Susie Adams

Substance Abuse Treatment for Women Offenders: A Research Review

Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in recidivism. Although women offenders have different reasons for drug use, drug use patterns, life circumstances, and parental responsibilities than men, treatment approaches for women offenders have been largely developed from studies of treatment for incarcerated men and non-offending women in the general community. The purpose of this article is to summarize the recent literature on the treatment needs of women offenders with substance abuse problems and critically examine the six empirical studies that evaluate gender-specific programmatic interventions designed for women offenders. A systematic review of these six empirical studies assessed design, methods, measures, and outcomes. While these studies contribute to the knowledge base, five areas were identified to advance research and improve treatment outcomes for women offenders: 1) randomized controlled design,...

Predictors of Retention of Women Offenders in a Community-Based Residential Substance Abuse Treatment Program

&NA; Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in the high recidivism rates of women offenders (50–70% within one year). Understanding factors that enhance and deter women from retention in substance abuse treatment will facilitate tailored interventions to improve treatment outcomes. This prospective study examined the relationship of substance use characteristics, childhood trauma, current trauma‐related symptoms, motivation to treatment, and socio‐demographic characteristics, in predicting the retention of women offenders in an urban, residential substance abuse program as they re‐enter the community from incarceration. All women were interviewed within the first week of admission to the residential program using the following measures: the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), and the Trauma Symptom Inventory (TSI), and socio‐demographic characteristics. Length of stay was tracked for all study participants (n = 105). Using multiple regression analysis, substance use characteristics did not predict retention. Age, current use of prescribed pain medication, sexual concerns, employment problems, and importance of drug treatment were significant predictors. Specifically, women remained in treatment longer if they were older, were not taking any prescription pain medication, reported concerns about employment, reported concerns about sexual problems, and reported lower importance of drug treatment, yet higher personal commitment to recovery. Higher scores for childhood emotional trauma, emotional neglect, and physical neglect were correlated with retention, but not statistically significant. These findings suggest the need to tailor individualized treatment to address the medical, employment, sexual and interpersonal relationships, and emotional trauma needs in this vulnerable population of women.

Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders

Background: A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. Although prior research indicates that women and men differ in their substance abuse treatment experiences, our knowledge of individuals with co-occurring substance abuse and mental health disorders as well as those attending private residential treatment is limited. Objectives: The purpose of this study is to examine gender differences on treatment retention for individuals with co-occurring substance abuse and mental health disorders who participate in private residential treatment. Methods: The participants were 1,317 individuals (539 women and 778 men) with co-occurring substance abuse and mental health disorders receiving treatment at three private residential treatment centers. Bivariate analyses, life tables, and Cox regression (survival analyses) were utilized to examine gender effects on treatment retention, and identify factors that predict treatment retention for men and women. Results: This study found that women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate the factors influencing length of stay differ for each gender, and include: type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. Conclusions/Importance: These findings can be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.

Putting the "Evidence" in Evidence-Based Practice: Meeting Research Challenges in Community Psychiatric Settings

Every psychiatric client deserves access to treatments that have evidence of efficacy, but in psychiatric nursing, this evidence remains sparse. To address this deficit, researchers must commit to conducting high quality, community-based psychiatric nursing intervention investigations. In service of this goal, the authors draw upon their research experiences in community psychiatric settings to suggest options for overcoming system-, clinician-, and client-related research barriers in community psychiatric settings.

Cultural Expressions of Intergenerational Trauma and Mental Health Nursing Implications for U.S. Health Care Delivery Following Refugee Resettlement: An Integrative Review of the Literature.

Purpose: The purpose of this integrative review of the literature is to examine cultural expressions of intergenerational trauma among refugees following resettlement, and to determine culturally sensitive mental health care practice implications for health care practitioners working in U.S. health care delivery. Methodology: Data were collected utilizing a comprehensive computer-assisted search in CINAHL and PsychARTICLES/ProQuest from 2003 to 2013 of full text, peer-reviewed, scholarly journal articles, published in English. Eight articles met selection criteria and were analyzed using Gadamer’s philosophical interpretation of play, symbolism, and festival in The Relevance of the Beautiful. Results: Six recurrent themes were identified important to refugee health care delivery: silence, communication, adaptation, relationship, remembering, and national redress. Implications for Practice: Practitioners need to consider cultural influences of intergenerational trauma in processing grief related to loss and how artistic modes of expression are experienced, both individually and communally, in refugee health care delivery.

