction and sexual concerns. Practitioners should consider potential links between substance abuse, trauma, and sexual behavior in treatment settings.

Migrant and Seasonal Farmworker Food Insecurity: Prevalence, Impact, Risk Factors, and Coping Strategies

In the United States, nearly 15% of the general population is considered food insecure; ethnic minorities, particularly Latinos, experience disproportionately higher rates. Food insecurity is particularly endemic among the migrant and seasonal farmworker population. This article systematically reviews current knowledge related to the prevalence of food insecurity among migrant and seasonal farmworkers. The impact, risk factors, and coping strategies of food insecurity are also presented. The authors argue for targeted social work efforts at mezzo- and macrolevels and make recommendations aimed at the prevention and amelioration of food insecurity.

Attrition in drug court research: Examining participant characteristics and recommendations for follow-up.

Drug court research is often challenged by study attrition. In this study, researchers attempted to predict study completion using variables traditionally associated with treatment attrition. Findings showed that participants who reported a need for additional help to resolve legal problems and who reported accessing outpatient treatments were more likely to complete the study at the 3-month follow-up. The study also demonstrated a relationship between trauma-related symptoms and study attrition. Although sample size was a limitation with these pilot data, researchers are urged to examine attrition and increase efforts to engage drug court enrollees in research studies, especially those with trauma-related symptoms.

Predictive validity of single-item motivational measures for emerging adults in substance-use disorder treatment

Objective: Few studies have examined which measures of motivation for change predict abstinence and early remission outcomes (AER) for emerging adults with substance-use disorders, and recent research suggests that single-item measures may perform as well as longer readiness-to-change scales. This study extends findings to emerging adults (ages 18–25) treated in outpatient settings by investigating the predictive validity of a single-item motivational measure. Method: Using a national data set of emerging adults receiving outpatient substance-use disorder treatments (N = 1,951), we predicted AER at 3 and 6 months in logistic regression models that controlled for demographics, global severity, and baseline values of the dependent variable. Separate models were run based on self-reported quit status at intake, and all models were corrected for site differences. Results: The single-item motivational measure significantly predicted AER status for quitters at both 3 and 6 months and for nonquitters at 6 months. Conclusions: The single-item motivational measure was the only motivation measure to predict 3- and 6-month outcomes. Thus, it could be used in many situations, except when researchers are interested in clarifying theoretical considerations pertaining to motivation.

Risk assessment with actuarial and clinical methods: Measurement and evidence-based practice

Child welfare agencies have adopted assessment tools and instruments to inform the level of risk and guide the agencys level of intervention with the family. Actuarial assessments may be more uniform but inflexible with respect to practice wisdom whereas clinical or consensus-based assessments are more comprehensive and intuitive but lack objectivity. The purpose of the current study is to compare clinical and actuarial methods of risk assessment used by child welfare workers to make decisions about substantiation and services. The current study examined the (1) association between clinical and actuarial dimensions, (2) association between actuarial dimensions and outcomes, (3) association between clinical dimensions and outcomes, (4) caseworker primary use of actuarial dimensions, and (5) caseworker supplementary use of actuarial dimensions. Findings indicated that the actuarial may not be solely predictive of agency intensity with respect to case decision and service provision. Our findings suggest that dual-measurement does inform intensity, and we speculate from these findings that the measures may be involved with decision-making in a complex way. This study may be best viewed as a means by which researchers begin to parse how decisions are made; with this information, instruments may be better tailored to facilitate clinical, critical thought.

Social Services and Child Well-Being Among CPS-Involved Families

ABSTRACT Once children and families become involved with the child welfare system, they are usually referred to a myriad of social services (e.g., concrete services, behavioral, mental, or physical health services). To examine a broad array of social services and child well-being over time, this study utilized secondary analysis of the National Survey of Child and Adolescent Well-Being via structural equation modeling with complex sampling techniques. Results showed that child well-being at baseline was significantly related to well-being over time. As social services were added to the model, child well-being decreased (i.e., significant partial mediation). There may be a trend to load higher-risk families with services. Trends like this suggest a need for more exploration of programming that directs resources toward lower-risk families to halt the cyclic nature of child welfare involvement. Practitioners and researchers are urged to consider the need for systematic measurement of service and dose. Close empirical examination will ultimately improve the effectiveness of the service delivery system and consequently the well-being of children and families engaged in child welfare services.

