Inspiring Hope,Envisioning Alternatives: The Importance of Peer Role Models in a Mandated Treatment Program for Women

ABSTRACT

This article presents evidence from a program evaluation effort conducted with clients in a mandated treatment setting for drug-involved women charged with felony-level offenses. We present themes from qualitative interviews that stress the importance of identifying with a peer who is further along in recovery as a crucial mechanism for instilling hope and fostering program engagement. We also provide survey data that shows that a client's ability to imagine a life without using drugs, at intake, is a significant predictor of program success. Finally, the Stages of Change Readiness and Treatment Eagerness scale did not show any significant correlations with program success in this population. All women entered this program from very challenging situations, but we conclude that those who enter with the least hope and smallest (or absent) vision of any alternative future are especially vulnerable for a bad outcome. We urge researchers and practitioners to further explore the ways in which connections with peer role models facilitate engagement and successful outcomes; and to systematically evaluate the effect of interventions designed to foster such connections on program outcomes.     

A Program Evaluation of Los Angeles ACORN's Welfare Case Advocacy

SUMMARY

Bureaucratic confusion and client dissatisfaction since the 1996 changes in welfare policy opened opportunities for third party advocacy on behalf of welfare clients. This paper evaluates Los Angeles ACORN's case advocacy program for welfare clients. Outcomes analyzed include client satisfaction with ACORN's advocacy and effects of the program on welfare clients who later became ACORN members. Ninety-one percent of clients surveyed (N = 99) stated they were satisfied with the resolution of their welfare case complaint. Eighty-eight percent of respondents stated ACORN did a better job resolving their problem compared to the welfare department. Unique aspects of the program include peer advocacy and opportunities for welfare recipients to join ACORN and work on welfare policy changes among other issues.     

Strengths,weaknesses, opportunities,and threats to housing first in Metro Vancouver

ObjectivesTo understand the experience of Metro Vancouver’s Homelessness Partnering Strategy-funded Housing First program and how it is functioning from the perspective of a representative sample of providers and clients who deliver and receive HF services.MethodsThirty-four clients and providers who currently or formerly delivered HF in Metro Vancouver participated in one-on-one interviews (n = 26) or focus groups (n = 8) between March and April 2017 and data were thematically analyzed.ResultsStrengths of the HF program included: the ability to transition persons from the street into housing with individualized service supports and, in certain cases, with 12-month rent subsidies, household goods, and connection to community resources. Identified program weaknesses were: eligibility criteria, limited rent subsidy funds, limited provider capacity, and workload burden. Suggested opportunities to improve HF were: streamlining federal and provincial reporting and rent subsidy systems and building friendly landlord networks. Potential threats to HF described were: limited affordable housing, stigma and discrimination toward clients, inadequate income assistance, and limited opportunity for cross-sector collaboration.ConclusionsThe delivery of HF in regions that have limited affordable housing presents unique challenges. Recommendations are provided to improve HF practice and policy in these contexts.     

Transforming Into Men Who Matter: Increasing Empathy in Domestic Abuse Treatment

ABSTRACT

Men referred to domestic abuse treatment are typically involuntary clients, ranging from being legally mandated to being under significant pressure from others to attend. Such treatment programs have mixed results in achieving change in abusive behaviours. Most programs emphasise taking responsibility for abusive behaviour by examining the precursor thinking beliefs and values, with less attention paid to learning new interpersonal skills that replace antisocial behaviours with prosocial alternatives. Empathy provides a measurable moderator of moving beyond simply acknowledging responsibility for past abuse into learning and applying prosocial relationship enhancement skills with their treatment cohort, families, and significant others. This paper describes a program that builds empathy skills through a series of program and mentalisation tasks that include routine client feedback using the Partners for Change Outcome Management System (PCOMS). Evidence of increased retention and statistically significant changes in empathy using the Social Empathy Index are provided from a previous study examining the same program. The practice and research implications for domestic abuse clients and other involuntary populations are discussed.

IMPLICATIONS

• Involuntary clients continue to have high dropout rates across a range of client populations and are a challenge to engage in the change process. With the application of the client feedback tools and relationship enhancement skills described in this paper professionals can more effectively engage other types of involuntary clients in their change efforts.

• The focus on empathy and relationship enhancement skills can lead to reduced treatment dropout across involuntary client populations referred for substance use, domestic violence, or other offender behaviours.

