Does allocation to a control condition in a Randomized Controlled Trial affect the routine care foster parents receive?

‘Strengthening Foster parents in Parenting’ (SFP) is a support program for foster parents who care for foster children with externalizing problem behavior. Its effectiveness was examined with a Randomized Controlled Trial (RCT). In this paper, we examine the treatment as usual (TAU) that was offered in the control condition of this RCT. For this purpose, the TAU from the SFP control group was compared with TAU provided to a similar group of foster parents outside any RCT.Our results show that TAU is diverse and varies widely. Furthermore, being part of the control condition was positively associated with both the counseling frequency from the foster care services and with external help-seeking behavior (finding and using additional support).In order to prevent condition contamination in future trials, TAU should be clearly described and standardized, and treatment fidelity should be carefully monitored.     

Is multidimensional treatment foster care (MTFC) more effective than treatment as usual in a three-year follow-up? Results from MTFC in a Swedish setting

This study examines three-year post-baseline outcomes for a randomized controlled trial of Swedish antisocial youths who received either multidimensional treatment foster care (MTFC) or treatment as usual (TAU). Several studies in our literature review indicated that MTFC intervention is preferred to the alternative (TAU) in the USA during follow-up. Two studies (one conducted in the UK and one in Sweden) have shown indications of a washout effect between the intervention alternatives during follow-up. However, this study showed few but positive significant outcomes at follow-up for the MTFC programme in comparison to TAU. Juveniles who participated in MTFC spent fewer days in locked settings and had committed fewer violent crimes, according to the social case records. Two key features of the MTFC programme certainly merit use in general social service—namely, reducing exposure to deviant peers and increasing school participation.     

When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.     

Partial Hospitalization Treatment for Clinical Depression

Abstract

This article describes an outcome study evaluating the effectiveness of a partial hospitalization program (PHP) on the treatment of clinically depressed clients. Within the context of a relatively non-intrusive one-group pretest-posttest research design, nine adult clients completed the Generalized Contentment Scale (a measure of non-psychotic depression) at admission to, and discharge from, the PHP. The clients experienced statistically significant and clinically meaningful improvements between admission and discharge from the PHP. This MSW student-conducted program evaluation represents the type of easy-to-conduct outcome studies which are increasingly being called for in today's practice environment.     

Closing the Need-Service Gap: Gender Differences in Matching Services to Client Needs in Comprehensive Substance Abuse Treatment

Despite the broad recognition in social work that services are more effective when they are tailored to individual client needs, we have only limited evidence of the impact that services matched to client needs have on treatment outcomes. This study examines gender differences in the impact of matched services, access services, and outcome-targeted services on substance abuse treatment outcomes by using data collected from 1992 through 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and clients. The analytic sample consists of 3,027 clients (1,105 women and 1,922 men) who reported needed services from 59 treatment facilities. Findings from the study indicate that overall programs have only limited success in targeting services to client needs, but when they do, receipt of substance abuse counseling and matched services predicts both remaining in treatment and reduced posttreatment substance use for both women and men, but especially for women.     

Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties

ObjectiveTo compare the effectiveness of a Brief Intervention (BI) and Treatment As Usual (TAU) in a sample of children and adolescents seeking mental health treatment from a Child and Youth Mental Health Service (CYMHS). BI comprised up to six sessions of psychological therapy from trainee psychologists, and TAU involves case management incorporating assessment and psychological treatment (e.g., individual, parent, family therapy), plus linkage to other services.MethodA matched subjects design was used to evaluate the BI (n = 79) and TAU (n = 79) treatment conditions. Participants were matched according to age, gender, and baseline symptom scores on the Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA), which was completed at pre- and post-treatment. The HoNOSCA is a clinician-rated measure of symptoms experienced in the previous two weeks.ResultsBI and TAU both significantly reduced mental health symptoms, with no significant difference between treatments overall, on Externalising or Emotional problems subscales, or on the percentage of most problematic items for participants.ConclusionsBI was as effective as TAU in reducing mental health symptoms in some children and adolescents. BI however is briefer, and could form part of a Stepped Care model for CYMHS. Further research is required to establish the most effective elements of BI in reducing mental health symptoms.     

An Evaluation of the Therapeutic Learning Program

Abstract

The Therapeutic Learning Program (TLP) is a structured, model-based treatment designed to help clients counter self-doubts that interfere with personafdevelopment. Specific information is collected and a therapist helps the client interpret it, select goals, and overcome emotional barriers to action. Undergraduate volunteers (N = 66) seeking counseling to solve academic problems were randomly assigned to a condition in which they entered TLP information on a computer (TLP1), a condition in which they entered the TLP information on a paper check list (TLP2), or participated in a personally chosen option (PCO) control. The post-test data showed equal satisfaction and setf-concept gain for all three treatments. Sessions with the computer were longer, involved the clients in more individual effort, and were probably more thorough.     

