The residential treatment of an abusing family

Abstract

This article discusses the residential treatment of an abusing family in a local authority setting, when the use of short-stay children's homes was changed to provide a preventive service for families in trouble. The Centre has room to admit a family where the child's safety cannot be guaranteed in its own home.

The structure of the treatment programme is described, the partnership of residential and field work staff, the monitoring role provided by residential staff and the importance of supervision, particularly for those closely involved with the family. The role of the NAI Conference is discussed, and the individual functions of its members in relation to the family. The varied methods of working with the family are described, and the family's emotional response is illustrated with the theme of separation.

The article concludes that the family did respond to treatment, and that we have further to go in developing residential work with abusing families at our Centre.     

Recovery coaches and the stability of reunification for substance abusing families in child welfare

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.     

The effect of race/ethnicity on the relation between substance use disorder diagnosis and substance use treatment receipt among male serious adolescent offenders

The high rates of substance disorders in the juvenile justice system, as well as the relation between substance use and reoffending, suggest the importance of substance use treatment service and understanding the factors that influence treatment provision. The current study tested whether race/ethnicity affects the relation between substance use disorder diagnosis and the receipt of substance use treatment services among a sample of male serious juvenile offenders (N = 638). Findings showed that among adolescents with a substance use disorder diagnosis, there were no race/ethnicity differences in substance use treatment receipt. However, among adolescents without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use treatment than were Hispanics or African-Americans. Additionally, findings showed that there were race/ethnicity differences in service receipt at moderate levels of substance use problems, such that non-Hispanic Caucasians were more likely to receive substance use treatment than Hispanics or African-Americans. There were no race/ethnicity differences in treatment receipt when substance use problems were either very severe or very low. Results suggest that race/ethnicity may play a role in service provision in the juvenile justice system when levels of need are less clear.     

An analysis of the self-control and criminal versatility of gang and dating violence offenders

How versatile are gang and dating violence offenders? Current gang research highlights the versatility of gang members, yet the versatility of intimate violence offenders is often unexamined. Gottfredson and Hirschi, A General Theory of Crime (1990), support the idea of versatile rather than specialized offenders and suggests that low self-control is associated with a host of criminal and noncriminal risk-taking activities. Using data from a self-report sample of 1139 youths in grades 9 through 11, we investigated both the versatility of gang and dating violence offenders and theoretical variables associated with each. We find disproportionate offending by dating and gang violence offenders in a variety of crimes, as well as considerable overlap in the independent variables associated with both types of violence. Low levels of self-control and exposure to general and crime-specific criminal opportunities are significantly associated with engaging in dating and gang violence.     

The effects of family stressors on substance use initiation in adolescence

Smoking and drinking are critical problems in adolescence that have long-term adverse impacts on health and socio-economic factors. We examine the extent to which family stresses influence the timing of initiation of smoking and drinking. Using national panel data from the National Educational Longitudinal Study (NELS) we capitalize on the survey design and use school-level fixed effects that control for the local environments, including prices of cigarettes and alcohol. In addition, we narrow our control group to classmates who will experience a similar stressor in the future. We find that a composite measure of family stressors when young increases the likelihood of initiating tobacco and alcohol use, with much of the impact attributable to parental divorce. In our baseline estimates, the composite stress measure is associated with a 30% increase in the likelihood of smoking and a 20% increase in drinking. When we control for multiple sources of confounding, the impact shrinks and remains significant for smoking but not for drinking. We conclude that studies which do not control for confounding are likely to significantly overestimate the impact of family stress on substance use. Our approach helps to move the literature forward by separating causal results from spurious associations.     

Parental substance abuse and the development of children in family foster care

To determine the impact of parental substance abuse on children, the cognitive skills and behavior ratings of 268 school-age children placed in family foster care were examined. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Recommendations for further study of these factors and for enhancing outcomes for children in care are provided.     

Sexual offending in adolescence: a comparison of sibling offenders and nonsibling offenders across domains of risk and treatment need

Sibling sexual offending has received limited empirical attention, despite estimates that approximately half of all adolescent-perpetrated sexual offenses involve a sibling victim. The present study addresses this gap by examining male adolescent sibling (n = 100) and nonsibling offenders (n = 66) with regard to maltreatment histories and scores on two adolescent risk/need assessment instruments, the ERASOR and YLS/CMI. Adolescents who sexually abused a sibling, versus a nonsibling, were more likely to have histories of sexual abuse and been exposed to domestic violence and pornography. There were no group differences on ERASOR and YLS/CMI scales. This study adds to the limited discourse on sibling sexual offending and the larger literature on the heterogeneity of adolescents who have sexually offended.     

Focusing on the big picture

As a postdoc in cognitive neuroscience who's also a neurology fellow, Adam Gazzaley is a meld of basic science expertise and clinical experience: He studies brain aging in people by using functional magnetic resonance imaging at the University of California (UC), Berkeley, and he also sees patients at UC San Francisco's Memory and Aging Center. The 34-year-old native New Yorker dives with equal fervor into scientific research and nature photography, two lenses for viewing a single world of discovery. Growing up in Queens, Gazzaley knew from age 7 that he wanted to become a scientist, and as a teenager, he commuted long hours to attend the Bronx High School of Science. He earned an M.D.-Ph.D. from the Mount Sinai School of Medicine in New York City. Gazzaley's hobby as a shutterbug periodically takes him on backpacking trips to document the beauty of the great outdoors. He sells fine-art prints of his photographs to individuals, hospitals, and clinics through his company, Wanderings Inc.     

