Residential Treatment Program Research Articles

CARF adds OBOT accreditation and ASAM certification

CARF is launching two new programs: (1) an addition to its accreditation programs, this time for office‐based opioid treatment programs (OBOTs), and (2) a certification program in which CARF is partnering with the American Society of Addiction Medicine (ASAM) to certify residential treatment programs; programs eligible for the certification will be at specific levels of care in the ASAM criteria.

The impact of rural classification systems on a comparison of risky drug-related behaviors in Kentucky and Ohio counties

ABSTRACTTo analyze county-level differences in injection drug use (IDU) behaviors and overdoses in Kentucky and Ohio, and to assess the impact of using different models to classify counties as rural.Existing clinical data were pooled from three regional programs: 1) an opioid overdose prevention program (OOPP) within a residential addiction treatment program (n=163), 2) a regional evaluation of four OOPPs (n=655), and 3) a mobile syringe services program (n=1,379), representing 17 counties each in Kentucky (n=516) and Ohio (n=1,618). Pearson chi-square tests were used for dichotomous variables and an analysis of variance (ANOVA) was used to compare continuous variables. A Tukey HSD posttest was used to identify statistically significant comparisons.Age at first IDU was consistently younger in rural counties. However, findings changed based on the classification scheme used. This was also true for the prevalence of methamphetamine use.The rurality classification applied at the county level may be an important consideration in the analysis of research studies.

Predictors of Co-Occurring Substance Use among Asian Americans in Residential Treatment Programs

Although severe and chronic mental disorders are common among Asian Americans in residential treatment programs, little has been known about the prevalence and predictors of co-occurring substance use in this population. The purpose of this study was to examine predictors of co-occurring substance use among Asian Americans with mental disorders in residential treatment programs. This cross-sectional study included 375 clinical records of Asian Americans from residential treatment programs between 2007 and 2011. Demographic variables, principal psychiatric diagnoses, and data on alcohol, stimulant, and marijuana use were obtained from the clinical records. Separate binary logistic regression analyses were used to examine the demographic and diagnostic contributions to the risk of each type of substance use. Findings of this study indicated that the prevalence of co-occurring substance use was about 53% in Asian Americans with mental disorders. Binary logistic regression analyses revealed that male gender, older age, and depressive disorder predicted more alcohol use, but homelessness and schizophrenia predicted less alcohol use. Male gender, homelessness, and smoking predicted more stimulant use. Male gender and younger age predicted more marijuana use. Based on the findings of this study, awareness about co-occurring substance use problems of ethnic minority psychiatric clients should be increased and appropriate substance use prevention and treatment programs should be developed and provided for high-risk groups.

Biofeedback as an adjunct to conventional stress management and relaxation techniques in substance abuse disorders: A randomized controlled interventional study

Background: Biofeedback has been employed in substance abuse disorder over the last three decades. Stress, anxiety, and depression are commonly seen in patients with substance abuse disorders. Biofeedback employed in conjunction with other relaxation therapies may be useful in enhancing certain outcome of therapy. Biofeedback either alone for alcoholism or in combination with other relaxation techniques for stimulant and mixed substance abuse and combined with residential treatment program is probably efficacious. Objectives: This study is aimed at assessing effectiveness of biofeedback-assisted relaxation techniques and stress management for substance abuse population. Study Design: A randomized controlled interventional study design was chosen for the research. Methods: The study sample consisted of 60 in-patient males aged 18–55 years, diagnosed with mental and behavioral disorders due to multiple drug use and use of other psychoactive substance, according to the International Classification of Diseases-10, Diagnostic Criteria for Research (1992) criteria (30 in biofeedback and 30 in control groups). The patients were first screened for inclusion criteria and then recruited from CIIMHANS Mental Health Institute of Central India using lottery method for random allocation. A randomized controlled interventional study design was chosen for the research. Sociodemographic data and clinical details of all the patients were assessed using Depression-Anxiety-Stress Scale followed by biofeedback-assisted relaxation techniques, which was conducted for 30 days. Results: The present study shows that there was significant difference in the stress (t = 3.841, P

Pilot study of a 3-day residential treatment for smoking cessation in Hong Kong.

