Addiction Treatment with Deaf and Hard of Hearing People: An Application of the CENAPS Model

ABSTRACT

Alcohol and drug addiction is a significant problem among deaf and hard of hearing people. Looking through a Deaf culture lens, treatment for alcohol and drug addiction is key for providing care for deaf and hard of hearing clients. Using the CENAPS model, an applied cognitive-behavioral therapy program is recommended for addiction treatment. The CENAPS model provides clinicians with tools for stabilizing deaf and hard of hearing clients, supporting their transition to early recovery. Educating the client about the stages of relapse and the stages of recovery, clinicians using this model can better treat and prepare deaf and hard of hearing clients for long-term recovery.     

Register data in the evaluation and program planning of addiction treatment programs: Using Sweden as an example

Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts.The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.     

Computer systems in addiction treatment programs: Availability and implications for program evaluation

Addiction treatment programs have been slow to adopt computerized information systems. Little systematic data exist on programs' technological infrastructures and use of electronic databases to store and analyze client information. Likewise, there is little information available on counselors' access to and use of the Internet for learning about new treatment techniques. Drawing upon data obtained in 2002–2003 from nationally-representative samples of publicly- and privately-funded addiction treatment centers and their counselors, this article describes the current state of the field in terms of data system availability and Internet usage. The availability of client-level databases is variable but continues to evolve. Programs maintaining electronic client data appear to be at an advantage for implementing outcomes monitoring activities. While counselors' access to computers is high, their use of the Internet and the NIDA website is low. The implications of these findings, and directions for future research, are discussed.     

Briefly Noted

A project that began a year ago (see ADAW, Jan. 15, 2018), Shatterproof's rating system of addiction treatment programs took another step last month when the nonprofit announced it would start out with a pilot, now that it has $5 million. Saying the current addiction treatment system is broken, Shatterproof founder and CEO Gary Mendell said the project was made possible by funding from two foundations (the Laura and John Arnold Foundation and the Robert Wood Johnson Foundation) and a coalition of five insurance companies. “People who need help for addiction don't know what to look for or where to turn,” said Sam Arsenault, director of national treatment quality initiatives at Shatterproof, in the Dec. 18 announcement of the project. “We are taking rating system best practices from health care and other business sectors and applying them to addiction treatment. This will not only provide critical information to individuals looking for care but also drive a long overdue transformation of the addiction treatment industry.” The Shatterproof Rating System will utilize data from three sources: insurance claims, provider surveys and consumer experience, with collaboration from the National Quality Forum (NQF), a membership organization composed of payers. Initially, the program will begin with a pilot, with analysis done by RTI International. “Consumers can find information and accurate data on the quality of nursing homes, hospitals, physicians and most other types of providers,” said Tami Mark, director of behavioral health financing and quality measurement at RTI International. “It's time that patients have reliable information on addiction treatment.”     

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.

     

Beyond “Dry Drunkenness”: Facilitating Second Stage Recovery Using Wilber's “Spectrum of Consciousness” Developmental Model

ABSTRACT

The usefulness of Wilber's “Spectrum of Consciousness” developmental model in the treatment of substance abuse is demonstrated by a case study that illustrates how underlying emotional pain and intimacy issues can be worked through in the counselling process with a client during the second stage of recovery from addiction. Wilber's model allows for narcissistic, critical self, social, identity, intimacy, existential, and psycho-spiritual issues to be integrated into the counselling process for long-term recovery. This model provides social workers and addictions counselors with a useful map in embracing client recovery.     

Pathological gambling: The initial screening interview

This paper reviews basic components of the initial screening interview for applicants to treatment programs for pathological gamblers. The therapeutic potential of the interview is seen as primary and the collection of information follows an initial period of unstructured exploration of feelings. Specific information needed in making an admission decision is reviewed including items related to the gambling addiction, to family, employment, health, co-addiction, attitude, and demographics. Some items of information required by the client are reviewed. Criteria for acceptance or rejection are mentioned throughout. The rationale for various items of policy is reviewed briefly in a number of situations.     

Getting a picture of the client's world-view: Art-making and subjectivity as evidence

Paintings and drawings can enrich and amplify understanding of dilemmas which may otherwise be limited by reliance on verbal data alone, such as client conversations, interviews and case-notes. In order for social workers to make sense of this additional information, they will need to use their subjective understandings, which because of their very subjectivity need then to be cross-checked with other forms of evidence. This article outlines an approach useful in social work practice with adult clients. It is based on research with a community group of volunteers from the Midlands who chose to join a project exploring midlife and its transitions. It was found that art-making of a particular order, which accentuated sensory exploration, curiosity and experimentation, contributed towards a changed relationship with self and with the external world. Key indicators lay in changes in use of language, choice of art materials and colour.     