Exploring the implementation of justice-based alcohol and drug intervention strategies with juvenile offenders: Reclaiming Futures,enhanced adolescent substance abuse treatment,and juvenile drug courts

There is a need for practice models to match young people in the juvenile justice system with timely and effective alcohol and drug intervention services. This paper reports on a new demonstration effort in which three practice approaches currently operating in the United States are being combined to maximize the potential of each. This public–private partnership combines juvenile drug courts (funded by the Office of Juvenile Justice and Delinquency Prevention), adolescent treatment improvement efforts (funded by the Center for Substance Abuse Treatment) and the Reclaiming Futures initiative (funded by the Robert Wood Johnson Foundation). Benefits of combining the three strategies are discussed, emergent implementation challenges and lessons are presented, and suggestions for further evolution are provided.     

The simulated family as an aid to learning family group treatment.

Role-playing by students as "family members" and "therapist" in a simulated family situation provides a stimulating learning experience for the participants and the student audience.     

Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

ADHD in juvenile offenders: treatment issues nurses need to know

1. When working with juvenile offenders with ADHD, advanced practice nurses should consider prescribing stimulant medication in conjunction with other psychosocial interventions to achieve maximum treatment success. 2. Nurses working with young people with ADHD in the justice system must carefully coordinate care among all health care providers and juvenile justice personnel, including attorneys, probation/parole officers, and court assessment personnel. 3. Advocating for the individual needs of clients and their families is critical; often, this includes advocating for care that is not only evidence based, but also culturally competent.     

Cost-effectiveness of family-based substance abuse treatment

In order to compete in a financially sensitive health care system, family systems-based treatments must demonstrate effective clinical results as well as cost-effectiveness. Cost-effectiveness research can demonstrate to health care insurers and policy makers which treatments are viable options for implementation. The present literature review identified eight cost-effectiveness family-based substance abuse treatment studies. The results suggest that certain family-based treatments are cost-effective and warrant consideration for inclusion in health care delivery systems.     

Treating drug-abusing offenders. Initial findings from a five-county study on the impact of California's Proposition 36 on the treatment system and patient outcomes

Five counties (Kern, Riverside, Sacramento, San Diego, San Francisco) that demonstrate both variations and similarities in their implementation of Proposition 36 (e.g., treatment approaches, urine testing) and patient mix have been selected to participate in a study assessing how California's Proposition 36 is affecting the drug treatment system and patient outcomes. Except for San Francisco, treatment admissions increased during the first year of Proposition 36 implementation over the prior year (27% in Kern, 21% in Riverside, 17% in Sacramento, and 16% in San Diego), mostly in outpatient drug-free programs. Compared to non-Proposition 36 patients, Proposition 36 patients were more likely to be men, first-time admissions, treated in outpatient drug-free programs, employed full-time, and users of methamphetamine or marijuana. They were less likely to be treated in residential programs or methadone maintenance programs and fewer reported heroin use or injection drug use. Guided by the multilevel open systems framework, the study examines key issues of Proposition 36 that influence treatment systems and outcomes and empirically identifies "best practice" approaches in treating drug-abusing offenders.     

Day versus residential treatment for juvenile offenders: the impact of program evaluation

A case study of a public service department's program evaluation provides insights into the social policy-making process as well as findings on the effectiveness of two different forms of treatment for the same social problem.     

Vulnerability in custody: perceptions and practices of police officers and criminal justice professionals in meeting the communication needs of offenders with learning disabilities and learning difficulties

Information provision and communication within the Criminal Justice System can be highly problematic for young people and adults with learning disabilities and difficulties. Paper-based communication is common, and is mandated for the provision of rights and entitlements in custody, but such communication can be poorly understood, potentially leading to miscarriages of justice. This article uses the piloting of a more accessible version of the rights and entitlements notice in custody to explore the communication practices with vulnerable detained persons from the perspectives of professionals within the Criminal Justice System. As a legally mandated text in a context heavily imbued with organisational power, the rights and entitlements notice in custody has sociological significance as a lens through which organisational practices, and understandings, can be examined. The stressful, fast-paced and transitional context of custody shapes communication and interaction in ways that are challenging for the detained person and also the professionals who support them.     

Current practices in residential treatment for adolescent sex offenders: a survey

A list of all treatment facilities for adolescent sex offenders that described themselves as inpatient or residential was requested from the Safer Society Foundation in Brandon, Vermont. A total of 203 such facilities were identified in this manner. Each was sent a questionnaire regarding their policies and practices. Of the 50 questionnaires that were returned, 49 were usable. Items on the questionnaire dealt with major phases of operating a residential program, including number of beds, average daily census, number of males and females in treatment, testing and assessment procedures, most frequent diagnoses, average IQ of patients, abuse history, therapeutic approaches used, number and types of individual/group treatment sessions per week, qualifications of therapists, average length of treatment, and follow-up research on treatment.     

Use of evidence-based substance use treatment practices in Mississippi

Over the past decade, substance abuse treatment professionals have begun to implement evidence-based practices (EBPs) into the treatment of substance use disorders. There is a growing body of research on the diffusion of EBP in addiction treatment; however, less is known about individual state initiatives to implement EBPs among community providers. The current study aimed to evaluate the progress of an initiative of the Mississippi Department of Mental Health (MDMH) to increase the implementation of evidence-based substance abuse treatment practices by certified providers. In addition, the study examines potential barriers to implementing these practices. To accomplish this goal, we reported the findings of two surveys of Mississippi addiction professionals conducted in 2010 and in 2013.