Johnson Innovation Research Articles

Pain Prevalence in Head and Neck Cancer

This study aimed to explicate the prevalence of pain in patients with head and neck cancer (HNC). Head and neck cancer is associated with intense, multi-modal treatment that may result in substantial morbidity. Research suggests a high prevalence of pain among patients with HNC, and the level of pain may predict patients' 5-year survival. Understanding the pain prevalence of patients with HNC during and after treatment may inform strategies for caring for patients with HNC. This study was a secondary analysis of a systematic review of symptom and function measures used by patients with HNC. A systematic search of CINAHL, PubMed, APA PsycInfo®, and Health and Psychosocial Instruments (HaPI) databases between January 2005 and April 2020 generated 529 titles. Articles that described symptoms and functional limitations in HNC and met quality criteria were retained and reviewed for reports of pain prevalence. The review was registered with the National Institute of Health Research (CRD42021242513) and conducted according to PRISMA guidelines. The literature review identified eight articles that contained 12 reports of pain prevalence in patients with HNC. The highest prevalence of pain occurred at week 4 or later during treatment for HNC (83.4%), 3 months after diagnosis (54.1%), and with metastatic disease (66%). Between 38% and 45% of patients continued to report pain 12 months after diagnosis. Pain is a critical problem in HNC during and after treatment. Early detection and intervention for pain may help patients with HNC better tolerate treatment, uncover early cancer recurrence, and improve quality of life. Research initiatives are needed to understand the biological underpinnings of chronic, post-treatment pain in HNC and develop pharmacologic and non-pharmacologic treatments. Grant support from the following sources: The Hartford Change AGEnts Initiative (supported by a grant to the Gerontological Society of American from the John A. Hartford Foundation), The Palliative Care Research Cooperative Group funded by the National Institute of Nursing Research (U24NR014637), Oncology Nursing Foundation, Johnson & Johnson Innovations, National Science Foundation (2106141), NYU Mega-Grants Initiative, and Research Challenge Fund.

Paul Stoffels, CSO of J&J, to retire

Paul Stoffels, Johnson & Johnson’s chief scientific officer, will retire at the end of the year. Stoffels is credited with leading the development of J&J’s COVID-19 vaccine, as well as vaccines and treatments for HIV, Ebola, and tuberculosis. He also spearheaded Johnson & Johnson Innovation, a program to identify and incubate promising technologies and treatments. J&J has not announced Stoffels’s successor.

INSIDE INDUSTRY

$150,000 fundraiser launched to sequence South Asian genomes. United States dominates biosimilars market. Icon Group signs MoUs with two Vietnam hospitals. Philips opens Southeast Asia’s first Sleep and Respiratory Education Center. BlackBerry helps to secure and advance melanoma research in Australia. Asia-Pacific is fastest growing region for Bayer’s pharmaceuticals sales globally. Invion secures research alliance with Hudson Institute of Medical Research. New digital laboratory to provide tailored early life nutritional care. Johnson & Johnson Innovation announces S$5.1 million in World Without Disease Research Grants.

Third Annual Geneva R. Johnson Forum on Innovations in Physical Therapy Education: Formation of a Doctoring Professional: Are We Shying Away From Education that Really Matters in the Lives of Our Graduates?