     

Women in Substance Use Treatment

Abstract

The objective of this study was to examine the differences between women with children in substance use treatment who are involved in Child Protective Services (CPS+) and those who are not involved (CPS-). Using a sample of all alcohol and other drug (AOD) clients (N = 6,023) receiving substance use treatment over a three-year period (1997-99), the study found that CPS+ women were more likely to be younger, have more children, have been arrested less often, be mandated to receive treatment, to have an unsatisfactory exit status or be transferred to another treatment program at discharge. CPS+ women were also more likely to have attended outpatient or day treatment for the AOD treatment. This study points out that there may be specific risk factors in place for a subgroup of women with children in AOD treatment.     

A Computer-Assisted Self-Interview (CASI) Assignment in the MSW Classroom

ABSTRACT

This article reviews the research regarding computer-assisted self-interviews and describes a specific program, the Addiction Severity Index-Multimedia Version (ASI-MV), a self-administered audio assessment of substance use as well as concurrent psychosocial problems. This program was integrated into a graduate substance abuse course through a simulated exercise intended to introduce students to computer-based assessments. Students (N = 21) later evaluated the exercise and their reactions to computerized assessment at the end of the semester. Overall, students reported increased assessment skills, more comfort with the use of computers to assess clients, and willingness to incorporate computers into social work practice.     

Social Work Admissions and Academic Accommodations for Students with Disabilities

ABSTRACT

The Americans With Disabilities Act of 1990 (ADA) protects students wth disabilities from discrimination by academic and professional programs in higher education. A student with a disability cannot be denied admission to an educational program because of his or her disability if the student is otherwise qualified. This means that a student with a disability who is qualified for an academic or professional educational program cannot be denied admission to a program based solely on the student&s disability. This educational requirement mandated by the ADA applies to all educational fields including social work education. The purpose of this study was to explore how social work programs are dealing with these requirements in their admission and academic accommodation procedures. Twelve social work programs located in the mid-western United States participated in the study. Representatives of each of these programs were given an in-depth interview focusing on their admissions process, academic accommodations, and general topics related to social work education and disabilities. All programs taking part in the research were accredited by the Council on Social Work Education (CSWE). The CSWE is the national accreditation body for social work education within the United States.     

A Joint University—Field Agency: Toward the Integration of Classroom and Practicum

Abstract

The authors describe an innovative program designed to create a joint university and local municipality agency in Israel. The agency was structured to be a teaching laboratory that would offer innovative services for social work clients and a unique field placement for students. Four major goals involved joint outcomes for both university and municipality. These included (a) demonstrating evaluation research as a means of accountability and as a tool for practice; (b) using generic social work methods for work with families; (c) reaching out to difficult and high-risk clients with innovative programs; and (d) using the laboratory as a training center for welfare workers, agency supervisors, and students from all levels of the social work programs. The authors describe and evaluate each of the goals, discussing the implications for teaching and for social work practice.     

Impact of Computerized Rapid Assessment Instruments on Counselors and Client Outcome

Abstract

The effect of the availability of Rapid Assessment Instrument (RAI) (1) computer scoring, and (2) computer administration on: (3) counselor behavior, and (4) client outcome was inspected. Counselors without computer assistance employed fewest RAIs with their clients; those with computer scoring available employed more RAIs, and those with computer administration available employed RAIs most frequently. When more RAis were employed, clients improved more in counseling, terminated against medical advice less frequently, and were also more satisfied with their counseling experience.     

Young Clients of Hotel-Based Sex Workers in Bangladesh: Vulnerability to HIV,Risk Perceptions,and Expressed Needs for Interventions

ABSTRACT

A qualitative study was conducted among key informants and 53 young clients (15 to 24 years of age) of commercial sex workers from nine hotels in Dhaka, Bangladesh. Respondents reported first sexual encounter before 18 years of age, and reasons for purchasing sex were to prove masculinity or to reduce wet dreams and masturbation, thought to be detrimental to health. Limited knowledge of HIV and sexually transmitted infections was linked to high-risk sexual practices. Condom use was related to perceptions of cleanliness, status, and trust in the sex worker.

A hotel-based, confidential intervention program promoting safe sex practices among clients of sex workers is warranted.     

Patterns of Consumer Usage of Homeless Outreach Services

Abstract

Outreach programs are a vital part of the continuum of services for the homeless. To investigate the characteristics of consumers of such programs and the services they receive, a sample of 446 clients of a homeless outreach program in New York City was divided into those who visited only once, two to three times, and four or more times during a 1-month period. Chi-square analyses revealed that the groups differed significantly with regard to previous client status, clinical diagnosis, referrals provided, and service outcome. Correspondence analyses further specified relationships between visit frequency and select characteristics. Implications of the findings for service delivery are considered.     