INTRODUCTIONThe Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation has been providing free smoking cessation services since 2009. The average quit rate from 2009 to 2014 was 37%. In order to boost the quite rate, we have implemented a residential treatment program for smokers who volunteered to participate. Having run the program for two years, we conducted a retrospective cohort study to evaluate its effectiveness.METHODSWe recruited the participants who had failed previous quit attempts and who came to seek our smoking cessation services. A 3-day residential program of activities were arranged for our participants. Intensive individual and group counseling was provided. Pharmacotherapy was also provided to alleviate withdrawal symptoms. This was followed by our usual treatment and follow-up program. Self-reported 7-day point prevalence abstinence rate at 26 weeks based on intention-to-treat (ITT) analysis was assessed.RESULTSA total of 40 clients volunteered to join the program, age 26 to 65 years old with a mean of 44.1 years. There were 25 (62.5%) males and 15 (37.5%) females. The quit rate at 26 weeks was 57.5%. Smokers older than 43 years, having cohabiting smokers, and smoking for more than 28 years, were more likely to quit and this was statistically significant.CONCLUSIONSThis pilot study demonstrated that a 3-day residential program is effective in helping addicted smokers who volunteer to quit smoking and is cost effective compared to longer residential programs.

Association of Neural Responses to Drug Cues With Subsequent Relapse to Stimulant Use

ImportanceAlthough chronic relapse is a characteristic of addiction to stimulants, conventional measures (eg, clinical, demographic, and self-report) do not robustly identify which individuals are most vulnerable to relapse.ObjectivesTo test whether drug cues are associated with increased mesolimbic neural activity in patients undergoing treatment for stimulant use disorder and whether this activity is associated with risk for subsequent relapse.Design, Setting, and ParticipantsThis prospective cohort study of 76 participants included a control group for baseline group comparisons. Veteran patients (n = 36) with stimulant use disorders were recruited from a 28-day residential treatment program at the Veterans Affairs Palo Alto Health Care System. Healthy controls (n = 40) were recruited from the surrounding community. Baseline data were collected between September 21, 2015, and January 26, 2018, from patients and healthy controls using functional magnetic resonance imaging during a performance of a reward cue task. Patients’ stimulant use was subsequently assessed after treatment discharge (at approximately 1, 3, and 6 months) to assess relapse outcomes.Main Outcomes and MeasuresPrimary measures included neural responses to drug and food cues in estimated mesolimbic volumes of interest, including the medial prefrontal cortex, nucleus accumbens (NAcc), and ventral tegmental area. The primary outcome variable was relapse (defined as any stimulant use), assessed both dichotomously (3 months after discharge) and continuously (days to relapse). Brain activity measures were contrasted between groups to validate neural measures of drug cue reactivity, which were then used to estimate relapse outcomes of patients.ResultsRelative to controls (n = 40; 16 women and 24 men; mean [SD] age, 32.0 [11.6] years), patients (n = 36; 2 women and 34 men; mean [SD] age, 43.4 [13.3] years) showed increased mesolimbic activity in response to drug cues (medial prefrontal cortex, t74 = 2.90, P = .005, Cohen d = 0.66; NAcc, t74 = 2.39, P = .02, Cohen d = 0.54; and ventral tegmental area, t74 = 4.04, P < .001, Cohen d = 0.92). In patients, increased drug cue response in the NAcc (but not other volumes of interest) was associated with time to relapse months later (Cox proportional hazards regression hazard ratio, 2.30; 95% CI, 1.40-3.79). After controlling for age, NAcc response to drug cues classified relapsers (12 patients; 1 woman and 11 men; mean [SD] age, 49.3 [14.1] years) and abstainers (21 patients; 1 woman and 20 men; mean [SD] age, 39.3 [12.3] years) at 3 months with 75.8% classification accuracy. Model comparison further indicated that NAcc responses to drug cues were associated with relapse above and beyond estimations of relapse according to conventional measures.Conclusions and RelevanceResponses in the NAcc to stimulant cues appear to be associated with relapse in humans. Identification of neural markers may eventually help target interventions to the most vulnerable individuals.

Comparing GBMI and non-GBMI Female Prisoners in Michigan.

