Determinants of the treatment climate in psychiatric and substance abuse programs: implications for improving patient outcomes.
ABSTRACT This study examined determinants of the treatment climate in 89 psychiatric and substance abuse programs. Clearer policies giving patients more control, and more health and treatment services, were related to more supportive, autonomous, expressive, and practically oriented milieus. In contrast, more policy choice and daily living assistance were associated with less support, personal expression, and practical orientation. Programs in which staff had more paraprofessionals and better team functioning, and in which patients had more social resources and better mental functioning, tended to be more supportive and to have more emphasis on autonomy, personal expression, and practical orientation. Based on these results, we suggest some guidelines on how to change the treatment milieu to benefit patients' adjustment.
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ABSTRACT: BACKGROUND: Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems. Methods: We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse. Results: Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program's mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV+ status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs. Conclusions: SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training.Substance Abuse Treatment Prevention and Policy 09/2012; 7(1):37. DOI:10.1186/1747-597X-7-37 · 1.16 Impact Factor
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ABSTRACT: Emergency shelters, transitional housing, and permanent supportive housing are distinct programmatic responses to address the housing and service needs of the homeless population under the Continuum of Care (CoC) model for homeless service delivery. Using organizational-level data collected from a multi-site survey of 300 homeless residential programs in 14 communities, this study examines the extent to which operationalization of these programs is in accordance with the CoC model. Findings suggest consistency with as well as deviation from the CoC model in the operationalization of homeless residential programs. Recommendations are provided for local community service planning and development that can assure effective delivery of services for meeting the needs of homeless people.Administration in Social Work 03/2006; 30(1):67-94. DOI:10.1300/J147v30n01_05 · 0.36 Impact Factor
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ABSTRACT: Serious and persistent mental illness has posed a significant social problem for a majority of cultures across most historical periods. Most recently in the United States, the aftermath of the deinstitutionalization policies of the 1950–1970s has resulted in many individuals who in the past might have spent the majority of their adult lives living in hospitals roaming city streets homeless, impoverished, and vulnerable to victimization or to being arrested for minor offenses. This paper reviews the changes both in the population of individuals with serious mental illness and in the systems that care for them over the last 25 years, and suggests that a “Tower of Babel” scenario has resulted inadvertently from the shift from hospital to community care. Following the dissolution of the monolithic hospitals (i.e. Towers of Babel), mental health providers have been dispersed among a myriad of community agencies, each with its own vision and standards of community care. Without a shared map to guide their work, community systems have become characterized by disarray, paralysis, and a lack of integration and coordination of care for a population of individuals who typically require more than one service from more than one provider at any given time. To address these issues, we offer a core set of “principles of care” developed by one local service system in an attempt to (re-)constitute a common map for their shared territory. We closed with a discussion of the issues that remain unresolved despite this collaborative process, and with suggestions for future directions to explore.Research in Social Problems and Public Policy 05/2001; 8:17-41. DOI:10.1016/S0196-1152(01)80004-1