The Implementation of a “Work First” Welfare-to-Work Program in a Changing Environment

ABSTRACT

Current welfare-to-work programs grapple with the issue of putting welfare recipients to work immediately or investing in long-term education and training. Because of the 1996 welfare reform time limits, “work first” approaches are predominating. This paper examines the innovative program developed by Goodwill Industries of Southern California, which meets the challenges of implementing a work first model with a low-skill Spanish-speaking population, while also providing services to overcome barriers to employment. This is accomplished in the context of a unique profit-generating business enterprise, which makes program participants both clients and employees.     

Evaluation of a Housing Support Program for People Who Are at Risk of Homelessness: Perspective of People Who Refer Clients

Abstract

Strategies assisting people to maintain their tenancies are at the forefront of current government policy to prevent homelessness. Based on an intensive case management model, the Housing Support Program (HSP) aimed to prevent homelessness by providing ongoing assessment, advocacy, assistance and coordination of services for clients who are deemed at risk of losing their secure accommodation.

The aim of this study was to evaluate the HSP from the perspective of the people who referred clients to the program. Twenty nine referral agents were surveyed. A focus group was also conducted. A large majority of participants (n=25, 86%) ‘strongly agreed’ or ‘agreed’ that the housing outcomes improved for referred clients after HSP intervention. Over three quarters of participants (n=23, 80%) believed that there are too few agencies actively working to support those at risk of loss of tenancy. The focus group discussion reaffirmed the role HSP plays providing continuity of care and ‘plugging the gap’ in services for disadvantaged clients.     

An evaluation of substance abuse aftercare program for homeless women with children using confounding variable-control design

An outcome evaluation of a substance abuse aftercare program for homeless women with children was conducted using confounding variable-control evaluation design. The confounding variables are chosen from pre-treatment and other contextual variables of the clients that are known to have significant influence on the program outcome, but those that could not have been influenced a priori by the client involvement in in-treatment program activity at Transition House (TH). The latter is the independent variable of this evaluation design. The pre-treatment variables are measured by severity of alcohol and other drug (AOD) problems of the clients, their mental health status, age, and their job status before enrollment in the program. The contextual confounding variables are composed of family and social support available to the clients before and during recovery. While applying multiple regression analysis, we were able to explain 50.8% of the total variance in program outcome by four pre-treatment variables. By adding two contextual variables of family and social support, the total variance in program outcome explained is increased to 64.1%. Finally, by adding the degree of client involvement in in-treatment program activity, we were able to augment the total variance of the program outcome to 69.7%. By estimating the changed variance of program outcome by the in-treatment program activity during the final step, controlling for all other variables previously entered, we were able to establish that client involvement in in-treatment program had unique and positive impact on the program outcome distinct from those explained by the confounding variables. The additional variance uniquely added by in-treatment program activity is 5.6% (p < .001). It has been determined that the degree of client involvement in in-treatment program had positive and systematic impact on the program outcome.     

Development of a Questionnaire to Assess University Students’ Intentions to Use Behavioral Alcohol-Reduction Strategies

Abstract

Objective: To evaluate the psychometric properties of a new self-report questionnaire designed to assess college students’ intentions to employ 31 specific alcohol-reduction strategies. Method: Students attending a large public university were recruited to complete alcohol-reduction, drinking history, and personality questionnaires online. Results: Based on item–total correlations and principal components analysis, the authors eliminated 3 items and calculated average intention ratings across the remaining 28 items. The resulting scale had appropriate unidimensionality and excellent internal consistency. Correlations of intention questionnaire scores with measures of drinking history, alcohol outcome expectancies, sensation seeking, and impression management provided some support for criterion and discriminant validity of the questionnaire. Conclusion: This questionnaire could be employed as an outcome measure to evaluate prevention programs and as a clinical tool to identify clients who have little intention to employ drinking reduction strategies in heavy drinking situations.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Total Client Sampling and a Test of Family Preservation Services

Abstract

This study evaluates a five year quasi-experiment in the provision of family preservation to families at imminent risk of placement, comparing outcomes with a five year baseline experience and “customary services” program in a similar city. Clients in the experimental group received concrete services and a large amount of psychotherapeutic care of one sort or another. Clients in the two comparison groups probably received similar amounts of concrete services but much less therapeutic care. Clients in the experimental group were placed at a much lower rate than clients in either comparison group. Moreover, the home environment of experimental clients also improved much more than the home environment of controls.