The guilty but mentally ill (GBMI) verdict was first adopted in Michigan in part to provide treatment for offenders suffering from mental illness. Currently, little is known of its impact among women prisoners. Therefore, the primary aim of this study was to explore if GBMI women (n = 30) spent more time on acute and residential treatment program (RTP) units in prison and/or had a higher number of violence tickets, compared with matched guilty mentally ill prisoners (non-GBMI, n = 30). The secondary aim was to characterize Axis I and Axis II disorders in GBMI female prisoners. Finally, we analyzed the data to find which Axis I and II disorders, if any, were significantly associated with violence tickets in the first year of incarceration and time in acute and RTP settings. Results showed there were no significant differences in time on acute units or the number of violence tickets between groups. Across both groups, those diagnosed with Borderline Personality Disorder had a higher number of violence tickets in the first year of prison (p < .001). The results supported the arbitrariness of the GBMI verdict in the female population and advocated for Dialectical Behavioural Therapy (DBT) programs in prisons.

Analysis of Therapeutic Factors and Effects of Residential Treatment Program for Youth

Analysis of Therapeutic Factors and Effects of Residential Treatment Program for Youth

Predictors of change in cognitive processing therapy for veterans in a residential PTSD treatment program.

Cognitive processing therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD); however, questions remain regarding variability in treatment response. A total of 123 veterans participated in group-based cognitive processing therapy (CPT) in residential PTSD treatment. Change over time in PTSD symptoms was modeled as a function of selected demographic and clinical variables. PTSD checklist (PCL) scores decreased by an average of 1 point per session (standard deviation [SD] = 0.1). Initial PCL scores were predicted by the Beck Depression Inventory-II (γ01 = 0.25; standard error [SE] = 0.08), Insomnia Severity Index (γ02 = 0.53; SE = 0.15), and Infrequency (F) scale of the Minnesota Multiphasic Personality Inventory-2 (γ03 = 0.09; SE = 0.04). Rate of change was predicted by the Somatic Complaints (RC1) scale (γ11 = -0.03; SE = 0.01) and the Antisocial Behavior (RC4) scale (γ12 = 0.02; SE = 0.01). These results provide insight into characteristics that may influence degree of benefit received from group-based CPT.

Integrating comprehensive hepatitis C virus care within a residential substance use disorder treatment program

Background and aimsAlthough central to the hepatitis C virus (HCV) epidemic, many patients with both substance use disorders (SUD) and HCV have difficultly engaging in treatment for either condition. To facilitate HCV care in Veterans with active SUD, a comprehensive HCV screening, education, referral, and treatment program was integrated into a VA residential SUD treatment program. MethodsEvaluation of HCV screening, education, referral, and treatment initiative among admissions to a residential SUD treatment program from December 2014 to April 2018. ResultsTo date, 97.49% (582/597) of admissions to the program have been screened for HCV infection, with 12.71% (74/582) of the cases confirmed HCV-positive, and 100% (74/74) of the positive cases being connected or re-connected to the infectious disease clinic for further evaluation and, if appropriate, to begin HCV pharmacotherapy. Importantly, 18.92% (14/74) of the HCV-positive cases were newly diagnosed and would have likely gone undetected without this program. Of the HCV-positive cases, 78.38% (58/74) have received pharmacotherapy, with a sustained virologic response rate of 82.76% (48/58). ConclusionsIntegrating comprehensive HCV care within a residential SUD treatment program using a collaborative care model can substantially increase the detection of previously undiagnosed infections, facilitate linkage to care, and promote HCV treatment uptake among HCV-infected Veterans with SUD.

Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs

Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt. VHA electronic health records and program survey data were used to describe pharmacotherapy provided to a national cohort of VHA patients with OUD in residential treatment programs (N = 4,323, 6% female). Staff members (N = 63, 57% women) from 44 residential programs (response rate = 32%) participated in interviews. Barriers to and facilitators of pharmacotherapy for OUD were identified from transcripts using thematic analysis. Across all 97 residential treatment programs, the average rate of pharmacotherapy for OUD was 21% (range: 0%-67%). Reported barriers included provider or program philosophy against pharmacotherapy, a lack of care coordination with nonresidential treatment settings, and provider perceptions of low patient interest or need. Facilitators included having a prescriber on staff, education and training for patients and staff, and support from leadership. Contrary to our hypothesis, barriers to and facilitators of pharmacotherapy for OUD in VHA residential treatment programs were consistent with prior research in outpatient settings. Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VHA providers, may help improve receipt of pharmacotherapy for OUD.

Mindfulness-based stress reduction for mental health in youth: a cluster randomized controlled trial.

