Article

Design Strengths and Issues of SAMHSA's Women, Co-occurring Disorders, and Violence Study

Policy Research Associates, Inc., in Delmar, New York 12054, USA.
Psychiatric Services (Impact Factor: 2.41). 11/2005; 56(10):1233-6. DOI: 10.1176/appi.ps.56.10.1233
Source: PubMed

ABSTRACT

In 1998 the Substance Abuse and Mental Health Services Administration launched the Women, Co-occurring Disorders, and Violence Study (WCDVS). The WCDVS developed, implemented, and evaluated the outcomes and costs of comprehensive, trauma-informed treatment programs for women with a history of violence and trauma who have substance use and mental health disorders. This article discusses the overall design features of the study, issues related to such a design, results of the outcomes and cost evaluations, and suggestions for future research. The nine WCDVS sites were located across the continental United States, with six sites on the East Coast, two on the West Coast, and one in Colorado. A total of 2,729 women (1,415 in the intervention condition and 1,314 in the comparison condition) were enrolled over the 13.5-month baseline accrual period (January 2001 through February 2002). Follow-up interviews were conducted with all participants at three, six, nine and 12 months post-baseline. Women in the intervention and the comparison groups showed improvement in outcomes in four areas: alcohol use, drug use, mental health, and trauma. At six months women in the intervention group scored modestly better than women in the usual-care group for outcome measures for drug use, trauma, and mental health. At 12 months women in the intervention group maintained their improvement in drug use outcomes and continued to improve in mental health and trauma outcomes. After a start-up period, costs for services were not significantly different between the intervention and comparison groups at both follow-up points. Despite their very modest nature, the WCDVS results are promising.

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    • "to fi t women's " levels of immediacy " needs in addressing certain issues over other less prioritized ones, especially in working with women with co-occurring disorders, patterns of recovery suggest that stabilization of substance abuse behaviors may be necessary before gains can be made in reducing mental health and trauma symptoms. (Brown, Melchior, & Panter, 2000; Noether et al., 2005). "

    No preview · Article · Jan 2006
    • "to fi t women's " levels of immediacy " needs in addressing certain issues over other less prioritized ones, especially in working with women with co-occurring disorders, patterns of recovery suggest that stabilization of substance abuse behaviors may be necessary before gains can be made in reducing mental health and trauma symptoms. (Brown, Melchior, & Panter, 2000; Noether et al., 2005). "

    No preview · Article · Jan 2006
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    ABSTRACT: Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women. A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling. A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling. Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.
    Full-text · Article · Nov 2005 · Psychiatric Services
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