Client Needs and Services in Outpatient Drug Free Treatment

1
Client Needs and Servicesin Outpatient Drug
FreeTreatment
Addiction Health Services Research
Conference Philadelphia, PA October 6-8, 2004
Funding from
Kirk M. Broome, Patrick M. Flynn, Danica K.
Knight, D. Dwayne Simpson Texas Christian
University
2
Overview of Needs Services

• Clients enter treatment with array of needs
• Supplemental services targeting needs improve
  outcome
• But services can be
• Expensive to provide
• Difficult to access

Etheridge, et al., 1995 (JSA) Friedmann, et al.,
2000 (HSR) McLellan, et al., 1998 (Addiction)
3
Programmatic Concerns

• Strategy for meeting needs
• Impact on staff working environment

What are current practices?
4
Service Networks
TreatmentProgram
5
Intake of Clients With Needs
Preliminary data from 30 program directors in
TCUTreatment Cost and Organizational Monitoring
(TCOM) Project
6
Linking to Legal Services
Percent of programs
7
Linking to Mental Health Services
Percent of programs
MH Assessment / Diagnosis
Psychiatric Services
p lt .05
8
Economic Influences
Budget Changes
Insurance Arrangements

• 33 reported shrinking budget
• More likely to enroll high CJ referrals
• No significant differences in service patterns

• 77 reported revenue from private insurance
• No significant differences in enrollment
• Less use of referred psychiatric services

9
Services Summary

• On-site delivery associated with mental health
  needs
• Economic concerns did not have straightforward
  impact on delivery method
• Calls for more fine-grained assessment

See Fletcher, et al., 2003 (JSAT) Friedmann, et
al., 1999 (JSAT) 2000 (HSR)
10
What About Working Environment?
11
Conceptual Model of Organizational Foundations
for Treatment Process and Change
12
Program Change Model
Institutional Personal Readiness
Program Change
Staff
Organizational Dynamics
Based on Simpson, 2002 (J Substance Abuse
Treatment)
13
Organizational Functioning

• Climate
• Mission
• Cohesion
• Autonomy
• Communication
• Stress
• Change

• Resources
• Offices/Staffing
• Training
• Equipment

• Staff
• Growth
• Efficacy
• Influence
• Adaptability
• Orientation

• Motivation
• Program Needs
• Training Needs
• Pressures

Simpson, 2002 (J Substance Abuse Treatment)
14
Organizational Profile for ORC ScalesWith 25th
75th Percentile Scores (TCU N1,623)
Motivation
Resources
Staff Attributes
Climate
15
Contingency Theory

• Key idea organizational coordination varies in
  response to the nature of the work
• Nonroutine tasks
• Highly variable
• Complex technology
• Organic management
• Participative decision-making
• Teamwork
• Nonroutine tasks call for organic management

Perrow, 1967 (Am. Soc. Rev.) Rowan et al., 1993
(EAQ) Thompson, 1967
16
Contingency Theoryapplied to treatment programs
Diversity of clientneeds makes counselorswork
less routine
Organic managementto help counselors cope
Combination ofAutonomy,Cohesion,
Communication
SD of need count,7 areasMedical, Psych., Job,
Educ.,Legal, Social,Transportation
17
Climate Predictions
Based on 450 clients 87 staff from 36
outpatient programs
OrganicManagement
p lt .05
Effects expressed in standard deviation units
18
Climate Summary

• Diversity of needs related to less organic
  management
• Treatment planning not sufficiently flexible
  coordinated
• May be sign of overload
• Suggests a need for
• Assistance in meeting client needs
• Organizational/managerial guidance

19
IBR
Institute of Behavioral Researchat Texas
Christian University
IBR HOME PAGE
A National Research Centerfor addiction
treatment studies in community and correctional
settings
WHATS NEW ABOUT IBR STAFF PROJECTS NEWSLETTERS P
UBLICATIONS PRESENTATIONS MANUALS FORMS OTHER
LINKS Search Contents Site map
TCU Resource Collections National
Treatment Evaluations Correctional Treatment
Evaluations Treatment Process Counseling
Manuals Cognitive Interventions Technology
Transfer Client/Treatment Assessments
Spotlight_______________ TCOM Project is
funded by NIDA  Read the in-depth articles on
IBR's newest project in the latest Research
Roundup Newsletter (Spring-Summer 2003 issue).
This multi-year project focuses on developing the
Treatment Costs and Organizational Monitoring
(TCOM) information system for drug treatment
providers. CJ-DATS for Southwest Region
 NIDA's cooperative agreement for Criminal
Justice Drug Abuse Treatment Studies includes the
IBR as one of its National Research Centers.  See
also the article in this Research Roundup
Newsletter (Fall 2002 issue).
SITE GUIDES

• New Activities___________
• The IBR Website is redesigned to streamline
  access and highlight integrated sets of materials
  manuals, forms, findings in specialized
  Resource Collections

Summary PowerPoint Presentations
www.ibr.tcu.edu
20
(No Transcript)