Using a community-based participatory research approach to evaluate resident predictors of involuntary exit from permanent supportive housing

OBJECTIVE The aim of this study was to determine an association between resident characteristics at time of entry to permanent supportive housing and exit status. METHODS A community-based participatory research (CBPR) approach was the guiding framework for the design, implementation and evaluation of this project. This retrospective observational study used an administrative data source from a local permanent supportive housing provider to compare resident characteristics among those who left housing voluntarily or involuntarily. RESULTS The population based sample (n=407) was comprised of 51% males and 47% African-Americans with a mean age of 40 years (SD=11.8). Involuntary exits (IEs) occurred in 40% of the sample (n=166). IE was less likely with receipt of mainstream benefits, compared to employment income (O.R.=.546, p=.032). IE was more likely for residents self-identifying as African-American (O.R.=1.56, p=.037) and when children resided in the household (O.R.=2.03, p=.013). CONCLUSIONS Despite limitations of community-derived data, findings suggest that supportive housing providers consider income source and family status when designing interventions to decrease IEs. A CBPR approach is a promising framework to guide evaluation efforts for supportive housing programs.

Integrated recovery management model for ex-offenders with co-occurring mental health and substance use disorders and high rates of hiv risk behaviors

&NA; This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex‐offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5‐year evaluation, data were collected from 426 individuals during baseline and 6‐month follow‐up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex‐offenders in treatment.

APNA's Transitions in Practice (ATP) Certificate Program: Building and Supporting the Psychiatric Nursing Workforce.

One in every four nurses leaves a position within their first year of clinical practice (National Council of State Boards of Nursing [NCSBN], 2013a), indicating inadequate preparation for the position for which they were hired. The U.S. Bureau of Labor Statistics (2013) projects the need for 526,800 new registered nurse (RN) positions due to growth and an additional 525,000 for replacement RNs for a total of 1.05 million RN positions by 2022 (AACN, 2014a, 2014b). This nursing shortage highlights the critical need to retain new and experienced nurses within clinical practice settings. In response to this workforce issue, the NCSBN developed a Transition to Practice® (TTP) Model designed to engage and retain newly licenses RNs/licensed practical nurses through workforce orientation, transitions to practice modules, and ongoing institutional support. The TTP modules include patient-centered care, communication and teamwork, evidence-based practice, quality improvement, and informatics within the context of clinical reasoning and safety (NCSBN, 2013b). A randomized control trial of the TTP in 105 U.S. hospitals using trained preceptors who guided new RNs for their first 6 months and who completed the five modules found no statistically significant differences between the two groups. However, when the control group hospitals were categorized as established programs versus limited programs, those with established programs demonstrated higher retention, fewer patient care errors, fewer negative safety practices, higher competency levels, lower stress levels, and better job satisfaction (Spector et al., 2011). The American Psychiatric Nurses Association (APNA) Board of Directors (BOD) recognized similar workforce issues in retaining new graduates and nurses transitioning from other service lines into psychiatric inpatient nursing settings. The APNA BOD was also cognizant of faculty concerns about diminished psychiatric-mental health content and clinical rotations in undergraduate education due to increasing competition of additional curricular content, which further compromises the preparation of nurses to practice in inpatient psychiatric settings. In 2013, the APNA BOD identified the need to address this growing gap in psychiatric-mental health (PMH) nursing knowledge among newly licensed RNs and experienced RNs transitioning to inpatient psychiatric settings. Drawing on membership expertise, the APNA developed a 15-hour, modularized curriculum to provide the foundational PMH knowledge that RNs need as they transition into mental health practice settings to build and support the PMH nursing workforce. The modularized curriculum, called APNA Transitions in Practice (ATP), focuses on the knowledge and skills that will ensure the success of nurses new to PMH nursing settings as well as improve the overall health care of people with mental health disorders.

TeleMental Health: Standards, Reimbursement, and Interstate Practice :

BACKGROUND: TeleMental Health (TMH) is gaining widespread acceptance in the United States. OBJECTIVE: Summarize current evidence regarding TMH risks and benefits, standards of care, practice guidelines, reimbursement, and interstate practice issues pertinent to psychiatric nurses and consumers. DESIGN: A targeted review of literature, current practice, and TMH websites was generated using the following key search words: clinical outcomes, practice guidelines, regulations, interstate practice, and reimbursement for TMH. A search of government and professional organization websites and a literature review of PubMed and PsychINFO databases was limited to the past 15 years. RESULTS: Studies demonstrate TMH services are equal in efficacy to that provided in face-to-face encounters and preferred by some populations. Current TMH practice guidelines, reimbursement, and regulatory issues are reviewed. CONCLUSIONS: Providers, including psychiatric advanced practice registered nurses, can use TMH to effectively address the growing need for mental health services, although regulatory, licensure, and clinical issues must be addressed prior to offering TMH services.

USING A WEB-BASED PATIENT-PROVIDER MESSAGING SYSTEM TO ENHANCE PATIENT SATISFACTION AMONG ACTIVE DUTY SAILORS AND MARINES SEEN IN THE PSYCHIATRIC OUTPATIENT CLINIC: A PILOT STUDY.

Patient satisfaction is imperative in providing safe, effective, and quality patient care. Several articles have examined the effect of a secure on-line communication system in the primary care setting to improve the delivery of patient care. This article describes the use of an asynchronous Web-based messaging system in the psychiatric outpatient setting to enhance patient satisfaction among active duty military service members.