OUTCOME MEASURES AT ODYSSEY HOUSE

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OUTCOME MEASURES AT ODYSSEY HOUSE

• Presentation by
• Dr Alex Davidson
• MRSNZ, Research Analyst

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Odyssey Profile (1)

• Odyssey House treats around 400 clients a year.
• There are 8 programmes (6 residential, 2 non-
  residential).
• The client population is young (average age 23
  years).
• The clients are 60 male and 40 female.
• 58 of clients are Caucasian, 33 Maori, 4
  Pacific Islanders, 5 Asians.
• The major problem substances are cannabis (72
  of all clients), alcohol (61),
  meth- amphetamines (36), amphetamines (8).

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Problem Substances
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Odyssey Profile (2)

• Most clients have more than one admission. The
  average is 1.80 admissions per client.
• The average time they remain in treatment is 5.07
  months per client, or 3.08 months per admission.
  
• The effectiveness of the treatment is less
  dependent on the length of time spent at Odyssey,
  and more dependent on the treatment level
  reached.
• Odysseys model has a Start Phase, three
  Treatment Phases, two Re-entry Phases and an
  Aftercare Group.

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Research History

• Research Officer appointed April 2002
• SPSS statistical package bought mid-2002
• New clinical data base (MIS)
• introduced August 2003
• Research DB draws data directly
• from MIS via Access data base
• Research Data Base now holds over 2000 client
  records in coded form.
• Each client record is split into 733 variables.
• Monthly and Annual Reports provided since August
  2002
• 1. Demographic details
• 2. Clinical details
• 3. Treatment details
• 4. Performance measures against budget/targets

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The Research Data Base (1)

• Supplies demographic reports

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The Research Data Base (2)

• Supplies statistical reports

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The Research Data Base (3)

• Supplies performance measures

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Therapeutic Community
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Research Projects (1)

• Treatment outcomes 1 ? Success in treatment

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Progress in Treatment

• Progress in treatment is assessed by a model
  based on harm reduction criteria. Four outcome
  domains are measured by a number of instruments.
  These are
• Decreased distress over drug and alcohol problems
  (instruments Goldberg Depression Test, McLean
  Craving Index).
• Effectiveness and efficiency of facilities and
  service delivery (indicators occupancy rates,
  retention in treatment, waiting period before
  admission, staff support assessment).
• Client satisfaction increase measured across time
  (instrument Client Satisfaction Survey).
• Assessment of four TC-related treatment domains
  (instruments CAS and SAS tests). The four
  domains are

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Assessment of four TC-related treatment domains

• Socialisation change cease drug-related
  behaviours, enhanced social skills, motivation to
  pro-social activity such as in-treatment duty
  assignments.
• Psychological change decreased acting-out,
  increased verbal expression, enhanced self-esteem
  and insight, regulation of emotions.
• Developmental change enhanced maturity,
  acceptance of responsibility, attitude towards
  others, capacity to receive feedback, etc
• Community membership increased investment in
  treatment milieu and willingness to serve as role
  model, reflecting greater social responsibility.

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Paired test results for the last 6 months

• The Progress in Treatment project uses six
  iterated tests to provide indications of client
  improvement during the treatment process. These
  tests are repeated at least once at established
  intervals, the differences between the scores
  indicating improvement or deterioration in key
  aspects of change in response to Therapeutic
  Community treatment. Positive differences
  indicate improvement, and vice versa.

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Aftercare Service (1)

• Formal treatment represents just one chapter in a
  persons life, and once individuals leave the
  programme environment there are a myriad of other
  influences that come to bear on their lives.
• In order to assist them to maintain the social
  and psychological stability obtained while in
  intensive residential treatment, continuing care
  services must be established.

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Aftercare Service (2)

• The Odyssey Aftercare Service aims to provide a
  holistic service offering advice, guidance and
  support for those who have been in Odysseys
  residential programmes.
• The service will meet the following objectives

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Aftercare Service Aims

• To maintain the therapeutic relationship
  established whilst in intensive residential
  treatment in order to achieve positive outcomes
  for the client.
• To improve pathways into treatment and ensure
  continuity of support.
• To provide coping skills training within the
  context of the clients actual social
  environment.
• To provide an environment in which support and
  encouragement can be obtained from ones peers.
• To minimise the harm associated with mental
  illness and addictions.
• To adopt a case management approach in order to
  assist clients in accessing and utilising social
  support services available within the community.
  This also includes assistance to gain and
  maintain employment or vocational training.
• To provide individual and family counselling
  where indicated.

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Research Projects (2)

• Treatment outcomes 2 ? Success post-treatment
• Odysseys Aftercare Programme members are
  assessed monthly by a single, multi-part
  instrument (the Post-Treatment Questionnaire).
  This measures progress in seven domains
  representing five dimensions. These are
• Drug abuse smoking, craving, substance use or
  gambling.
• Well-being depression, suicidal ideation.
• Family reunification, reconciliation with
  partner/parents etc.
• Employment and earnings.
• Interaction with the criminal justice system.

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Challenges

• Staff acceptance and compliance
• Clinical value and research value
• Compact tests vs. validity/relia-bility criteria
• Integration into clinical pathway

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Research at Odyssey

• The Clinical data base

and the Research data base

• valuable resources for
• management
• treatment
• planning