Delivery Of Substance Abuse Services Research Articles

Teaching Note—Meeting the Demand for Behavioral Health Clinicians: Innovative Training Through the GLOBE Project

ABSTRACTThe national move toward integrated mental health and substance abuse service delivery has a significant impact on social work education and necessitates changes in how we train students. To address this need, the Global Leaders of Behavioral Health Education (GLOBE) training project was developed. GLOBE is a student training and stipend program that prepares students for clinical behavioral health practice in integrated care. This teaching note describes GLOBE, reports challenges encountered in its implementation, and provides strategies for overcoming them. The challenges include assigning students to grant-compliant field placements, engaging other health care professionals in the educational efforts, and implementing curriculum changes. Suggestions for social work program administrators interested in integrated care training are provided.

Don’t Cut Drug-Abuse Research, Experts Tell Hill Staffers

Congressional staff hear why National Institute on Drug Abuse grantees must be allowed to continue research on substance abuse service delivery to veterans.

Results from the Pro-QOL-IV for Substance Abuse Counselors Working with Offenders

This study examines compassion fatigue, burnout and compassion satisfaction in two groups of counselors who specialize in substance dependency treatment in order to identify the unique features of substance abuse service delivery that may be related to professional quality of life. Qualitative interviews were conducted with 20 substance abuse counselors working with offenders both in prison and community facilities. In addition, interview subjects completed the ProQOL-IV to assist in exploring the unique challenges that may face the substance abuse treatment field with regards to professional self-care. Two key themes emerged from the examination of the group of interviewees that scored high on the Compassion Fatigue Subscale on the ProQOL-IV, revealing that working with women is more challenging, and substance abuse counselors who have family members with addiction problems or themselves are in recovery may make one more susceptible to compassion fatigue.

Ryan White Title I Survey: Services for HIV-Positive Substance Users

People living with HIV/AIDS who are also substance users need primary health care, substance abuse treatment, and support services. They also require care delivery strategies that are comprehensive and innovative. Forty-three of 51 Ryan White Care Act Title I grantees funding 197 substance abuse treatment agencies in the United States participated in this study. Grantees were surveyed to determine (1) use of Title I funding to provide services for HIV-positive substance users, (2) the types of substance abuse services provided, (3) strengths and weaknesses of different metropolitan substance abuse service delivery systems, (4) sources of information used to assess the needs of substance users, (5) gaps in knowledge about substance users and their service needs, and (6) examples of successful strategies within the eligible metropolitan areas. The results of the study demonstrate that most grantees use Title I funds to support some form of substance abuse treatment for people with HIV; however, many do not use the funds to address the barriers to care that they identified. Lack of provider knowledge, expertise, and awareness, were cited as important barriers to care by a majority of the grantees. The availability of harm reduction approaches to care is an area in which there is wide variation. Several Title I programs have supported innovative programs for HIV positive substance users that may be used elsewhere as program models. It is important to find ways to incorporate these issues into the needs assessment and service prioritization process.

Documenting Changes in the Delivery of Substance Abuse Services

This study explores the impact of managed care on the substance abuse service system by reviewing the current status of the programs that were among the elite service providers in 1988. A survey was conducted assessing the status of the one hundred centers touted as the 100 best treatment centers for alcoholism and drug abuse (Sunshine& Wright, 1988). Findings include the following: Almost a third of these centers (31%) are no longer providing services, the majority of the programs who reported data continue to provide services primarily at a residential level of care (92%); however occupancy rates have dropped, the number of annual inpatient admissions have risen, and the length of treatment episodes has significantly decreased. In 1988, almost all (97.5%) facilities adhered to the 28-day treatment regiment, as evidenced by average treatment episodes of 26 days or longer. However, in 2001, the majority of programs (57.5%) reported treatment episodes of 25 days or less. While these facilities represent a fraction of the number of facilities that provide substance abuse services, they do exemplify elite programs that should be insulated from economic troubles, and help to document the changes that have occurred in the delivery system. Awareness of these changes is important for every social worker that advocates for substance abuse services.

