Delivering Treatment Services Research Articles

Perceptions of newly graduated social workers’ initial substance misuse treatment service delivery capacities in a Midwestern state

ABSTRACT This article details the findings of a 2020 study that explored how substance misuse treatment program directors rate the initial treatment service delivery capacities of newly graduated, master’s level social workers in a Midwestern state. The study consisted of a cross sectional, quantitative survey of all treatment program directors listed in the state’s Treatment Program Directory. In total, 43 respondents, or 18% of all listed treatment program directors, participated in the study. The results suggest that the surveyed directors believe that Master of Social Work graduates have an initial deficit of substance misuse treatment skills, knowledge, and overall preparedness to deliver treatment services. Recommendations for addressing this deficit include strategically integrating Council on Social Work Education curricular guidelines for substance misuse into MSW programs, and mandating substance misuse training for new social workers. More expansive studies on social workers’ substance misuse service delivery capacities are also recommended.

Exploring the formation of treatment program director perceptions on entry-level social workers’ substance use treatment capacities in New York

Background: This article examines how program directors of substance use treatment providers in New York state form their perceptions on the overall substance use treatment service delivery capacities of newly graduated, entry-level social workers. Methods: The study discussed consisted of a cross-sectional, quantitative survey of treatment program directors in New York state (n = 245). Program directors were asked to rate entry-level social workers’ treatment skills, knowledge of treatment concepts, and overall preparedness to deliver treatment services in the field upon first entering the professional workforce. The collected data were then analyzed using multiple regression analyses to identify associations between the skill and knowledge items and perceptions of overall preparedness. Results: The results of the study showed that five of the ten skill and knowledge competency items were significantly linked with program directors’ perceptions of entry-level social workers’ overall preparedness to deliver treatment services, with the model accounting for 62% of the variance in the dependent variable. Of the independent variables with significant associations, the assessment competency item accounted for 50% of the variance, while the other four variables explained 1.2–6.4% of the variance respectively. Conclusions: The findings of the study suggest that training curriculums should strongly emphasize assessment competencies for new practitioners, and that implementing a standardized training curriculum is beneficial for the professional growth and preparedness of practitioners entering into the treatment field.

Developmental screening and early intervention in a childcare setting for young children at risk for autism and other developmental delays: A feasibility trial.

Efforts to decrease disparity in diagnosis and treatment for under-resourced children with developmental delays, such as autism spectrum disorder, have led to increased interest in developing programs in community settings. One potential setting that has already demonstrated feasibility in conducting universal screening is the childcare setting. The current study conducted developmental screening in a total of 116 children ages 16-80 months of age in an urban low-income community childcare center. Parents of 20 children who screened positive were enrolled in the intervention phase of the study, where children received a staff-delivered targeted early intervention or a waitlist control condition. Given the small and imbalanced sample sizes, confidence intervals from mixed effect models were used to measure changes across time for each group. Of the children who received treatment, there was an average increase in child initiated joint engagement, symbolic play, and language use. This study provides initial feasibility data for the implementation of a screening and early intervention program to service a predominantly low-resource and ethnically diverse population within the childcare system in a large metropolitan city. Autism Res 2019, 12: 1423-1433. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Identifying and delivering treatment services for young children with developmental delays, such as autism spectrum disorder, may be most successful in community settings, especially for those children from under-resourced areas. This study found preliminary evidence that the childcare setting is a good place to conduct screening and deliver early interventions for children at risk for autism and other developmental delays.

Reinventing Community Corrections

AbstractCommunity corrections in the twenty-first century faces three challenges: how to be an alternative to imprisonment, how to be a conduit for reducing recidivism, and how to do less harm to offenders and their families and communities. Community corrections will reduce imprisonment only if its use is viewed as a legitimate form of punishment and is incentivized, which involves subsidizing the use of community sanctions and making communities pay to imprison offenders (e.g., a cap-and-trade system). To reduce recidivism, it will be necessary to hold officials accountable for this outcome, to ensure that evidence-based supervision is practiced, to use technology to deliver treatment services, and to create information systems that can guide the development, monitoring, and evaluation of interventions. Doing less harm—avoiding iatrogenic effects—will require nonintervention with low-risk offenders, reducing the imposition of needless constraints on offenders (i.e., collateral consequences), and creatin...