Mental illness is among the most common causes of morbidity, mortality, and disability in childhood. Mindfulness-based stress reduction (MBSR) has shown significant benefit in mental health; however, evidence of its effectiveness in youth is limited. The objective of this study was to compare the efficacy of MBSR plus usual care versus usual care alone for reducing mental health symptoms in youth. A two-arm, mixed methods, randomized cluster-controlled trial of 12-18year olds who were residents of CASA House, a voluntary residential treatment program for adolescents, between January 2011 and March 2013 (clinicaltrials.gov, NCT01307943). Treatment terms were randomized to usual care, or MBSR plus usual care, which included eight MBSR sessions of 2hr/week. The primary outcome was impact on emotions and behavior at the end of the program, using the Behavior Assessment System for Children, Second Edition (BASC-2). Secondary outcomes included perceived stress levels, mindfulness, and emotional regulation. A total of 85 participants were randomized to either the MBSR arm (n=45) or control arm (n=40). Significant differences in favor of MBSR were found on Teacher ratings of the Internalizing Problems (p=.038) and Adaptive Skills subscales (p=.022) on the BASC-2. No significant differences were found on other outcomes. A post hoc analysis found that the MBSR arm had a significantly shorter time to discharge (p=.02). The results of this study indicate that MBSR is effective for improved coping with internalizing problems and adaptive emotional skills in our sample. Future studies should focus on larger, longer-term studies in youth.

Role of Motor Competence and Executive Functioning in Weight Loss: A Study in Children with Obesity.

This study aimed to compare motor competence and executive functioning (EF) between children with obesity and peers with healthy weight. Additionally, the predictive value of motor competence and EF in weight loss after a 5-month multidisciplinary residential treatment program was examined. Thirty-two children with obesity (7-11 years, 14 boys) and 32 age-matched controls (18 boys) performed 8 motor skill tasks and 4 tasks of EF (only at baseline). In the group of children with obesity, anthropometric measurements were performed at baseline and 5 months after the start of their treatment program. Also in control children, there was a time span of 5 months in between anthropometric measurements. Lower levels of motor competence and reduced updating abilities, inhibition control, and planning skills were observed in children with obesity compared with healthy-weight controls. Within the total group, better general motor competence and balance skills were significantly associated with better updating, inhibition control, and planning. Finally, hierarchical regression analyses revealed that ball skills, balance skills, and inhibition/updating at baseline predicted 14% to 17% of the variance in weight loss after a 5-month treatment program in children with obesity. These results suggest that motor competence and EF are both relevant factors associated with childhood obesity. Moreover, these factors seem to be significant predictors of weight loss. Future (intervention) studies are needed to understand the impact of the difficulties in motor and EF on obesity-related behaviors as well as on short-term and, especially, long-term weight loss and maintenance.

Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients

AimsTo evaluate the effectiveness of an addiction-related supportive text messaging mobile intervention to improve treatment outcomes for patients with alcohol use disorder (AUD). MethodsA single-rater-blinded randomized trial was conducted involving 59 AUD patients who completed a residential addiction treatment program. Patients in the intervention group (n = 29) received supportive text messages for three months following discharge. Patients in the control group (n = 30) received a text message thanking them for participating in the study. The primary outcome of this study was the three months Cumulative Abstinence Duration (CAD); secondary outcomes (units of alcohol per drinking day, numbers of days to first drink) and exploratory outcomes (health utilization) were evaluated. Subgroup analyses were also done. The enrollment rate in the study was 84%, and of those who enrolled, 73% were retained. ResultsWhen primary and secondary outcome measures were examined via effect size analysis, the number of days to first drink was longer in the intervention than control group (large effect size, although not statistically significant). The intervention group's mean first day to drink was over twice the length of the control group (e.g., approximately 60 vs. 26 days, respectively, with a mean difference of 34.97 and 95% CI of −5.87–75.81). Small to moderate effects were found for CAD and units of alcohol per drinking day. Small to negligible effects were found for health utilization. On subgroup analyses, the participants who received text messages, among those who did not attend follow-up outpatient counselling, showed a longer CAD. ConclusionsThe results suggest text messaging is a feasible and effective opportunity for follow-up care in patients discharged from residential AUD treatment.