Personal Accounts: "Doctor's Standing Orders"

Personal Accounts: "Doctor's Standing Orders"

The organization of substance abuse managed care.

Managed care came to dominate the delivery of substance abuse services during the 1990s. This paper uses literature and new data to describe and analyze the set of arrangements it implies. The description suggests that substance abuse managed care typically is "carved out" of the general health care plan and treatment is coordinated by a behavioral health managed care company that manages treatment access, length, type, and intensity. This administrative agent is provided financial incentives to keep costs low and otherwise faces such mandates as to ensure timely access to treatment and to deliver reports. A typical agent has some interest in improving the quality of decision-making, but has few incentives for controlling the treatment technology. In contrast, agents tend to control treatment providers through relatively rigid rules that substitute outpatient for inpatient care, regulate the length and intensity of services, provide limited social services, mandate accreditation, allow limited clinician discretion, administer an entire "network" of providers as an only slightly differentiated mass, and rarely shape the details of the treatment process. These patterns are analyzed in terms of transaction cost economics and institutional and resource dependency theories. In general, it is argued that managed care reflects an interest in controlling costs but also in ensuring access within an environment where there is uncertainty accompanying competing demands, varying conceptions of the client, and controversies over the efficacy of specific treatment technologies.

Provision of drug treatment services in the juvenile justice system: A system reform

This article proposes a systemic reform of the organizational structure and delivery of substance abuse services for adolescents within the juvenile justice system. It first discusses the impact of substance use on the juvenile justice system and then reviews which drug treatment programs and services are currently available. Following an evaluation of the most effective drug treatment programs and modalities, recommendations for system reform are given. The recommendations are based on a graduated sanctions framework, supported by systems collaboration and comprehensive case management. Systems collaboration between service providers must exist for juveniles to receive appropriate and comprehensive services. Case managers (CMs) both assess juveniles and help them move through and between judicial, drug treatment, and social service systems. In this way, juveniles receive the most suitable and complete services a community can offer while remaining firmly under juvenile justice system supervision.

The Evaluation of a Consultation Service for Delivery of Substance Abuse Services in a Hospital Setting

Objective. This study evaluated the institutional impact of a substance abuse consultation service in a hospital setting. Method. Treatment and matched comparison groups were compared on five outcome variables: length of stay, total cost, reimbursement, readmission, and appropriateness of care. The treatment group consisted of patients with discharge diagnoses falling into targeted Diagnostic Resource Groups (DRGs) and who received a substance abuse consultation. The comparison group consisted of patients with the same targeted DRGs, a coexisting substance abuse diagnosis, and who did not receive a substance abuse consultation. Results. No statistically significant differences were found for the five outcome variables. Findings closely approached statistical significance for rate of readmission with treatment patients being less likely to be readmitted during the 12 months following the consultation. Conclusions. Although cost savings were not found during the hospitalization when the substance abuse consultation was provided, the data suggests that the consultation may reduce the need for readmission during the year following discharge.

Improving substance abuse service delivery to Hispanic women through increased cultural competencies: a qualitative study.

In 1985, one woman in seventeen in the US was Hispanic-an estimated 8.5 million-and it is predicted that by the end of this century, Hispanics will comprise the largest ethnic group in this country (Amaro & Russo, 1987). Although the term "Hispanic" suggests a homogeneous group, united by similarities, this is not the case. The term refers to an ethnic group, not a racial one, whose chief commonalities are the Spanish language and some broad cultural values. Making substance abuse treatment services accessible to Hispanic women and their families requires that agencies become culturally competent to deal with this population. The authors of this qualitative study interviewed female Hispanic substance-abuse treatment clients and therapists to find what agencies might do to create a receptive atmosphere for Hispanic women.

Delivery of Substance Abuse Services During Spinal Cord Injury Rehabilitation

Delivery of Substance Abuse Services During Spinal Cord Injury Rehabilitation