Taking It To The Streets:

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• Taking It To The Streets
• Doing (Mostly) Substance Abuse Research in
  Community Agencies
• Eric E. McCollum Virginia Tech
• Terry S. Trepper Purdue Calumet
• University of Texas School of Social Work
• April 23, 2004

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History of Our Projects

• Adolescent Treatment
• Couples Treatment for Outpatient Women
• Couples Treatment for Inpatient Women
• Training Substance Abuse Counselors to Work with
  Families
• SFBT for Domestic Violence
• SF Group Therapy

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Adolescent Treatment

• NIDA-funded 5 year research project
• Three group, Random assignment
• Treatment and two controls
• Treatment integrated structural/strategic,
  behavioral
• Control One Family Psychoeducation
• Control Two Treatment as usual (Individual)

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Adolescent Treatment, Outcome

• Adolescents in a family-based therapy model
  showed a significant decrease in drugs used from
  pre- to posttreatment
• Adolescents in the family drug education program,
  nor individually-oriented treatment as usual did
  not show similar decreases

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Outpatient Couples

• NIDA-funded 5 year research project
• Abstinence-Based Methadone Maintenance
• Add-on Treatment
• Integrated Treatment Model

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Outpatient Couples Tx Model

• Structural/Strategic
• Whats the interpersonal problem?
• Intergenerational
• Why does it make sense?
• Behavioral
• What needs to change?
• SCT SIT

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Outpatient Couples Outcome

• Compared to Treatment as Usual
• Everyone got better during active treatment
• TAU maintained gains or got a little worse from
  post-test to 1 year follow-up
• Couples conditions continued to improve from
  post-test to 1 year follow-up

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Womens Residential Tx

• Imported the outpatient couples model to
  womens residential treatment
• SCT SIT
• Relationships a significant disruptor of womens
  residential treatment
• Looked at training substance abuse counselors to
  deliver the treatment

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Residential Tx Findings

• Qualitative data suggested improved functioning
  for women in the program
• Especially around parent-child interactions
• Substance Abuse counselor trainees less able to
  deliver the treatment

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Training CD Counselors

• Develop a circumscribed intervention
• Focus on basic skills
• Incorporated Solution-Focused therapy

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CD Counselor Settings

• State of Washington
• Adolescent Outpatient
• Adolescent Residential
• Counselors could learn the model
• Decreased attrition in treatment
• 82 of adolescents in model completed

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Domestic Violence

• NIMH-funded Stage 1 study
• Domestic Violence Focused Couple Treatment
• Treatment for couples who want to stay together
  when there has been violence
• Adapted SFBT model

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DV Outcome

• Quasi-experimental design
• N 51 couples
• 9 in convenience control group
• 42 randomized to couples conditions
• At 6 month follow-up female report of male
  assault
• Control group 66 recidivism
• Individual couples 43 recidivism
• Multi-couple group 25 recidivism

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Solution-Focused Group Therapy for Substance Abuse

• Pilot study
• Reverse engineering of a clinically useful
  model
• Pure SFBT delivered in group format
• Promising initial findings

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Group Therapy

• Probationers with drug/alcohol involvement
• Random assignment to SFGT or Hazelden
• 6 week treatment
• N 39 (19 per group)

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Group Therapy Outcome

• Trendy findings
• Pre-test to post-test change
• Substance Abuse
• SASSI Subtle Attributes scale (p .11, d .53)
• SFGT clients more likely to acknowledge problems
  than TAU at end

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Group Therapy Outcome (contd)

• Psychological functioning
• Beck Depression (p .06, d .64)
• OQ-45.2 Symptom Severity (p .07, d .61)
• SFGT improved more on depression/anxiety measures
  than did TAU
• Moderate effect sizes vs. an active Tx are
  encouraging

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NIDA Funding

• Currently have responded to the RFA for group
  treatments of substance abuse
• ??????

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Agency Issues

• Agency Characteristics
• Developing relationships
• Leadership
• Front line staff
• Who will deliver the treatment?
• Reconciling with disease-model approaches

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Effectiveness Research

• Do treatments that work well under controlled
  conditions, transfer to the clinic?
• Weisz, Weiss and Donenberg (1992)
• Child therapy produces much larger effects under
  experimental conditions than it does under real
  world conditions

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Working in Community Agencies

• Agency culture
• Relationships with agency staff
• Clinical credibility
• Using a treatment manual
• Recruiting research participants
• The wider social service context

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Agency Culture

• How open is the agency to research?
• What does agency want from research?
• Past experiences with research?
• Political issues intersecting with the research
  project?

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Relationships with Agency Staff

• Need to develop relationships at both line and
  administrative levels
• Give back to the agency staff
• Informal collaboration

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Clinical Credibility

• Communicate respect for the dilemmas of
  clinicians
• Be prepared for the collision of research and
  clinical cultures
• Demonstrate clinical expertise and agency savvy

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Participants

• Underestimation of subject pool
• Corrupting random assignment
• Cast a wide net early
• Use multiple modalities

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Wider Context

• Agency has obligations to wider social service
  context
• Have to explain the project to referral sources,
  other agencies, etc
• Especially true with a controversial treatment