INTRODUCTIONDr Geneva R. Johnson (Figure 1) continues to influence physical therapy education as an inspirational participant in the Third Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum (GRJ Forum). Dr Johnson is recognized for her longstanding leadership and mentorship, having contributed to the advancement of physical therapy education, practice, and research for over 60 years. The GRJ Forum started in 2014 through the collaborative efforts of the Academic Council of Academic Physical Therapy (ACAPT) and the Physical Therapy Learning Institute (PTLI).3,12 Once again it was the keynote for the 2016 Education Leadership Conference (ELC) held in Phoenix, Arizona. As expected, the Forum continues to foster creative ideas for positive change to promote excellence in physical therapist education, a hallmark of Dr Johnson's legacy.As in previous years, the Forum set the stage for energy, enthusiasm, and excitement for conference participants as discussions evolved to explore new opportunities to promote excellence in education. The GRJ Forum design is like no other in our profession. Key to its success is provocative speakers who share personal perspectives, immediately followed by active engagement all participants. As Tschoepe shared in her recognition to Dr Johnson and the introduction of the Forum, many remember what has become known as "Dr Johnson's 3 Ps of strong leadership skills": passion, persistence, and perseverance. Illustrations of these, as well as other essential personal leadership skills, were explored throughout the Forum by many speakers at ELC 2016.THE GRJ FORUM: ORGANIZATION AND STRUCTUREThe GRJ Forum is designed to:* Create a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than solving problems of the past.* Encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education.* Challenge educators to proactively advance physical therapy education to prepare graduates to meet projected societal and professional needs rather than merely react to external pressures.3The 2016 GRJ Forum featured Dr Emma Stokes, an international visionary leader and current World Confederation for Physical Therapy (WCPT) president, who energized the over-800 conference participants and set the stage for ongoing conversation and idea development throughout the conference. Her keynote was followed by 3 Ignite Talks from active leaders in physical therapy education in the United States - Dr Michael Majsak, Dr Bob Rowe, and Dr Chris Sebelski. Collectively, they shared individual perspectives of what each believed to be critical to foster graduate success in physical therapist practice that is entrepreneurial in spirit, illustrates personal ownership and accountability, and offers a unique value to the health care team to facilitate optimal, efficient, and effective individual-centered health promotion and management. Discussion by over 200 participants followed these speakers, and they more thoroughly explored the 13 themes presented, and discussed "how might we" or "wouldn't it be great if..." Participants had options to discuss 2 different themes, and table facilitators shared 3 possible highlights that might illustrate innovation and educational change to include education that really matters to better prepare physical therapist graduates for success in their future professional careersTHIRD ANNUAL GRJ FORUM HIGHLIGHTSKeynote Address - Walk With the DreamersEmma Stokes, PT, PhD, is deputy head of the Department of Physiotherapy and a fellow of Trinity College in Dublin, Ireland. She teaches in the university's entry to practice and PhD programs in Dublin and Singapore. Her research focuses on matters related to professional practice; particularly, leadership in the profession. She has received numerous awards and professional recognitions for her contributions to the physiotherapy profession and has been a board member of the World Confederation for Physical Therapy (WCPT) since 2007. …

Dynamic portfolio insurance strategies: risk management under Johnson distributions

The purpose of this paper is to analyze the gap risk of dynamic portfolio insurance strategies which generalize the “Constant Proportion Portfolio Insurance” (CPPI) method by allowing the multiple to vary. We illustrate our theoretical results for conditional CPPI strategies indexed on hedge funds. For this purpose, we provide accurate estimations of hedge funds returns by means of Johnson distributions. We introduce also an EGARCH type model with Johnson innovations to describe dynamics of risky logreturns. We use both VaR and Expected Shortfall as downside risk measures to control gap risk. We provide accurate upper bounds on the multiple in order to limit this gap risk. We illustrate our theoretical results on Credit Suisse Hedge Fund Index. The time period of the analysis lies between December 1994 and December 2013.

Second Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum: Inspiring Voices to Orchestrate Change in Physical Therapy Education