Counseling for the Family: The Neglected Aspect of Addiction Treatment in Canada

ABSTRACT

There has been a historic neglect of both research and practice in the area of counselling for the family members of alcohol or other drug abusers by the addiction field in Canada. As a result, treatment for individual family members affected by alcoholism and other drug addiction remains a neglected component of the majority of Canadian addiction programs. When family involvement is incorporated, the tendency has been to concentrate on orientation and education rather than on the provision of counseling for the family members. This dearth of programming exists despite the knowledge that an active alcohol or drug abuser's behaviour disrupts the entire family system, including the functioning and development of children. Each family member is uniquely affected with negative outcomes ranging from economic hardship to violence being perpetrated against them to an increased risk among children of becoming alcohol or drug abusers themselves. Thus, treating only the active alcohol or other drug abuser is limiting and an overly narrow orientation for the enhancement of both family and community health.     

Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China

ABSTRACT

This study explores strategies for dealing with client resistance that are commonly used by a group of selected counsellors who work closely with illicit drug users in the community-based compulsory treatment programs in China. Through semistructured in-depth interviews with 16 counsellors, this study finds that different forms of client resistance were experienced in their day-to-day practice, encompassing passive and active behaviours. Five typical strategies are used by Chinese counsellors in this study to deal with client resistance: showing respect and caring and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination. Considering these strategies can also be seen as general principles for dealing with involuntary clients in other fields of social work services, the findings of this study may have broader impact.

IMPLICATIONS

• Effective ways that can be used by counsellors for reducing illicit drug users’ resistance during treatment include: showing respect and caring, and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination.

• Professional social work training is urgently needed among community-based drug treatment social work practitioners in China, to achieve efficient practices and better outcomes.

     

Nurse-led art expression in addiction treatment.

Creative expression can be a potent force in recovery programs, and psychosocial nurses trained in group processes can use art expression as part of addiction recovery and relapse prevention. Enabling clients to understand recovery and recognize what life offers without addiction is one of the best defenses against relapse during difficult times.     

Liability and the Internet: Risks and Recommendations for Social Work Practice

SUMMARY

Use of the Internet for counseling and information services has increased dramatically in the last five years. Although the Internet may benefit consumers by helping them secure needed services and resources, social workers and social service agencies who provide counseling over the Internet need to be aware of the legal risks associated with its use. Among the most salient concerns that need to be addressed are client confidentiality and privacy of records, appropriateness of treatment services, and the duty to warn others of harm that a client might pose to them. This paper looks at these legal concerns in light of appropriate Social Work practice and recommends methods to abate the risks that might occur when Internet counseling and service is provided.     

Abstinence-Only: Are You Not Working the Program or Is the Program Not Working for You?

Low retention rates are common in substance use treatment programs. The dominant model of service delivery in the United States is abstinence-only, a high-threshold service delivery model requiring abstinence. What “doesn’t work” for the client—from the client point of view—is an overlooked source of insight about client engagement and disengagement. We report client counter-narratives about the choice to disengage from abstinence-based services, shifting from a story of “dropouts” to one of self-respect. Understanding why clients choose to disengage from treatment can help us as practitioners to “meet clients where they are” and enhance engagement in substance abuse treatment.     

Caring for Persons with Serious Mental Illness

Abstract

This article places evidenced-based knowledge of practice within the social context of care and proposes five policy objectives and specific policy and program changes to address care needs of people with serious mental illness. In spite of demonstration programs that provide the basis for proposed policy initiatives throughout the United States, treatment provision for this population remains inadequate and their safety and well-being continues to be at risk. The authors suggest that treatment initiatives need to be tied to stable policies protecting the mentally ill from adverse social context changes. The authors conclude that policies are needed that will enhance housing assistance, independent social functioning, personal empowerment, and treatment engagement. In addition, efforts are needed to make better use of inpatient hospital care, to better understand the role of assisted treatment, and to better develop consistent long-term fiscal support for the seriously mentally ill. They offer specific policy recommendations for changes in HUD programs, Medicaid and Medicare funding, and treatment programming that address these needs.     

