Briefly Noted

Clayton Stafford died after using Vivitrol, and his family is suing Alkermes, the manufacturer, saying that the medication doesn't adequately treat addiction, compared to buprenorphine and methadone, and that the manufacturer knew this. In the lawsuit, California‐based law firm Lieff Cabraser alleges that Stafford, his parents and his treatment providers were misled into thinking Vivitrol was an appropriate treatment for his opioid use disorder. “Clayton Stafford's tragic death could have been avoided,” notes Lieff Cabraser partner Fabrice N. Vincent, who filed the lawsuit on behalf of the Stafford family. “The well‐reported defects in Vivitrol made Clayton's overdose a near‐foregone conclusion, and had the Staffords received accurate information about Vivitrol's risks and effective deficiencies from Alkermes, they would never have consented to its use by Clayton.” Naltrexone doesn't work to treat addiction and cravings, but just to block the effects of opioids, according to the lawsuit (and many others agree with this). “Because the patient's addiction is not adequately treated, the patient requires indefinite Vivitrol use to merely block the euphoric effects and keep the patient from seeking opiates,” Vincent said. “Patients therefore remain highly likely to relapse despite indefinite use of Vivitrol.” The lawsuit also makes note of Alkermes' direct‐to‐consumer marketing campaign, which extended into influencing the criminal justice system to use Vivitrol. Stafford had been mandated to use Vivitrol. Last year, the Food and Drug Administration issued a warning letter to Alkermes stating that its advertising did not state that stopping Vivitrol can lead to relapse and overdose, as is clearly stated by the label and package insert (see “FDA warns Alkermes about OD risk on Vivitrol ads,” ADAW, Dec. 16, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32566 ).     

When pricing treatment,know your costs and set your profit margins

Billing, ethics and parity have been hot‐button issues for substance use disorder (SUD) treatment centers for years, but the National Association of Addiction Treatment Providers (NAATP) is getting closer to finding solutions. At its annual leadership meeting in Washington last month, members, not to be deterred by a surprise lawsuit on opening day from American Addiction Centers (see ADAW, May 20, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32368 ), gathered to hear from experts on how to properly conduct billing in a dynamic new environment.     

An Evaluation of a Community Collaboration Approach to Psychosocial Rehabilitation

ABSTRACT

This article reports on the results of a multiagency collaboration demonstration project that was designed to replicate the salient features of an exemplary practice, single-agency program of psychosocial rehabilitation for persons with serious mental illness (SMI). The community collaboration extended over two phases for 2 years and involved over 20 mental health service providers. The demonstration project itself was designed to be a replication of the Village Integrated Services Agency (Village ISA) of Long Beach, California. Additionally, this article reports the results of a rigorous evaluation of the project. The treatment group outcomes were substantially superior to all control group measures at or beyond the 0.05 level of significance. With due regard for limitations imposed by a small sample size (n = 50), the project demonstrates that the replicated model of intervention can be effectively implemented through a collaborative organizational structure involving a coalition of agency service providers.     

NAATP guidebook not only for residential care

The National Association of Addiction Treatment Providers (NAATP) has released its draft guidebook for minimum standards for members (see ADAW, April 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32334 ). NAATP is not only for residential treatment providers, however. “Our position at NAATP is that we are a membership association for providers along the entire continuum and that, while residential holds an important place in our work and is our historical foundation, our membership is in no way limited to residential,” NAATP Executive Director Marvin Ventrell told ADAW last week. “Even apart from our membership, we intend our resources, including ethics and the guidebook, to reach and guide the entire continuum. It is true that some of the guidelines have application more or less relative to type of care, but as a whole it should be viewed as a provider guide, not just a residential provider guide.” We regret any confusion. The field — and prominent organizations within it — is changing.     

AAC statement on NAATP lawsuit

As the National Association of Addiction Treatment Providers (NAATP) was beginning its annual leadership meeting May 6, American Addiction Centers sued the organization in federal court (see “AAC sues NAATP for defamation,” ADAW, May 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32362 ). We wanted to provide further information on the lawsuit (which we linked to in our story last week). Below is a statement provided exclusively to ADAW by AAC May 15.     

Therapists’ Assessments in Treating “Sex Addiction” and Their Relationship to Clients’ Gender,Relationship Status,and Exclusivity Status

A total of 208 therapists and therapists‐in‐training were surveyed to better understand if clinical assessments and recommendations regarding “sex addiction” changed based upon a client's gender, relationship status, or exclusivity status. Using clinical vignettes, this study examined the clinical assessment and recommendations of licensed mental health providers (n = 92) and mental health providers in‐training (n = 116). Results indicated that professional ratings differed based on relationship exclusivity and gender; specifically, female nonmonogamous behavior was rated more negatively than male nonmonogamous behavior, while male monogamous behavior was rated more negatively than female monogamous behavior. Recommendations for treatment varied, with higher addiction ratings leading to greater odds of recommending individual, group, and community support over relational therapy. Clinical and training implications are discussed. Video abstract accessible by clicking here .     