INTRODUCTIONThe vision and inspiration of Dr Geneva R. Johnson (Figure 1) led to many innovations in professional education and, by extension, in physical therapy practice and research. The Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum (GRJ Forum) honors Dr Johnson's prodigious impact on education for physical therapists and provides an opportunity annually for educators to explore options for innovation and change outside the boundaries of tradition or institutional constraint. The annual GRJ Forum was inaugurated in 2014 by the American Council of Academic Physical Therapy (ACAPT) and the Physical Therapy Learning Institute (PTLI) to launch the Education Leadership Conference (ELC), held annually to unite educators in the pursuit of excellence in physical therapy education. Key to its success was the use of appreciative inquiry (AI)1,2 to encourage exploration (rather than problem solving), creativity (rather than imitation) and bold action (rather than maintaining the status quo). The outcomes of the 2014 GRJ Forum3 excited the continued query of What If? as a pathway for discovering new possibilities for transforming the education that supports our profession. Reported below are the outcomes of the Second Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum, held as the opening session of the 2015 ELC in Baltimore, Maryland. The GRJ Forum continues to foster the courageous pursuit of change demanded by Dr Johnson, whose leadership in physical therapy education is legendary, but never static.THE GRJ FORUM: ORGANIZATION AND STRUCTUREThe GRJ Forum is designed to:* Create a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than focusing on problems of the past.* Encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education.* Challenge educators to proactively advance physical therapy education forward to prepare graduates to meet projected societal and professional needs rather than merely react to external pressures.3The 1st GRJ Forum had 5 components: (1) an inspirational keynote address delivered by a known provocateur, (2) 3 brief Ignite Talks delivered by change-oriented leaders invited to prod the audience further toward creative thought, (3) cafe style discussions facilitated by leaders trained to guide discussion into imaginative thinking, (4) reporting of key ideas developed in the discussions, and (5) a summary designed to invigorate energetic partnership in excellence for the education of all future generations of professional physi cal therapists. This year, a sixth element was added to create postconference momentum for change and encourage continued discussion of new possibilities. Participants selected a target for change in their home environments, made a commitment to action, and gave permission to be contacted in 6 months to determine progress toward that idea. This feature of the 2015 opening session extends the impact of the GRJ Forum beyond the walls of ELC and into the authentic world of physical therapy education.The 2015 GRJ Forum featured a keynote address delivered to all 700 conference participants by Dr Susan S. Deusinger, PT, PhD, FAPTA, leader and visionary in physical therapy education who used a musical analogy to demonstrate the dynamics of change in our profession. The Ignite Talks were delivered by 3 leaders active in academic and clinical education who shared their insights on innovative ideas for change in physical therapy education. The cafe style discussions engaged discussion among 300 participants around 22 topics generated by the keynote and ignite talks. These discussions were facilitated by an invited group of table facilitators who deftly used the principles of AI to help each group explore new possibilities for change. Guiding discussion with key phrases such as Wouldn't it be great if could or How might we fueled the excitement of participants to generate new ideas and prepare to report 3 major suggestions for change to the entire participating group. …

BIOBOARD

SINGAPORE – IBN Executive Director Professor Jackie Y. Ying Elected Fellow of the American Association for the Advancement of Science. SINGAPORE – NUS Researchers Develop Highly Efficient Nature-inspired Membrane that Can Potentially Lower Cost of Water Purification by 30 per cent. SINGAPORE – APACMed Implements Universal Code of Ethical Conduct for Corporate Members. CANADA – Victoza(R) (liraglutide) provides greater glycaemic control than SGLT-2 inhibitors. UNITED STATES – Neuroscientists Now Can Read the Mind of a Fly. UNITED STATES – Composting Food Waste remains your Best Option, new study says. UNITED STATES – How Music and Language Shape the Brain. UNITED KINGDOM – Cypralis Limited Announces Collaboration with Johnson & Johnson Innovation in the field of Neurodegenerative Diseases. JAPAN – Avantium reserves capacity in its first FDCA production plant for Mitsui. JAPAN – Takeda, Kyoto University start joint research on iPS drugs targeting six maladies.

Good Works

“If you do good work, it will be shared.” —Anonymous This issue is full of examples of this axiom. First, we have articles from our authors presenting the findings from their research efforts: Denton et al examine changes in students’ cultural competence in response to various learning activities in physical therapist education programs using a standardized measure. Gagnon et al provide information across multiple physical therapist education programs about the lack of student comfort with using social media and technology for professional purposes. Utley et al present data from almost 200 students about how content knowledge changes in response to the focus of clinical education experiences. Wilgens et al use qualitative design and techniques to explore conceptualization of theory related to mindfulness. Over the past 5 years, the editors and members of JOPTE’s Editorial Board have spoken frequently about important principles of sound educational research that strengthens design and methods, allowing great validity in and trust of results. The underlined terms show how these authors have used these principles. Good work! We also have 2 position papers in this issue, presented by authors with expertise and experience in these important areas: Kaplan et al are faculty with expertise in teaching and studying evidence-based practice (EBP) who developed guidelines for teaching EBP and shared strategies for using these guidelines. Perlow et al make the case for changing the approach to patient handling in physical therapy education to help reduce patient and therapist injuries in the future. In addition, we have an invited position paper from Deusinger that presents the talk she gave at the second Geneva R. Johnson Forum at the 2015 Educational Leadership Conference. This paper uses the principles of music composition to consider physical therapist education and is also available with a podcast that includes the virtuoso violinist, one of JOPTE’s own Editorial Board members, Dennis Fell, PT, MD. Good work all! We also have 3 other additions to this issue: A summary of the Second Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum is provided. We recognize the award recipients from the 2015 JOPTE published manuscripts. We thank all the hard working JOPTE reviewers. Thank you all for the good work done and the good work shared!