Use of Reflective Journaling to Understand Decision Making Regarding Two Evidence-Based Psychotherapies for PTSD: Practice Implications.

As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their successes and challenges in using prolonged exposure and cognitive processing therapy. This paper provides content analysis on the reflective journals of 24 of these providers. Five main themes were identified: EBPs are great but not sufficient for patients in residential treatment with chronic posttraumatic stress disorder and complicated life circumstances, and thus, more treatment is necessary after discharge. Modifications were made or thought needed for optimal outcome and successful delivery of these 2 EBPs; some providers blended aspects of prolonged exposure and cognitive processing therapy; what happens when providers and patients do not agree on choice of which EBP to first implement; and provider concerns on when to discontinue an EBP. Reflective journaling appears to be a promising way for trainers and treatment developers to gather important information about the clinical application and decision-making process for front-line providers, which may offer insight into how to improve EBP implementation and sustainability. Incorporating reflective journaling and strategies for accomplishing this into training, supervision, and consultation may also be 1 strategy for increasing feedback, expanding implementation, and informing ways to increase sustainability of EBPs in populations with multiple clinical and psychosocial needs.

The War Within: A Personal Journey with Obsessive Compulsive Disorder/Complex Post Traumatic Disorder-The Struggle, the Fight, and Recovery

For years, I had suffered from OCD. I have been in and out of many psychiatric facilities both in the United States and in Canada. My experiences are complicated but also very informative for those seeking help with OCD. I have been in many crisis situations and have endured many treatments like CBT, mindfulness, guided meditation, ERP, hospitalization, and withstanding very intense OCD and CPTSD residential treatment programs. In time, with the right medical team, support groups, medication and self-motivation to fight against the debilitating symptoms OCD, I have gone from being on LTD for the inability to function and complete daily tasks like showering and dressing without compulsions, to reclaiming back my life and returning back to teaching. I hope to be able to pay it forward and speak to the great resources and staff available at Sunnybrook Hospital. I hope to share my story of struggle and recovery to help bring resource information and hope for those suffering from any mental illness. I have seen the good, the bad and the ugly. But, I have also seen hope and light. I now am able to know how it feels to be able to function again, as well as acknowledge a strength that I could never have known I had if it was not for the experiences I endured. I have the authority to now say OCD is not a life sentence, OCD can, in fact, be managed. I can be the voice that I so desperately needed years ago, when all I wanted to do was end my life because I had a lack of experience around me of seeing those who made it, those who survived and not just survived, but thrive into productive individuals who are able to manage their OCD and be successful.

Safety and psychological impact of sailing adventure therapy among Veterans with substance use disorders

ObjectivesMany Veterans suffer from substance use disorders (SUDs). Treatment challenges include poor treatment engagement and high relapse rates. Complementary interventions have the potential to enhance both. This study was a preliminary evaluation of sailing adventure therapy (SAT) for this population. DesignRetrospective chart review. Participants in the intervention were 22 Veterans (20 male, 2 female) aged 22–65 who entered a Veterans Administration residential SUD treatment program. All subjects had two or more SUDs, and many had psychiatric (95%) and/or medical (77%) comorbidities. The age, gender and diagnosis-matched control group (n = 22) received residential SUD treatment as usual (TAU) in the same program but without SAT. SettingResidential SUD treatment program at a Veterans Administration Medical Center. InterventionSailing adventure therapy. Main Outcome MeasuresPositive and Negative Affect Schedule (PANAS), State Trait Anxiety Inventory six-item short form (STAI: Y-6 item), Acceptance and Action Questionnaire II (AAQ II), Five Facet Mindfulness Questionnaire (FFMQ) and a locally developed patient survey. Outcome comparison among SAT plus TAU group versus TAU – only group included measures of successful completion of residential SUD treatment program as well as psychiatric hospitalizations and/or residential SUD treatment program readmissions within 12 months. ResultsNeither physical injuries nor increases in anxiety or negative affect occurred, as measured by the PANAS (positive change, p = 0.351; negative change, p = 0.605) and the STAI: Y-6 item (p = 0.144) respectively. There was no significant change in FFMQ (p = 0.580) but a significant increase occurred in AAQ II scores (p = 0.036) indicating an increase in psychological flexibility. Survey responses indicated the participants perceived the experience to be both pleasurable and calming. The preliminary outcome evaluation revealed a significant between-group difference (X2 = 5.34, DF = 1, p = 0.02, r = 0.35) indicating participating in SAT was associated with a greater likelihood of successfully completing residential SUD treatment. However, there were no significant between-group differences in number of psychiatric hospitalizations (X2 = 1.09, DF = 1, p = 0.29, r = 0.16) or residential substance abuse treatment program readmissions (X2 = 0.23, DF = 1, p = 0.64, r = 0.07) in the 12 months after discharge from the program. ConclusionsPreliminary evidence suggests that SAT is physically safe and not associated with increased anxiety or negative affect. Participant’s perceptions of the experience were positive. Preliminary outcome measures suggest associations between participation in SAT and increased psychological flexibility as well as successful completion of a residential SUD treatment program. Further research is indicated to determine whether SAT may be developed as an effective complementary intervention for Veterans with SUDs.