Personal and Professional Knowledge of and Experience With Suicide and Suicide Prevention Among Stakeholders in Clinical and Community Practice

Community-dwelling veterans at risk for suicide may be in contact with a variety of providers in agency-based settings that offer health and human services. The study aim is to describe the perspective of agency-based clinical and community providers who may come into contact with veterans in need of suicide prevention services and to examine the nature of their personal and professional relationships to individuals at risk for suicide among this sample.

This study reports on qualitative data from a sample of Veterans’ Affairs (VA) and community providers serving veterans and military families in one Midwestern state (N = 70). Providers completed a survey assessing exposure to suicide, including contact with and relationship to someone suicidal, and organizational characteristics of the providers’ employing agencies. Semi-structured interview questions probed for the nature of how they would react with suicidal individuals. Most providers (94%) had some prior contact with someone who was suicidal, and nearly three quarters (77%) knew someone who had died by suicide. Providers reported powerful emotional responses of sadness and remorse to suicidal experiences. While these providers interact with veterans and military families as part of their jobs, they may have their own history of being exposed to suicide, both professionally and personally.     

Informal shelter providers: Low income households sheltering the homeless

Despite the important role they play in preventing homelessness, those who shelter people who can not afford housing of their own have been neglected by researchers. This study examines the characteristics of these low income informal shelter providers. While informal shelter providers were similar to a comparison group of low income households that did not shelter others, there were also significant differences between the two groups. Informal shelter providers were more much more likely to live in single family dwellings, they were more likely to be long-term residents of the community, they were more likely to have experienced homelessness themselves, and they devoted a disproportionate share of their incomes to housing.     

‘Incentivizing Recovery’ follow‐up: White paper was a ‘first step’

Last week's issue featured the announcement of a new payment model for addiction treatment, a combination of capitated and bundled reimbursement that places the treatment provider at risk in the event of repeat admissions. Greg Williams, executive vice president of Facing Addiction with NCADD, described the rationale for the system: Treatment providers should not be paid if patients don't get well. Anne Marie Polak, senior director at Leavitt Partners and in charge of the “Incentivizing Recovery” project the organization is convening, described the basics of how the project works. None of the treatment organizations participated in the project, which resulted in the white paper released Sept. 7 (see ADAW, Sept. 17).     

Examination of the relationship between social support and treatment outcomes in mothers referred by Child Protective Services utilizing the Significant Other Support Scale

ABSTRACT

Supportive social networks may play an important role in recovery for mothers within the umbrella of Child Protective Services (CPS). However, investigators have yet to develop methods of measuring how significant others contribute to the treatment and recovery process. In this study, the influence of significant others was examined in the family-based treatment of 38 mothers who were referred for Family Behavior Therapy by CPS. The Significant Other Support Scale (SOSS) was empirically developed and subsequently utilized to assess the extent to which participants’ significant others were perceived by treatment providers to support the participants’ goals during treatment sessions. Results indicated that SOSS scores (but not participant and significant other session attendance) were associated with lower participant child abuse potential and drug use frequency at the conclusion of treatment. There was no relationship found between SOSS scores and participant session attendance. However, there was a positive correlation between SOSS scores and significant other session attendance (r = .489, p < .01). The results of this study suggest the quality of significant other support during treatment sessions in this population of mothers may be more important to improving treatment outcomes than session attendance per se. Future directions are discussed in light of the results, including methods of using SOSS scores to assist family-based treatments.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

RISING AUTISM PREVALENCE: REAL OR DISPLACING OTHER MENTAL DISORDERS? EVIDENCE FROM DEMAND FOR AUXILIARY HEALTHCARE WORKERS IN CALIFORNIA

Autism is a development disorder that has increased in prevalence from 0.5 to 14.7 per 1,000 children over 1970–2010. Using annual wages and provider counts from the American Community Survey and information from 21 regional development centers in California, we estimate the labor demand for auxiliary health providers. We focus on this subset of providers because, unlike physicians and psychologists who can diagnose autism, these workers cannot induce their own demand. If the incidence of autism is increasing independently of other mental disorders, then the demand for auxiliary health providers should increase, leading to higher wages and labor supply. Otherwise, the increase in autism diagnosis is merely displacing other mental disorders. We find that a 100% increase in autism cases increases the wages of auxiliary health workers over non‐autism health occupations by 8–11% and the number of providers by 9–14%. Furthermore, we find that one of every three new autism diagnoses is merely supplanting mental retardation diagnoses, but does not displace other mental disorders. These estimates suggest that at least part of the increase in autism diagnoses, about 50–65%, reflects an increase in the true prevalence of the disorder. (JEL L11, J2, J3)     

Service Provision for Men with Eating Issues in Australia: An Analysis of Organisations', Practitioners', and Men's Experiences

Abstract

Research was undertaken to explore issues surrounding service provision for men with eating issues in Australia. Qualitative and quantitative data were gathered from key stakeholders—organisations that provide treatment (n=15), practitioners that have worked with men with eating issues (n=10), and individual men with eating issues (n=5). Four key areas were explored: rates of access to services, the expression and development of eating issues in men, factors inhibiting or facilitating the recovery process, and recommendations to improve service provision. Results highlighted the need for increased awareness about men's eating issues within society generally, but for health professionals specifically, the need for better recognition of the expression of eating issues in men, and the expansion of existing services to be more “male friendly”. It is anticipated that service providers will benefit from these findings by identifying ways to reduce barriers and encourage help-seeking behaviour in men. Future research should seek to replicate and expand these findings using a larger sample size.     