What does pharma want from academic drug discovery?

The pharmaceutical industry needs to collaborate with a wide group of stakeholders to identify and develop effective treatments for neurodegenerative disorders such as Alzheimer's disease, in particular academic partners. There are multiple advantages to industry-academic partnerships. Such collaborations bring together significant depth and breadth of complimentary expertise. Academia can often be the source of ‘disruptive innovations’, including new targets, biomarkers, and delivery approaches, allowing new insights, technologies and model systems to be developed from unexpected sources, either directly from academia or via the biotech companies which may have spun out of academic teams. Funding sources, such as charities or investors, may allow academic groups to make orthologous bets on novel treatment approaches. It is important for patients that industry and academia work closely together to develop the best molecules against validated targets with the ability to determine the right dose and the right patient populations. Johnson & Johnson Innovation was established in order to access innovative approaches, with Innovation Centres located in California, Boston, London and Asia Pacific with the ability to invest in or directly collaborate with academic teams or biotech spin offs. So what is industry looking for from academic drug discovery? In the ideal situation, the academic researchers will have a novel lead molecule which is likely to be safe, well tolerated and developable, with a validated or at least plausible biological hypothesis that can be tested early. However, significant value can be generated earlier than this new methods can develop molecules against previously intractable targets. Alternatively, academic drug discoverers may focus on the demonstration of the effects of treatment combinations which may be beyond the bandwidth of industry, but are likely to be of increasing importance. There is significant value in academic drug discovery, but this value relies on harnessing the unique aspects of academic research as opposed to replicating the drug discovery apparatus found within small and large industry. It is important that industry and academia work together for the benefits of the patients.

ACAPT First Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum: Doctor of Physical Therapy (DPT): So What? Now What? Educating DPTs as Leaders to Meet Future Societal Needs

INTRODUCTIONThe American Council of Academic Physical Therapy (ACAPT) is a component of the American Physical Therapy Association (APTA) and represents the institutions that provide physical therapist (PT) education. The purpose of ACAPT is to advance the enterprise of academic physical therapy by promoting the highest standards of excellence. For the purposes of ACAPT and its activities, academic physical therapy includes all aspects of PT education, including clinical education and post-professional education. ACAPT has a leadership role in establishing the direction of PT education and has the responsibility and accountability to duly reflect the interests and needs of the academic and clinical PT educational community.Critical to advancing the ACAPT vision, the ACAPT Board of Directors explored opportunities in 2013 to develop a think tank of sorts, where we could bring together multiple stakeholders in a safe environment to incubate ideas, encourage dialogue and intellectual discourse, and set the stage for action to positively impact the future of PT education. The Forum idea, held in conjunction with the Educational Leadership Conference, was thus born. It was named in honor of Dr Geneva R. Johnson, who for over 60 years has served as an extraordinary leader in physical therapy education. As was stated at the Forum, Dr Johnson began her physical therapy career in the United States (US) Army. As she developed her clinical skills, she also developed a profound sense of the importance of education for practice. She used her skill and vision to found the first graduate program in physical therapy at Case Western Reserve University in 1960. In her subsequent years as a physical therapy educator, she has taken the lead in residency education, interprofessional education, interprofessional practice, advocacy, and mentorship. Figure 1 is a graphic representation of all the things that Dr Johnson has meant to her colleagues in physical therapy.Thousands of students, faculty, and clinicians have benefited from Dr Johnsons insightful tutelage and her continual encouragement. She has tirelessly focused on educating and inspiring educational leaders who can clearly articulate a vision for our professional future and who are willing to take risks to achieve that vision. She continues to be a true visionary and inspires those around her to focus on the possibilities rather than on barriers. Dr Johnson has led the way with countless innovations in physical therapy education, including developing the first PT graduate program. She is a fitting namesake for the ongoing discussion of innovation in physical therapy education.The Forum will be presented annually with the goals of:* Creating a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than focusing on problems.* To encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education.* To challenge educators to proactively move physical therapy education forward instead of reacting to societal and professional needs.FORUM ORGANIZATION AND STRUCTUREAfter a presentation on Geneva R. Johnson, the Forum began with a keynote by a leading educator outside of physical therapy, followed by 3 short talks by PT educators designed to apply the keynote concepts to physical therapy. The last portion of the Forum consisted of development of new possibilities using the Appreciative Inquiry approach.1,2 Appreciative Inquiry is a way of thinking, seeing, and acting for powerful, purposeful change in organizations and has been found to be particularly useful in systems being overwhelmed by a constant demand for change, like that of physical therapy education. Appreciative Inquiry approaches change by assuming that whatever you want more of already exists in the organization, and that learning from best practices leads to new innovations. …

