Peter J. Delany

Treatment Service Patterns and Organizational Structures An Analysis of Programs in DATOS-A

The availability of a variety of treatment services was examined within a national sample of programs treating adolescent drug abuse patients. Treatment service delivery profiles were created and examined in the context of organizational variables such as program modality, program directors’ academic credentials, program capacity, staff composition, accreditation, and patient problems. Results suggested that distinct profiles of services existed within residential and outpatient modalities and that these service profiles were related both to organizational factors and to patient problem profiles.

Patient and program factors in obtaining supportive services in DATOS.

This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients (N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.

Opportunities for social work under the Affordable Care Act: A call for action

ABSTRACT The Affordable Care Act (ACA) has profoundly restructured American health care. Numerous social work authors have commented on the importance of the ACA’s reforms to social work practice, education, and research. This article summarizes the literature, adds relevant information, and makes recommendations for future actions. The policy, opinion, and peer-reviewed literatures were systematically reviewed. Sixty-three publications appeared between 2010 and 2015 are included. Five themes emerged, as follows: 1) the crucial provisions of the ACA, 2) the natural affinity of social work and the ACA reforms, 3) curricular adaptations needed to address changing workforce needs, 4) areas for continued social work advocacy, and 5) opportunities for high-impact social work research. This article provides a comprehensive introduction to the ACA, its reforms, and opportunities for social work to assume a high visibility leadership role in implementing the reforms, with particular emphasis on needed curricular changes and opportunities for research.

Program and Client Characteristics as Predictors of the Availability of Social Support Services in Community-Based Substance Abuse Treatment Programs

Recent emphases on increasing accountability, using less intensive settings, and implementing evidence-based services helped to focus the research community on the structure, processes, and outcomes of services delivered to substance abuse clients. Considerably less attention has been given to understanding how to structure services to enhance engagement and retention leading to treatment continuity. This study examined structural characteristics of community-based treatment facilities in relationship to the availability of supportive services within a sample of 1,332 substance abuse treatment programs surveyed through the Alcohol and Drug Services Study in 1996 and 1997. Structural and client characteristics are important predictors of added supportive services. Furthermore, a program with a broader and established set of core services is more likely to have expanded supportive services. These findings have implications for public health professionals, both in terms of ensuring sustainable service programming for these chronic clients and in identifying services to adopt or discard to meet a population with multiple needs.

Expanding the Role of Health Services Research as a Tool to Reduce the Public Health Burden of Alcohol Use Disorders

The public and private cost of “heavy alcohol use” 1 is estimated to be more than 187 billion in lost productivity, health care and criminal justice expenditures, and other costs. This does not include the emotional and psychological costs to family, friends, and the community. Investments by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have led to a number of important advances in pharmacological and behavioral treatments for alcohol disorders. Yet, there continues to be a significant gap between research findings and progress in community-based care. Additionally, limited capacity, a lack of acknowledged standards, and a separation between the specialty substance use treatment sector and general medical practice contribute to this gap. As part of its ongoing efforts to encourage translation from clinical research to practice, NIAAA undertook a review of its alcohol related health services research program for the purpose of creating a vision for the next 10 yr that is sensitive to the changing needs of both the clinical and research communities. Central to the development of a new research agenda is a reconceptualization of alcohol use and misuse along a continuum that takes into account quantity and frequency of use as well as the consequences from “heavy use” and misuse of alcohol. This public health approach recommends a number of high priority areas to expand and improve the system of care for “heavy alcohol users” who may be at-risk or who may have developed an alcohol use disorder. These recommendations include research on dissemination and implementation of evidence-based practices, and improving access and utilization to care for individuals who are “heavy users.” The paper concludes by outlining some of the steps taken by NIAAA to further the continuing development of alcohol health services research. 1 The terms heavy alcohol use(rs), which are often used in the literature, are an unscientific taxonomy which is bounded (culture, time, and place, etc.) and which inadvertently homogenizes a heterogeneous population of alcoholic beverage consumers and patterns of use. Editors note.

Analyzing shelter organizations and the services they offer: Testing a structural model using a sample of shelter programs

Abstract Although the need for services for homeless people, including health, substance abuse, and mental health treatment, has been widely documented, very little attention has been paid to the structural demands on shelter organizations that deliver these services. The present paper presents an exploratory study of 192 shelters in 29 cities that provide overnight accommodation to individuals and families using structural equation analysis to analyze the characteristics of the organizational and service delivery system. The resulting model suggests that services and amenities offered within the sample of shelter organizations are best understood as being influenced by organizational structure, as measured by occupational specialization, mediated through the organizations relationship with the external actors. This preliminary model offers researchers, policy makers and program planners a tool for analyzing the organizational needs that are necessary to support different services and amenities.

Factors Related to the Delivery of Trauma Services in Outpatient Treatment Programs

In recent years there has been growing recognition of the role of trauma in substance abuse treatment; however, only 20% of outpatient treatment programs report offering trauma services. We conducted a secondary analysis of the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) and explore how demographic, population served, and organization variables distinguish those programs that offer trauma services from those that do not. In this article, we present the findings, which revealed that organizational structure, process, and population served variables were the most important predictors of trauma services. Implications for social work practice in the addictions are discussed.

Becoming Trauma Informed, by Nancy Poole and Lorraine Greaves (Eds.)

There has long been awareness that trauma is pervasive among individuals who suffer from mental and substance use disorders. However, only recently has the behavioral health field begun to systematically address trauma as a component of comprehensive care. Left untreated, trauma can have lasting and significant effects not only on the individual, but on the family, community, and the public health service system. In Becoming Trauma Informed, Poole and Greaves highlight a “paradigm shift” taking place in the Canadian behavioral health system that “recognizes how central the trauma can be to those with whom [they] work” (p. xi). The introduction provides a strong case for trauma-informed care and its importance in the fields of mental and substance use treatment. Early on, the authors identify key principles of trauma-informed care, many of which are easily recognizable to social workers, principles such as empowerment, maximizing client choice and control, and emphasizing cultural competence. Although the book draws primarily from experiences in Canada, the information is easily generalizable across systems in the United States and internationally. Organized into three parts, the book explores perspectives on practice and practice systems. The first part of the book focuses on theory and practice. Section 1 provides readers with a framework for the remainder of the book and includes chapters concerning the impact of trauma on the bio-psychosocial development of individuals, what can be learned from disclosure, how to work without disclosure, and feminist understandings and anti-oppression psychotherapy approaches to care that help view trauma as part of what has happened to an individual rather than trauma defining the individual. Each of these chapters, and indeed many of the later chapters, highlights a strengths-based view of care that is totally consistent with social work practice. Practitioners might find Section 2 on practice the most accessible part of the book, as it outlines how trauma-informed care can be integrated into existing practices. The authors demonstrate how current practices such as