Examining Trauma and Readiness to Change among Women in a Community Re-Entry Program

ABSTRACT Background: Posttraumatic stress disorder (PTSD) and co-occurring substance use disorders (SUDs) are common among women who are incarcerated. Objective: The purpose of this study was to examine the relationship between trauma and readiness to change substance use behaviors. Methods: This study used data from 103 participants enrolled in a residential re-entry program for women with SUDs and trauma history. Women reporting clinically elevated Trauma Symptom Inventory (TSI) subscale scores were compared to those without elevated scores on the University of Rhode Island Change Assessment (URICA) readiness to change instrument. Primary analyses included t-tests and ANCOVA to control for age and ethnicity. Results: In general, women with clinically elevated trauma scores also reported greater readiness to change. The analyses revealed significant differences on the URICA Readiness to Change scores between women who had elevated Defensive Avoidance and Impaired Self-Reference according to the TSI. Results approached significance for women who had elevated TSI subscale scores for Sexual Concerns and Dissociation. Conclusions: These results point to a need to further understand links between trauma and readiness to change, particularly, the role of posttraumatic growth and psychological distress. This study has implications for social workers and clinicians delivering evidence-based treatment. Women who had high trauma symptoms were more willing to address change. Findings also suggest a need to tailor interventions to include motivational components that are also trauma-informed.

Examining the relationship between psychological functioning, childhood trauma, and types of perceived coercion among drug court enrollees: Results from a pilot study

Abstract Background: Drug court interventions produce positive results—especially among mandated populations. Many criminal justice-involved persons, including drug court enrollees, have co-occurring substance abuse and childhood trauma disorders associated with psychological dysfunction. Given the coercive nature of mandated drug court treatment, it is important to understand whether childhood trauma and psychological functioning influence perceived coercion to enter treatment. Objectives: The purpose of this study was to describe the degree to which adverse childhood trauma and psychological functioning were associated with six domains of perceived coercion—self, family, legal, financial, health, and work—among a population of drug court enrollees. Methods: Data from 54 enrollees in a drug court pilot study were used to examine the relationship between childhood trauma, psychological functioning, and perceived coercion. Results: The pilot study data showed that psychological dysfunction and traumatic experiences in childhood were associated with higher perceived coercion to treatment, explaining 29% of the variance in coercion, controlling for gender and pre-arrest alcohol and drug use. Results indicated that the associations between psychological dysfunction and trauma were driven by non-legal types of coercion. In particular, childhood trauma was correlated with family (r = 0.32), financial (r = 0.32), and health (r = 0.47) types of coercion. Conclusions: Based on these preliminary findings, drug court practitioners are urged to assess perceived coercion, in addition to the behavioral health and childhood trauma of their clients, and to utilize non-legal types of coercion such as family, health, and financial impact to enhance treatment engagement.

Heterosexism, racism, and mental illness discrimination: Experiences of people with mental health conditions and their families

ABSTRACT Experiencing discrimination related to race/ethnicity, sexual orientation, or having a mental health condition is associated with negative outcomes. Research comparing types of discrimination or considering intersectionalities is lacking. This study reports findings from interviews with people with mental illnesses (PWMI) or family members of PWMI; all study participants also are of color and/or lesbian, gay, or bisexual. Findings include the following: participants experienced multiple forms of discrimination, mental illness discrimination shares characteristics with racism and heterosexism, and heterosexuals and people of color reported more mental illness discrimination than their counterparts.  Implications for change advocates, mental health providers, and researchers are offered.