The Next Big Idea!

Cecilia Graham, in the 2015 Cerasoli lecture, shared her passion for a new curricular model, the concept-based curriculum. Big ideas are the focus of this type of curriculum development and the instructional goal is to develop a deep understanding of these ideas in the learner by exploring linkages between the concepts and active learning.1 A big idea is certainly embodied in the vision statement for the physical therapy profession: “Transforming society by optimizing movement to improve the human experience.”2 This vision statement has been rapidly integrated into the organizational life of the American Physical Therapy Association (APTA). For example, APTA's Board of Directors has set its 3 major goals of transforming society, the profession, and the association. Many of the components are building plans and developing activities in a similar fashion. In addition to the vision statement, 8 guiding principles have been adopted to demonstrate how the profession will appear when this vision is enacted. One of those principles is “identity”: The physical therapy profession will define and promote the movement system as the foundation for optimizing movement to improve the health of society. Recognition and validation of the movement system is essential to understand the structure, function, and potential of the human body. The physical therapist will be responsible for evaluating and managing an individual's movement system across the lifespan to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. The movement system is the core of physical therapist practice, education, and research.2 This principle has generated a great deal of conversation. For example, the APTA Board has adopted this definition of the movement system: “The human movement system comprises the anatomic structures and physiologic functions that interact to move the body or its component parts.”3 At the same time, the Board adopted the following statement on the specific role of the physical therapist relative to the human movement system.3 PHYSICAL THERAPIST PRACTICE AND THE MOVEMENT SYSTEM Human movement is a complex behavior within a specific context. Physical therapists provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. Physical therapists examine and evaluate the movement system (including diagnosis and prognosis) to provide a customized and integrated plan of care to achieve the individual's goal-directed outcomes. Physical therapists maximize an individual's ability to engage with and respond to their environment using movement-related interventions to optimize functional capacity and performance. Read that again. We have defined a new system of the human body and stated that physical therapists bring a unique perspective to evaluation of this system and to movement-related interventions. Nordstrom used this concept to develop an Ignite Talk at the 2014 Geneva R. Johnson Innovations in Physical Therapy Education Forum. He postulated that this topic could become the universal accepted framework for physical therapist education curriculum.4 Graham also speaks to this, saying: We envision movement system experts who are leaders, innovators, collaborators, and entrepreneurs who can synthesize rapidly changing information, integrate advances in technology into practice, and have the flexibility to thrive in an evolving health care environment.5 This is indeed a big idea, one that can serve as the focus of our curricula, our research, and our practice. Do you understand the implications of defining a new body system on all that we do? How will you change what you teach, how you teach it, or how you organize your teaching? Are you prepared for this big idea?