Meeting Them Where They Are: An Exploratory Study of Staff and Shelter Resident Perceptions of Homeless Women's Needs

Abstract

Only a small number of studies have surveyed homeless people about their needs, and none has compared these perceptions with those of homeless service providers. In this small, preliminary, exploratory investigation, both shelter residents and staff at one homeless shelter dedicated to serving dually-diagnosed adult women were queried about shelter resident need. Residents and staff agreed on the need for immediate, non-change-oriented services (such as assistance with overdue bills and housing) and some shorter-term services (such as education and job skills training). The two groups disagreed on the need for longer-term, change-oriented services, such as substance abuse treatment, education about activities of daily living, and health/counseling services (with more staff than residents perceiving such need). Two potential recommendations are discussed. Staff could consider altering the timing of treatment plan creation to increase engagement with homeless clients. Shelter directors and funders could consider modifying the measurement of client outcomes to include client progression toward longer-term change.     

Chapter 8: Responding to Deaths of Faculty,Staff and Students at UC,Berkeley

SUMMARY

This article describes an important initiative designed to address the deaths of faculty, staff, and students at the University of California at Berkeley. Work-life and EAP practitioners can play a significant role in reducing the distress and lost work time associated with workplace deaths by helping employers to plan a response to employee and client deaths, and by participating in implementing that response. A model framework is presented to demonstrate the vital need for coordination and integration among many of the employers' programs, services, and activities in order to address deaths.     

Social Service Research and Religion

Abstract

Development of accountability standards to demonstrate cause and effect relationships are gaining rapid advancement in the field of social sciences. Many governmental agencies, foundations, and other funders have developed approaches that require organizations to utilize science-based programs and incorporate evaluative methods to show improved outcomes and cost benefits to society. This article will examine the need for increased accountability in developing effective interventions by faith-based organizations in the delivery of social service interventions. Recently, there has been a strong movement toward governmental funding for faith-based institutions to provide social services, although there has been inadequate scientific data to demonstrate that approaches implemented are effective in meeting needs or yielding favorable outcomes. Similarly, many faith-based organizations provide innovative and effective programs that could serve as model programs if there was appropriate empirical evidence. This article will discuss how rigorous evaluative approaches such as randomized clinical control trials can produce scientific data on program effectiveness. We will use a case example in the field of drug and alcohol treatment to illustrate these points.     

Phenomenology and intersubjectivity: considerations for webcam-facilitated psychotherapy

ABSTRACT

The clearest distinction between webcam-facilitated versus face-to-face psychotherapy is the available sensorial information. The following questions guide this discussion: 1. How do our senses inform the psychotherapeutic process? 2. What are the implications for the therapeutic process when sensory information is different than during face-to-face therapy? This examination of the role of the senses in the creation of knowledge is grounded in phenomenology. Individual unity of consciousness and reciprocal understanding are applied to literature on webcam-facilitated therapy. An amalgam clinical example illustrates these phenomenological concepts and role of intersubjectivity. The core issues are involvement of sensory processes in the process of psychotherapy and co-construction of knowledge. By accepting the limitations of therapist knowledge, the client is encouraged to articulate and develop their own knowledge, and make conscious their unconscious. It is not necessary for therapist and client to share a physical space for co-creation of knowledge necessary for client transformation.     

Linguistic Analysis as a Method for Assessing Symptoms After Sexual Trauma Among Female Adolescent Psychiatric Inpatients

ABSTRACT

Using a sample of female psychiatric inpatient adolescents, the current study aimed to extend this literature to an adolescent sample for the first time by examining if linguistic markers and their subcategories (cognitive process words, pronoun use, and somatosensory detail) in a trauma account are related to trauma symptomology and recovery during inpatient care. Results indicated that greater use of body words and fewer insight words were related to increased trauma symptoms at admission. In addition, use of fewer cognitive process words at admission predicted greater symptom change at discharge, extending previous research findings to an adolescent sample. Findings suggest that linguistic analysis may be an important component of adolescent trauma symptom assessment and treatment monitoring.     

Barriers to substance use disorder treatment in a sub-acute setting

ABSTRACT

With the changing times, it is essential integrate behavioral health within the primary care of patients. The need is based on the research that links a number of health issues being directly to substance use and mental health diagnosis. With the current opioid epidemic there is a need to address substance use disorders when treating patients in different health care settings. Despite the necessity of integrated care, there are barriers to addressing addiction in sub-acute care settings. With the lack of buy-in from the patients and health care providers and the stigma surrounding addiction it is time to address the barriers that prevents integration of care where it is most needed.