Challenges in the treatment of dangerous and severe personality disorder

Dangerous and severe personality disorder (DSPD) services have a relatively short history but are increasingly involved in the implementation of therapeutic programmes. We describe the background to the DSPD initiative in England and consider issues that arise in planning and delivering treatment services. Two bodies of evidence are particularly relevant: previous research into personality disorder and its treatment, which we suggest is as yet of limited value, and research into the outcomes of offender treatment programmes. The latter is clearly relevant but greater consideration of adapting programmes for the patient population and of breadth of treatment is required in the DSPD setting. The important task is to integrate components for the treatment of personality disorder and offending behaviour in a holistic manner. We describe three further challenges in delivering treatment and suggest that ongoing evaluation of treatments is critical in this area of practice, given the impoverished knowledge base.

Getting out and staying out

The government spends millions of pounds on delivering treatment services to chemically dependent offenders while they are serving sentences for drugrelated crimes ‐ but what happens to those offenders when they leave the prison gate? As RAPt (The Rehabilitation for Addicted Prisoners Trust) bids to raise charitable funds to pay for an aftercare team, Jessica Berens looks at good intentions and practical realities.

Can Psychiatry Prevent Suicide? Not Yet!

Let me begin by saying that I believe psychiatrists can and should play a significant role in the prevention of suicide in Canada. Whether this is currently the case is another question. Dr Lesage has advanced the “pro” opinion on this matter. It is my aim to examine these arguments in terms of scope, accuracy, and future planning. The “pro” part of this debate suggests that psychiatrists can prevent suicide in 3 ways: first, by adopting a shared care model that allows greater collaboration and thus better support for treatment of mental disorders (particularly depression) by general practitioners (GPs); second, by optimizing treatment of depression via the application of clinical management procedures as outlined by the Canadian Psychiatric Association; and third, by collaborating with addiction services, because alcohol and drugs are heavily involved in cases of completed suicide. Scope The merits of these points notwithstanding, they encompass an approach that falls far short of what might be considered comprehensive in regard to suicide prevention. In the first place, all the focus is on treatment of individuals who are actively suicidal and (or) suffer from mental illness. This approach has no room for early detection and intervention, no focus on healthy child development, and no emphasis on community development or ecologic interventions. To be fair, perhaps this is outside the purview of the In Debate section, since the topic refers to what psychiatrists can do, rather than to a comprehensive suicide prevention plan. Second, the focus seems to be on depression, but the evidence shows that virtually all mental disorders are associated with suicidal behaviour (for example, 1). In fact, schizophrenia and bipolar disorder show an equal or higher level of association with suicidal behaviour than does major depression (2,3). Third, it is important to consider suicide–substance abuse comorbidity, but suicide is related to any number of other social problems and conditions, including interpersonal violence, relationship difficulties, unintentional injuries, and being left out of the mainstream (4,5). This suggests that something causal underlies all these conditions, perhaps something social in nature. Finally, although it is reasonable, from the point of view of this journal’s readers, to conceive of a scheme with the medical profession at its centre, not everyone else sees it that way. Other professionals compete with psychiatry and general practice medicine to deliver treatment services—not as team members, but as primary care clinicians. It does not seem sensible either to ignore this or to compete. It should be noted, however, that the primacy of any mental health treatment specialist declines when we consider interventions at the societal level and when we engage in primary prevention with presuicidal children and youth.

The Status of Health Services Research on Adjudicated Drug-Abusing Juveniles: Selected Findings and Remaining Questions

This article focuses on the factors that affect the availability, accessibility, and opportunity of effective treatment for the adjudicated adolescent drug user. The social and developmental context of “drug abuse” and its treatment in adolescents, and particularly in adjudicated adolescents, is reviewed and compared with that in adults. Selected health services research findings on this population are discussed in terms of the effectiveness of delivering treatment services; the organization, management, and financing of services; and adoption of best practices (technology transfer).

Optimizing the cost-effectiveness of alcohol treatment: A rationale for extended case monitoring

There has been much research on and debate about the appropriate length of acute treatment for alcohol problems. In the United States, the lengthy and costly treatment programs of only a few years ago have been supplanted by ever-shorter and less intensive protocols, with little evidence that this trend will end soon. In this paper, we argue that, because of the chronic, recurrent nature of alcohol problems, an optimal system for delivering treatment services to alcoholics needs to focus on long-term engagement with clients. There is evidence from studies on research reactivity and telephone follow-up protocols that a low-intensity long-term protocol for maintaining contact with clients over time spans measured in years may result in better long-term clinical outcomes and reduced long-term health care utilization and costs. We describe a flexible long-term low-intensity follow-up protocol for alcohol abusers we call “case monitoring.” This protocol is specifically designed to minimize long-term health-care use. We predict that such an intervention should be especially efficacious for women, persons with comorbid Axis I disorders, and persons lower in sociopathy. The design of a study to determine the clinical and health service effects of this intervention is also described.