EYE ON CHINA

Clinical Genomics signs Chinese colorectal screening deal. WuXi PharmaTech laboratory testing division expands in U.S. with acquisition of XenoBiotic Laboratories. Roche to invest 450 million Swiss Francs in new diagnostic manufacturing facility in China. SCYNEXIS, Inc. enters into agreement with Waterstone Pharmaceutical for the development and commercialization of treatment for viral diseases. Johnson & Johnson Innovation launches Asia Pacific Innovation Center. ScinoPharm and Nanjing King-friend Biochemical Pharmaceutical team up to jointly enter the Chinese market for new drugs. Ascletis gains exclusive China market rights from Presidio for clinical stage Hepatitis C virus inhibitor. Irvine Pharmaceutical Services opens an analytical facility in Hangzhou, China. Pioneering application of Google Glass by Renji Hospital. WuXi PharmaTech launches representative office in Israel, forms strategic collaboration with Pontifax. International Symposium on molecular biology of fruit trees held at Huazhong Agricultural University.

INSIDE INDUSTRY

Fortis Escorts Heart Institute wins ‘Best Single Specialty Hospital - Cardiology‘ title. Probiodrug transfers its CDK9 inhibitor program to AstraZeneca. GE to expand in life sciences with acquisition of strategic assets from Thermo Fisher Scientific. MD Anderson teams up with Pfizer to advance cancer immunotherapy. Trovagene and US Oncology Research collaborate on a prospective study for urine-based KRAS testing in patients with metastatic pancreatic cancer. MedImmune and Immunocore enter immunotherapy agreement to develop novel cancer therapies. Nodality enters into a strategic collaboration with Johnson & Johnson Innovation in autoimmune diseases. Knopp Biosciences and NIH to collaborate in evaluating dexpramipexole in patients with hypereosinophilic syndrome. AMN Healthcare receives top workplace award. National Cancer Centre Singapore and Clearbridge BioMedics partner to bring circulating tumor cell technology closer to clinic. Latest updates on soaps, detergents, cosmetics, hair care industry at 4th Emerging HPC Surfactants Markets. CMT's 11th Phenol/ Acetone & Derivatives Markets in Shanghai, hones in on feedstock costs, excess capacities and more. A*STAR signs agreement with Nestlé to strengthen food & nutrition R&D in Singapore. Amorfix enters into agreement with a major global pharmaceutical company for Alzheimer's disease diagnostic. PHARM Connect Congress- One step before the future.

Biotech kibbutz

Johnson & Johnson and Takeda have partnered with the Israeli government and OrbiMed Israel Partners to build FutuRx, a collectively owned biotech incubator. The incubator is part of a global portfolio of partnerships and investments by Johnson & Johnson Innovation, the pharma's early stage collaborations unit.

INSIDE INDUSTRY

Singapore and Korea research institutes to collaborate on biomass-to-chemicals research. Nobel prize in medicine goes to cell transport discovery. Tri-institutional Therapeutics Discovery Institute, Inc. launched. Agilent Technologies collaborates with Florey Institute of Neuroscience and Mental Health. Quintiles selected by Muscular Dystrophy Association to develop U.S. Disease Registry. Joslin Diabetes Center forms alliance with John & Johnson Innovation to identify exercise-related drug targets to improve diabetes management. CLINATEC chairman Alim-Louis Benabid honored for Parkinson's disease work. AstraZeneca enters co-promotion agreement with Janssen in Japan for innovative prostrate cancer treatment. Scotland demonstrates its collaborative approach to cell therapy development. KineMed forms agreement with Amgen to develop kinetic biomarkers of brain proteinopathies. IMCD group opens its first pharmaceutical laboratory. Napier Healthcare wins Promising Healthcare IT Company of the Year 2013 Award from Frost & Sullivan Singapore. AB SCIEX opens R&D center in Singapore; hopes to drive scientific innovation.

The ARISE Intervention. Using family and network links to engage addicted persons in treatment.

An alternative method to the Johnson Institute's "Intervention" is presented which, while incorporating many of Johnson's innovations, is, additionally: (a) less confrontative, thereby avoiding the reactivity in clients and family members that such confrontational approaches have tended to evoke; (b) takes into account both the needs of the chemically dependent person as well as the needs of the larger family and network system; and (c) aimed toward enrolling substance abusers in outpatient (as well as inpatient) treatment, thus placing it more in line with managed care priorities. Principles for treatment engagement are presented, accompanied by case examples. The approach is part of a more comprehensive model designed to maximize successful engagement with a minimum amount of professional time and effort.