Thomas K. Gregoire

The relationship of legal coercion to readiness to change among adults with alcohol and other drug problems

Prior research on legally coerced treatment for substance abuse tends to find no difference between coerced and non-coerced clients with respect to treatment retention and treatment outcomes. There is less known about the relationship between coercion and a clients motivation to change. We considered the relationship of legal coercion and readiness to change among 295 consecutive admissions to five publicly funded outpatient treatment programs. A logistic regression analysis indicated that legal coercion was associated with greater readiness to change after controlling for addiction severity, prior treatment history, and gender. Persons entering treatment due to legal coercion were over three times more likely to have engaged in recovery-oriented behavior in the month preceding admission. Entering treatment more prepared to benefit from the experience could contribute to outcomes that are more positive.

Reliability and Validity of the Transracial Adoption Parenting Scale

The present study provides information on the reliability and validity of the Transracial Adoption Parenting Scale (TAPS), a multidimensional 36-item Likert-type scale that measures cultural competence among transracial adoptive (TRA) parents. The TAPS was theoretically developed and refined through feedback from experts in TRA adoption. A cross-sectional survey design was used with a national nonprobability sample of 1,411 TRA parents. Each parent completed the 53-item TAPS and three other instruments with which to examine criterion and construct validity. After a preliminary factor analysis of the 53-item TAPS, the authors found that 36 items were retained in six factors. The 36-item TAPS had excellent reliability (Cronbach’s alpha = 0.91), concurrent and discriminant validity were supported. Conclusion: Findings suggest that the TAPS holds promise of being a psychometrically sound instrument with which to measure cultural competence among TRA parents. Further investigation is warranted.

Gender and racial inequities in retirement resources.

ABSTRACT Two waves of a Social Security Beneficiary survey were analyzed to consider differences in the retirement resources of women and men based on marital status and race/ethnicity. Despite increased workforce participation the economic situation of single women, including white women, worsened over time. A bifurcation in retirement resources was found, with men relying more on private income sources and women depending more on Social Security. Current retirement policies based on privatization will continue to adversely impact women who work at low-paying jobs, receive lower wages, and live longer than men.

Building a Model of Family Caregiving for Children with Emotional Disorders

In this article we describe the results of an ongoing effort to better understand the caregiving process in families of children with severe emotional problems. We make two assumptions. First, we assume that these families are essentially like other families but are faced with a special challenge in raising and caring for their special children while at the same time performing the multiple tasks and demands faced by all families. Second, we assume that public policy and programs must be supportive of the care of these children in their own homes and communities whenever possible. The purpose of this article is to present a model of family caregiving that draws broadly from available theory and empirical literature in multiple fields and to subject this model to empirical testing. We use structural equation modeling with latent variables to estimate an empirical model based on the theoretical model. Results of the model testing point to the importance of the childs external problem behaviors and the familys socioeconomic status and coping strategies as determinants of caregiver stress. Other findings highlight difficulties in measuring and modeling the complex mediating process, which includes formal and informal supports, perceptions, and coping behaviors. The use of structural equation modeling can benefit our efforts to support families by making explicit our theories about the important dimensions of this process and the relationship between these dimensions, which can then be subjected to measurement and validation.

Factors associated with level of care assignment in substance abuse treatment

Managed-care approaches to controlling expenditures for publicly funded substance abuse treatment have proliferated in the past decade. As many as 40 states now have some type of utilization review mechanism. Many have adopted the American Society on Addiction Medicine placement criteria to assign persons to a level of care. This study examined the use of those criteria with 3,000 consecutive admissions to publicly funded treatment in Kansas and identified variables that predicted level of care assignment. For the most part, the placement domains predicted level of care as expected. However, even when controlling for the contribution of the placement domains, housing status and employment were among the best predictors of placement. These findings suggest a need for criteria that address social service as well as clinical concerns when working with vulnerable populations.