Models,methods and network topology: Experimental design for the study of interference

How should a network experiment be designed to achieve high statistical power? Experimental treatments on networks may spread. Randomizing assignment of treatment to nodes enhances learning about the counterfactual causal effects of a social network experiment and also requires new methodology (ex. Aronow and Samii, 2017a, Bowers et al., 2013, Toulis and Kao, 2013). In this paper we show that the way in which a treatment propagates across a social network affects the statistical power of an experimental design. As such, prior information regarding treatment propagation should be incorporated into the experimental design. Our findings justify reconsideration of standard practice in circumstances where units are presumed to be independent even in simple experiments: information about treatment effects is not maximized when we assign half the units to treatment and half to control. We also present an example in which statistical power depends on the extent to which the network degree of nodes is correlated with treatment assignment probability. We recommend that researchers think carefully about the underlying treatment propagation model motivating their study in designing an experiment on a network.     

Detecting and Decomposing the “Faith Factor” in Social-Service Provision and Absorption

Abstract

Faith-based provision and reception of social services may yield results that differ either randomly or persistently (via “fixed effects”) from the outcomes achieved under non-faith-based, but certainly not value-free, administration of these services. Yet attributing raw differences in performance to unobservable factors assumed to derive from “faith” should be a last resort. Instead, the objective of analysis should be to identify any such factors and their cost and strength operationally so that they can become a managed part of any program offered by existing providers or entrants.

These factors, or the cost effectiveness of employing them, could differ between secular and faith-based providers. Then members of the two groups optimally would use a different mix of means even if they were to pursue precisely the same ends. Yet program design and operation by both groups would stand to benefit from knowing the keys to their relative performance in particular areas of social service with particular groups of clients. Comparing the outcomes of experiments based on random assignment may provide little help in that regard. Micro-simulations may provide a superior approach to tightening the link between input-based model predictions and continuous learning from outcomes.     

A method for diagnosing and planning the treatment of adolescent drug abusers (the Adolescent Drug Abuse Diagnosis [ADAD] instrument)

There is a need for a diagnostic method and an instrument appropriate for adolescent drug abuse clients, that permits the assignment of clients to the most appropriate treatment setting, provides the basis for individualized treatment planning, and facilitates comparability across research studies. The development of the Adolescent Drug Abuse Diagnosis (ADAD), a 150-item instrument with a structured interview format, modeled after the Addiction Severity Index (ASI) (which is for adults), is described. The ADAD produces a broad-spectrum comprehensive evaluation of the client, the interviewer's ten-point severity ratings, and composite scores for each of nine life problem areas that are often relevant to the treatment needs of adolescent drug abuse clients. A series of validity and reliability tests are described. The characteristics of the standardization sample (N = 1,042), and the comparison of the characteristics of the three subsamples (outpatient, residential or non-hospital, and inpatient) are also presented.     

THERAPIST AND CLIENT BEHAVIORS IN THE FIRST INTERVIEW: EFFECGTS ON SESSION IMPACT AND TREATMENT DURATION

The first-session behaviors of therapists and clients in 38 cases were observationally codes and their relations to client ratings of session impact and treatment duration were examined. Results indicated that few first-session global types of behaviors of participants affect treatment durations. Clients may suspend judgement about continuing in therapy untill after they have attended more than one session, regardless of the first inverview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is individuals as opposed to couples and families.     

Index to Volume 29

This article measures the efficacy of two approaches to teaching students to assess clients for substance abuse: an alcohol and other drug (AOD) minor program and integration of AOD content into core courses. A quasi-experimental design involved nonrandom assignment to an AOD minors program or to a nonminors curriculum. Both groups reported on their usual AOD assessment and on AOD assessment in their first interview with their most recent client. Self-report outcomes, examined in relation to the number of courses with integrated AOD content taken, suggest that these courses lead to significantly more self-reported assessment for substance abuse.     

Assessing the Development of Cultural Proficiency Among Upper-Level Social Work Students

Graduate social work pedagogy is challenging to diverse faculty and students who work with diverse clients, often in international practice. We discuss the development, outcomes, and assessment of an assignment designed to stimulate students’ research on proverbs as cultural resources for practice and to promote attainment of six competencies related to diversity and social justice of the Council on Social Work Education’s Educational Policy and Accreditation Standards. We used procedures from grounded theory and Atlas.ti to analyze 40 student papers. More than 70% of papers reflected students’ mastery of three competencies, suggesting the assignment was insufficient to ensure attainment of all six competencies and signaling errors in the structure of the assignment and in the rubric. Ensuring students’ achievement of the competencies requires careful design and assessment of assignments and deliberate, structured assessment of the assignment outcomes.     

A joint examination of effects of decision task type and construal level on the attraction effect

The attraction effect refers to a situation in which adding an inferior alternative to a choice set increases the share of the relatively dominating alternative. This research posits that decision task type affect the attraction effect. People usually seek justification for their decisions. In a selection (or rejection) task, they are more likely to emphasize the positive (or negative) features of each option. The addition of an asymmetrically dominated decoy to a binary set of options undoubtedly provides an extra positive feature for the dominant option, and therefore induces a greater attraction effect. Contrarily, in a rejection task condition, the decoy in the trinary set seems to be the worst option and would be eliminated first, and the remaining comparison is identical with the original binary condition. Therefore, the attraction effect may decrease. Besides, the decision task type interacts with the construal level to affect the attraction effect. Specifically, a low construal level, compared with a high construal level, dampens the attraction effect to a greater extent in a rejection task than in a selection task. Results from three experiments support the proposed hypotheses.     

