Building Bridges for Treatment Effectiveness

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Building Bridges for Treatment Effectiveness
NTA Treatment Effectiveness Launch (30 June 2005
London)
Psychosocial Interventions Assessments for
Improving Treatment Engagement Retention
D. Dwayne Simpson TCU Institute of Behavioral
Research
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Daily Opioid Use (in Year 1 After Discharge)
Medication vs Treatment
Low dose, low intensity, medical management scheme
Same pattern for criminality !
0 Days (Intake Only)
1-30 Days in Detox Only
1-3 3-12 12 Mos in Methadone Maintenance
(plt.01)
of DARP Sample (N3,248)
Simpson Sells, 1982
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Treatment Process in 21 MM Programs

• Programs with Longer Retention had -
• Better assessment program planning
• Higher MM dose better UA monitoring
• Comprehensive (wrap-around) services
• Higher ratings for meeting client needs

Similar findings for other modalities
Joe, Simpson, Hubbard, 1991, J Substance Abuse
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Changes in Psychosocial Functioning(Methadone
Treatment DATAR N279)
Depression
Self-Esteem
Anxiety
Risk Taking
Social Conformity
plt.01
Problems (TCU Client Evaluation of Self
Treatment)
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Outcomes for Cocaine Treatment
Problem Severity Retention
plt.001
of DATOS Sample (N708)
Simpson, Joe, Broome, 2001 (Arch Gen Psychiatry)
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Retention of Clients (Beyond thresholds)
BestProgram
PoorestProgram
Simpson, Joe, Broome, Hiller, Knight,
Rowan-Szal, 1997 (PAB)
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Process Model for Treatment
Other Services or Support Networks
Users Problem Severity Treatment Readiness

• Early Engagement
• Participation
• Therapeutic Relationship

Adequate Retention

• Follow-up
• Outcomes
• Drug use
• Crime
• Social
• Functions

• Early Recovery
• Changes in --
• Thinking
• Acting

Targeted Interventions (Behavioral Cognitive)
Simpson, 2002, 2004 (J Substance Abuse Treatment)
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(No Transcript)
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Selection of Targeted Interventions
Readiness Interventions
Other Services or Support Networks
Users Problem Severity Treatment Readiness

• Early Engagement
• Participation
• Therapeutic Relationship

Adequate Retention
Adequate Retention

• Follow-up
• Outcomes
• Drug use
• Crime
• Social
• Functions

• Follow-up
• Outcomes
• Drug use
• Crime
• Social
• Functions

• Early Recovery
• Changes in --
• Thinking
• Acting

Simpson, 2002, 2004 (J Substance Abuse Treatment)
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TCU Readiness Intervention(Motivation/Trt
Readiness Training)
CJ Offenders Mandated to Treatment
Simpson Joe, 1993 (Pt) Sia, Dansereau,
Czuchry, 2000 (JSAT)
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TCU Cognitive Intervention (Mapping
Communications Planning)

• TreatmentEngagement
• Participation
• Rapport
• Satisfaction

Dansereau, Joe, Simpson, 1993 (JCP), Dees et al.
97 (JSAT) Simpson et al., 97 (JSAT)
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More treatment, better treatment, fairer
treatment
Dropouts

• Clients
• Problem Severity
• Motivation
• Functioning

Engagement Retention
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Conceptual Model for Treatment
Organizational Functioning Change (Staff
Motivation, Resources, Attributes, Climate)
Other Services or Support Networks
Users Problem Severity Treatment Readiness

• Early Engagement
• Participation
• Therapeutic Relationship

Adequate Retention

• Follow-up
• Outcomes
• Drug use
• Crime
• Social
• Functions

• Early Recovery
• Changes in --
• Thinking
• Acting

Simpson, 2002, 2004 (J Substance Abuse Treatment)
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Program Differences in Client Functioning
(Average scores for 3 Treatment Programs)
Motivation/Need
Engagement Scales
Social Scales
Psychological Scales
Hi Needs Dysfunctional
Psychosocial Interventions?
Joe, Broome, Rowan-Szal, Simpson, 2002 (J
Substance Abuse Treatment)
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Models of Care Issues
Improve Treatment Engagement Retention

• Clients
• Problem Severity
• Motivation
• Functioning

Tier 4 Intensive Services
Orientation
Care Plans
Services
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Organizational Functioning
Early Engagement
Supportive Networks
Early Recovery
Retention/ Transition
Change Behavioral
Program Participation
Drug Use
Adequate Retention
Crime
Change Psycho-Social
Therapeutic Relationship
Social Functions
Posttreatment
Is it relevant to quality of care?
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Organizational Functioning Client Functioning
Early Engagement

• Mission
• Cohesion
• Communication
• Stress

Program Participation
Better organizations provide better
services
Therapeutic Relationship

• Client Rating
• Rapport
• Satisfaction

Lehman, Greener, Simpson, 2002 (J Substance
Abuse Treatment)
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Climate Cohesion of Staff (Scale scores range
10-50)
Lowest
50 of Programs
Highest
64 LHA Programs (in Italy)
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TCU Program Change Model
Institutional Personal Readiness
Stages of Change
Staff
Program Improvement (Services/Process/ Management)

• 1-Exposure
• (Training)
• Lecture
• Self Study
• Workshop
• Consultant

Organizational Dynamics
Simpson, 2002 (J Substance Abuse Treatment)
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Evidence for Program Change
Institutional Personal Readiness
Organizational Dynamics
Simpson, 2002 (J Substance Abuse Treatment)
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