Subtypes of Alcohol Involvement and Their Relationships to Exits from Homelessness

This study sought to ascertain the presence of meaningful subtypes of alcohol and other drug involvement among homeless persons. Subtypes were derived using factor analysis to determine dimensions underlying alcohol involvement and cluster analysis to create unique subtypes. The types with the highest level of alcohol or drug use had the longest period of continuous homelessness and were less likely to have exited from homelessness when reinterviewed 6 months later. The dimensions represent a more sophisticated framework for describing alcohol and drug involvement among homeless persons and may be useful for practitioners in conducting assessments, designing programs, and planning interventions.

Theories of Motivation in Addiction Treatment: Testing the Relationship of the Transtheoretical Model of Change and Self-Determination Theory

This study explored the relationship between 2 theories of motivation: self-determination theory (SDT) and the transtheoretical model of change (TTM), and sought to determine whether the source of motivation described by SDT would predict TTMs stage of change. SDT was operationalized as the level of internal or external motivation for treatment, and TTM was operationalized as 3 stages of change: precontemplation, contemplation, and action. Our data came from the Drug Abuse Treatment Outcome Study published in 2004. A multinomial logistic regression analysis indicated that there was a significant relationship between source of motivation and stage of change at intake. Controlling for severity, treatment history, legal status, and primary substance use, persons entering treatment with higher levels of internal motivation were more likely to be in the action stage than the precontemplation stage. Higher levels of internal motivation also predicted a greater likelihood of being in the contemplation rather than the precontemplation stage.

THE VALIDITY OF A SOCIAL INDICATOR APPROACH TO SUBSTANCE MISUSE NEEDS ASSESSMENT

Factors other than the magnitude of a communitys drug- or alcohol-use-related problems may play a large role in resource allocation. Needs assessment approaches such as key informant interviews and household surveys can contribute to a more informed process. An additional approach to needs assessment, social indicator modeling, addresses the high cost of surveys and the potential subjectivity of key informant interviews. This paper discusses the history of social indicator approaches to needs assessment and reviews recent equitable distribution approaches. An equitable distribution model of alcohol- and other drug-use-related problems was created and validated. The drug model accounted for close to 50% of the variation in estimates of lifetime diagnosis of drug dependence or misuse. The alcohol model performed less successfully, accounting for 21% of the variation in lifetime diagnosis of alcohol-use-related problems.

An Assessment of the Utility of the Child Behavior Checklist/4-18 for Social Work Practice

The objective of this article was to analyze the structure of the Child Behavior Checklist (CBCL), which is often used to measure children’s emotional and behavioral problems. Considering its potential uses in social work, we logically deduced the optimal format for each use. Confirmatory factor analysis of the CBCL problem scales was the method conducted. Three alternative models were also proposed and tested. Data analyzed were parent responses from two clinical samples consisting of 542 children ages 3 to 18 years old living in Oregon or North Carolina. The CBCL author’s eight-correlated-factor model was confirmed. The data also fit the three alternative models to varying degrees. Conclusions reached were that the original model was judged most useful for diagnosis; the one-, two-, and three-factor models all were useful for screening; and individual items were most useful for treatment planning and outcome assessment. Using only the original internalizing and externalizing scores is not recommended.

If mothers had their say: research-informed intervention design for empowering mothers to establish smoke-free homes.

The Empowering Mothers to Establish Smoke-free Homes (EMESH) project developed in response to an interdisciplinary health team seeking effective interventions for reducing/eliminating the environmental tobacco smoke exposure of infants with compromised respiratory status. Two study phases that informed the EMESH intervention design are described. Phase I involved semi-structured interviews with 20 caretakers of infants diagnosed with Bronchopulmonary Dysplasia (BPD). In Phase II, 75 randomly selected medical records of infants with BPD were reviewed to explore the family demographics and staff behavior regarding environmental tobacco smoke (ETS) interventions. Interview results suggest that families are open to partnering with social workers and interdisciplinary team members in addressing infants’ ETS exposure, families’ unique circumstances indicate a need for tailored interventions, and the use of self-efficacy and decisional balance tools are feasible options. Results from the medical records review indicate that many families are economically vulnerable and reside in regions where smoking is common. There is a paucity of staff documentation regarding ETS conversations and interventions, indicating that these conversations may not take place. Together these results suggest a two-pronged approach in the next phases of EMESH: staff training in hosting and documenting ETS conversations and a tailored, parent-driven set of intervention options.