Dataset Information

Program structure and counselor-client contact in outpatient substance abuse treatment.

ABSTRACT:

Objectives

To examine organizational structural attributes associated with counselor-client contact.

Data sources

Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs.

Study design

The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predictors of time in counseling and case management, and caseload size, controlling for geographic differences.

Data collection

Directors at 116 outpatient drug-free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure.

Primary findings

Clients received more counseling hours in programs that were "intensive," publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in "intensive," private-for-profit or publicly owned (versus private-nonprofit) programs, serving a lower proportion of dual-diagnosis clients, and providing more on-site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients.

Conclusions

Organizational attributes are related to counselor-client contact and may have implications for staff turnover and service quality.

SUBMITTER: Knight DK

PROVIDER: S-EPMC2442366 | biostudies-literature | 2008 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Program structure and counselor-client contact in outpatient substance abuse treatment.

Knight Danica K DK Broome Kirk M KM Simpson D Dwayne DD Flynn Patrick M PM

Health services research 20080401 2

<h4>Objectives</h4>To examine organizational structural attributes associated with counselor-client contact.<h4>Data sources</h4>Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs.<h4>Study design</h4>The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predi ...[more]

PMID: 18370970

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Project description:BACKGROUND:While treatment satisfaction has been associated with better outcomes in substance abuse treatment, there is an obvious need for a more profound understanding of what predicts client's satisfaction with treatment. This study elucidates factors relevant to treatment outcome measured at follow-up in terms of satisfaction with the treatment received. METHODS:The research was implemented as a multisite study in outpatient clinics (N?=?7) in southern and western Finland. Data consists of therapists (N?=?33) and their clients (N?=?327). Each consenting client beginning a treatment period was accepted as a research subject and all therapists at the clinics in question participated. The study was conducted as part of the clinic's normal activity. Clients were allocated to therapists according to a randomization list drawn up in advance. Apart from the randomisation and the completion of questionnaires, it did not interfere with the progress of treatment. Follow-up lasted 6 months. Multiple Classification Analysis (MCA) was used through combinations of variables organized by content, e.g. client demographics, previous substance use, therapist's characteristics and client's expectations. The analyses were based in part on conventional statistical testing (t -test, ?2-test, ANOVA). RESULTS:Among 37 independent variables few were statistically significant in the final model. The results suggest that high treatment expectations at baseline are a strong predictor of satisfaction at follow-up. Also, previous substance use predicted treatment satisfaction; people using multiple substances were less satisfied than those taking only one substance. Stronger predictors reduced the statistical significance of those independent variables that were statistically significant in the first analyses. Therefore, therapist's role in recovery and readiness to change should be also seen as antecedents to treatment satisfaction. CONCLUSIONS:It seems that treatment expectations are fulfilled among those participating in follow-up. Yet many are lost during treatment and by follow-up. Service users have experiential knowledge that differs from professionals' and policymakers' knowledge. It is clinically relevant to understand what factors affect client's satisfaction. Hence, it is possible to identify the population whose treatment should receive the most attention, how the client's experience, their commitment to treatment, and treatment effectiveness could be improved.

Project description:Research has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators. A large proportion of IPV perpetrators is diagnosed with co-occurring substance use disorders and it has been demonstrated that successful treatment of alcohol dependence among alcohol dependent IPV perpetrators also led to less IPV. The current study investigated the relative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) to cognitive behavioral treatment addressing substance use disorders including only one session addressing partner violence (CBT-SUD+) among patients in substance abuse treatment who repeatedly committed IPV. Substance use and IPV perpetration were primary outcome measures.Patients who entered substance abuse treatment were screened for IPV. Patients who disclosed at least 7 acts of physical IPV in the past year (N?=?52) were randomly assigned to either I-StoP or CBT-SUD+. Patients in both conditions received 16 treatment sessions. Substance use and IPV perpetration were assessed at pretreatment, halfway treatment and posttreatment in blocks of 8 weeks. Both completers and intention-to-treat (ITT) analyses were performed.Patients (completers and ITT) in both conditions significantly improved regarding substance use and IPV perpetration at posttreatment compared with pretreatment. There were no differences in outcome between conditions. Completers in both conditions almost fully abstained from IPV in 8 weeks before the end of treatment.Both I-StoP and CBT-SUD+ were effective in reducing substance use and IPV perpetration among patients in substance abuse treatment who repeatedly committed IPV and self-disclosed IPV perpetration. Since it is more cost and time-effective to implement CBT-SUD+ than I-StoP, it is suggested to treat IPV perpetrators in substance abuse treatment with CBT-SUD+.

Dataset Information

Program structure and counselor-client contact in outpatient substance abuse treatment.

Objectives

Data sources

Study design

Data collection

Primary findings

Conclusions

Publications

Program structure and counselor-client contact in outpatient substance abuse treatment.

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