Distress tolerance but not impulsivity predicts outcome in concurrent treatment for posttraumatic stress disorder and substance use disorder

ABSTRACTPosttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly co-occur. Emerging research suggests that both distress tolerance and impulsivity may underlie this comorbidity. However, to our knowledge no studies have examined whether these 2 constructs predict outcome in PTSD-SUD treatment. The current study investigated whether pretreatment distress tolerance and impulsivity predicted posttreatment PTSD and cravings severity in a sample of 70 Veterans receiving concurrent treatment for PTSD and SUD in a residential day treatment program. Veterans completed measures of symptom severity before and after treatment. Results demonstrated that pretreatment distress tolerance predicted posttreatment PTSD severity while controlling for pretreatment PTSD. By contrast, pretreatment impulsivity was not predictive of posttreatment PTSD while controlling for pretreatment values. Neither distress tolerance nor impulsivity predicted posttreatment cravings severity. The findings support the notion that distress tolerance may help to explain the co-occurrence of PTSD and SUD and suggest that targeting this construct in PTSD-SUD treatment may be important for successful outcomes.

Outpatient continuing care after residential substance use disorder treatment in the US Veterans Health Administration: Facilitators and challenges

ABSTRACTBackground: In the U.S. Veterans Health Administration (VHA), residential treatment programs are an important part of the continuum of care for patients with substance use disorders (SUDs). Outpatient continuing care after residential treatment helps maintain early recovery and treatment gains. Knowing more about the drivers of variation in continuing care practices and performance across residential programs might inform quality improvement efforts. Methods: Metrics of continuing care were operationalized and calculated for each of VHA's 63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs) and 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track in fiscal year 2012. Management and frontline staff of these programs were then interviewed to learn what factors might contribute to high or low program performance on the metrics compared with national averages. Results: Among SUD RRTPs, the mean rate of outpatient SUD/MH continuing care was 59% within 7 days and 80% within 30 days, and the mean rate of SUD continuing care was 63% within 30 days. Among MH RRTPs with a SUD track, these rates were 56%, 75%, and 36%, respectively. There was substantial variability in continuing care rates across the 97 programs: 21%–93% for SUD/MH care within 7 days, 36%–100% for SUD/MH care within 30 days, and 4%–91% for SUD care within 30 days. Interviews with representatives of 44 programs revealed key facilitators of continuing care: accountability of program staff, predischarge scheduling, predischarge introductions to continuing care providers, strong patient relationships, accessibility, and persistent emphasis. Key challenges included inadequate program staffing, lack of program staff accountability, and poor accessibility. Conclusions: Wide variation in continuing care rates across programs and identification of common facilitators at high-performing programs suggest substantial opportunity for improvement for programs with lower performance.

Where's Dad? The Importance of Integrating Fatherhood and Parenting Programming into Substance Use Treatment for Men.

Large numbers of men enter substance use disorder treatment each year, yet very little attention is paid to the fatherhood and parenting status of these men. Substance use treatment programs rarely incorporate a parenting component into their treatment planning, despite increased success of women's treatment programs that focus on gender and motherhood. This paper provides: 1) a review of the literature on the fathering of substance using men, what has been learned from substance use disorder treatment for mothers, and the implications for children and families; 2) pilot quantitative and qualitative outcomes on implementation of a fatherhood focused intervention for men in a residential substance use treatment program; and 3) recommendations for the application of these findings for fathers in substance use disorder treatment and the implications of program modifications and increased focus on fathers for child welfare.