Applying marketing management and communication management theories to increase client retention in the short-term insurance industry

Businesses must retain their clients to remain profitable. The academic field of marketing management considers customer relationship management (CRM) as most appropriate to achieve this, while communication management focuses instead on public relations (PR). The purpose of this research was to analyse theories in these two disciplines and derive an integrated theoretical framework of CRM and PR client retention. The framework was then tested through in-depth interviews with short-term insurance clients and short-term insurance providers (brokers and direct insurers) in South Africa to gain perspectives from both sides. The importance of some fundamental elements found in literature were affirmed, two elements’ importance were questioned and it was established that three inconsistencies existed between what providers regard as essential to retain clients and what clients regard necessary for them to stay in a relationship with an insurance provider. This may explain the many unsuccessful client retention efforts of South African brokers and direct insurers. Six new CRM and/or PR elements, not found in literature, are presented in the article for exploration in future research. In order to assist client retention in the very competitive short-term insurance industry, results were applied to the core tenets of Niemann's (2005) SA model for the implementation of strategic integrated communication (IC). Finally, the authors present an integrated approach to client retention strategies in the South African short-term insurance industry, incorporating both marketing and communication theories.     

Long‐term continuous clients and their needs: a New Zealand analysis

National New Zealand data (2002) indicate that 27% of gambling clients remain in treatment for longer than 12 months. This research retrospectively analysed data from long‐term continuous, re‐admitted and brief therapy clients. The data were obtained from a national database and were analysed quantitatively and qualitatively. Results indicated that relevant differences between long‐term continuous and other clients occurred in ethnicity and clinic location. The latter was confounded by the number of clinics versus clients. The average age of long‐term continuous clients was 43 years; 5–6 years older than other clients; however, this marginally failed to reach a level of statistical significance. The results led to the proposal of two alternative models of therapy for clients with gambling problems: (a) a six‐session capsule model and (b) an inductive, open‐ended model (with regular review component). Further research is required to test the efficacy of these models.     

Unique Characteristics of Cohabiters Seeking Therapy

There is limited information on cohabiters presenting for therapy. The authors examined the characteristics of 143 married and 54 cohabiting, young (m = 30.39), Caucasian, couples presenting for therapy. We hypothesized that cohabiters presenting for therapy would be more satisfied and committed than married couples and that they would be similarly emotionally differentiated. We conducted a repeated‐measures MANOVA to test the hypothesis. Significant effects between partners and between dyads were found, indicating a difference between clients based on relationship status. Cohabiting clients presented earlier in their relationship and were more satisfied and committed. Cohabiting male partners were less emotionally reactive. Without the institutionalized rules of marriage, cohabiting couples may perceive threats to their relationship earlier than married couples.     

Negative attitudes,nonverbal behavior and self-fulfilling prophecy in simulated therapy interviews

This research investigated if interpersonal expectancies in a psychotherapeutic context were mediated through nonverbal behavior. Beginning (male) therapists served as interviewers and interacted with (male) subjects who were introduced as clients (who were treated for psychological problems) or normal students. It was hypothesized that the therapists would have a more negative attitude toward the supposed clients than toward the nonclients and show more arm position symmetry and less forward lean toward the supposed clients. The interviewees were predicted to show more ah-filled pauses, speech disturbances, and less looking at the interviewers in the client condition than in the nonclient condition. The results demonstrated that therapists had more negative expectancies toward supposed clients than toward nonclients. Support was shown for the hypothesis that more arm position symmetry would be shown in the client condition than in the nonclient condition. The results also indicated that supposed clients used more ah-filled pauses and speech disturbances than nonclients. The therapists used this information when they attributed more discomfort to the supposed clients. It is suggested that the findings of this study have implications for understanding the process of self-fulfilling prophecy in a therapeutic context.     

Residential treatment: linkage with community drug treatment programs.

The realization that the program and services offered at the residential treatment center were not fully effective for some clients with multiple problems was an emotionally wrenching, but unavoidable, process. As the need for outside community substance-abuse referrals continues, it is important that ongoing relationships among agencies be established and nurtured. Dilemmas in creating these relationships have to be expected by all involved. Ways to resolve these problems must be put in place as quickly as they occur. Windows of opportunity to help residential treatment center clients with drug and alcohol problems must be recognized early on in treatment to ensure optimal services. Agencies must coordinate and cooperate with each other to be in position to seize these opportunities when they arise.     

READING ALOUD AS AN INITIAL ASSIGNMENT IN MARITAL THERAPY*

This paper suggests conjoint reading aloud as an initial assignment in behavioral marital therapy. The spouses are directed to read a book on marital conflict and communication five times during the week following the initial interview. At that interview they negotiate an agreement on when they will do the reading. Conjoint reading is compared with two alternative initial assignments, Caring Days and the Spouse Observation Checklist. It is argued that the advantage of the conjoint reading is that it addresses the experientially salient problems of verbal conflict. Details for instigating the assignment are presented.