Families of Children with Serious Emotional Disturbances: Parent Perceptions of Family Resources and Stressors

This study addresses the dearth of research on families of children with serious emotional disturbances (SEDs) by examining parents’ perceptions of their families’ resources and stressors. Parent and/or guardian responses on the Family Inventory of Resources and Stressors (FIRST) whose children were receiving treatment for SEDs (n = 80) were compared to those with children without SEDs (n = 48). One-way ANCOVA analyses revealed that, when controlling for income and education level, families of children with SEDs reported significantly greater stress levels than families of children without SEDs, but both groups reported similar levels of resources. The principles derived from this study provide critical information for treatment providers and researchers seeking to develop an in-depth understanding of the resources and stressors of families of children with SEDs so as to more effectively collaborate with them in treatment planning.     

Implementation of an intimate partner violence screening program in a university health care clinic

Abstract

Objectives: To examine whether an intimate partner violence (IPV) screening program is related to a positive change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening. Participants: Eleven health care providers at a university health care clinic participated in the IPV screening program. Methods: A one-group pretest-posttest design was used to examine whether an IPV screening program was related to a change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening. Results: Findings indicated that there was a significant difference (p?<?000) between the posttest scores and the pretest scores on the Domestic Violence Healthcare Provider Survey Scale. Domain analysis of the scale revealed a significant difference in perceived self-efficacy (p?=?.001), system support (p?=?<.002), victim provider safety (p?=?.015), and beliefs of blaming victims (p?=?<.004). No statistical difference was found in professional role resistance/fear of offending (p?=?.158). Conclusions: A university health care clinic IPV screening program was related to a positive change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening.     

Differences in health-related quality of life among persons living with HIV/AIDS

We sought to identify differences in health-related quality of life (HRQoL) among a sample of HIV positive individuals receiving case management services in northern Florida. Our study consisted of 97 individuals receiving HIV case management that included 56 males (57.7%) and 81 African Americans (83.5%) who were 47.05 years old (SD = 9.33). HRQoL was measured using the HIV/AIDS Targeted-Quality of Life scale (HAT-QOL). Results show significant group differences in HRQoL by race, income, tobacco use, alcohol use, drug use, and CD4 cell count, despite only 43% of this sample being able to recall their most recent CD4 count. Translating these findings to inform practice, HIV care providers need to provide continuing education to patients about their disease status, knowledge, and treatment as it relates to self-care. Also, HIV care providers should be especially cognizant of the impact that tobacco, alcohol, and illicit drug use has on HRQoL for persons living with HIV/AIDS (PLHA) by working to assess social support, identify readiness for change, and make appropriate referrals for treatment.     

Till Death Do Us Part: Testamentary Manumission in Seventeenth-Century Lima,Peru

This article joins a long-standing conversation among slavery scholars regarding the tensions that emerged from the legal status of slaves as property and as persons. This feature of quasi-personhood and property was perhaps most pronounced in the testamentary devise of freedom granted by slave owners. Posthumous bequests of freedom simultaneously recognised the property rights of the deceased in human beings, while validating the affective ties of loyalty and devotion spawned by the master–slave relationship. The article traces the efforts of Margarita de Torres, an enslaved woman, who waged a nine-year lawsuit for her freedom against the executrices of her owner's estate. In so doing, the article analyses Margarita's motivations for embarking on a protracted and costly lawsuit, given the odds in favour of, and against, slaves seeking to enforce testamentary promises of manumission in seventeenth-century Lima. More broadly, the article explores the affective relationships between owners and slaves, the conditions that accompanied testamentary freedom and the complexities that arose with the legal treatment of enslaved offspring of free fathers.     

THE VALUE OF CONSUMER CHOICE AND THE DECLINE IN HMO ENROLLMENTS

Health insurance contracts may restrict consumers' choice of medical provider (e.g., hospital) in order to minimize moral hazard inefficiencies. In this article, I assess the economic value of this strategy by comparing the estimated “option value” that consumers assign to provider choice to the negotiated discounts that insurers can achieve by negotiating with a restricted set of providers (i.e., volume discounts). Using a panel of federal employees' health plan choices from 1999 to 2003, I show that the practice of selective contracting (SC) with a limited set of hospitals reduced health maintenance organization (HMO) plans' expected utility by $62–$118, on average, for a standard reduction in the provider choice set. I also conduct simulations which show that by 2003 health plans using SC were theoretically unable to achieve sufficiently large volume discounts from hospital providers to fully compensate for the associated utility losses. My results help to explain the flight from HMO enrollments that occurred in the early 2000s. (JEL I10, I11, L15, D83, D12)