Determinants of the Treatment Climate in Psychiatric and Substance Abuse Programs: Implications for Improving Patient Outcomes
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States Journal of Nervous & Mental Disease
(Impact Factor: 1.69).
03/1998; 186(2):96-103. DOI: 10.1097/00005053-199802000-00005
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.
Available from: Christine Timko
- "Evidence supports the validity of outcomes at the program (or client aggregate) level in that they are relatively stable (i.e. are not sensitive to changes in the individual making the report or to turnover in the client or staff population) and have convergent and discriminate validity [39,40]. More generally, research shows that SUDP directors, including those serving offenders, provide valid and reliable data on program practices and their determinants and outcomes [37,38,41,42]. "
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Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems.
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.
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.
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.
Available from: Leonard A Jason
- "Settings with social climates that are more involving, offer consistent support, and help people adapt to their unique life circumstances tend to promote better outcomes (Boydell et al., 1992; Holahan et al., 1982; Moos, 2003; Timko et al., 1998). A key question is what types of recovery communities might best promote these characteristics. "
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ABSTRACT: This study compared the social climate of peer-run homes for recovering substance abusers called Oxford House (OH) to that of a staffed residential therapeutic community (TC). Residents of OHs (N = 70) and the TC (N = 62) completed the Community Oriented Programs Environment Scales. OHs structurally differ on two primary dimensions from TCs in that they tend to be smaller and are self-run rather than professionally run. Findings indicated significantly higher Involvement, Support, Practical Orientation, Spontaneity, Autonomy, Order and Organization, and Program Clarity scores among the OH compared to TC residents. Additional analyses found the OH condition was higher Support, Personal Problem Orientation, and Order and Organization scores among women compared to men residents. These results suggested that these smaller OH self-run environments created a more involving and supportive social milieu than a larger staff-run TC. These findings are interpreted within Moos' (2007) four theoretical ingredients (i.e., social control, social learning, behavioral economics, and stress and coping), which help account for effective substance abuse treatment environments.
Available from: upenn.edu
- "The RESPPI is a multi-dimensional inventory designed to examine four sets of program characteristics, including physical and architectural features, policies and services, aggregate resident characteristics, and treatment or support climate . The RESPPI has been applied to the assessment of program environment of hospital-based and community-based residential programs in the fields of mental health, substance abuse, and gerontology (Moos & Lemke, 1994; Timko & Moos, 1998). "
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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.
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