Examining Rates of Engagement over Time with Court-Ordered Men in a Domestic Abuse Treatment Program

Limited research exists on the engagement process in domestic abuse treatment. This exploratory study of a large urban domestic abuse program (N = 81) examined the engagement of men entering group treatment using the Group Engagement Measure (GEM-27) over two time points. The GEM-27 pointed to significant change in engagement scores reported by facilitators between pre- and posttest, despite the involuntary nature of the treatment process. The subscore Means for the category “working on own problem” at time one was significantly higher for completers compared to dropouts. Implications for research and practice are discussed.     

Baby Boomer’s Substance Abuse and Researcher Indifference

The current older adult population is more likely to need and seek treatment for alcohol and drug abuse than previous cohorts of older adults, which necessitates the need for age-appropriate substance use treatment. Building on previous research that examined the lack of attention on substance use among older adults, this study examines articles addressing substance use disorders among older adults in leading gerontological and substance abuse journals and federal funding between 2011 and 2017. Publications were identified from ten leading gerontological and ten leading substance abuse journals using Medical Subject Heading (MeSH) terms. During this time-period, there were 68 and 44 articles published in gerontology and substance abuse journals respectively related to substance use disorders in older adults. Most (59.8%) addressed alcohol abuse and 7% involved intervention studies. In the 7-year period, there were 13 federal grants. A paucity of published or funded work exists in this area despite growing misuse and treatment seeking among older adults with substance use disorders. Effectively addressing substance abuse in older adults will require a coordinated effort between researchers and practitioners to establish and implement best practices for practitioners to rely on when working with substance abusing older adults.     

The Influence of Rural and Urban Substance Abuse Treatment Counselor Characteristics on Client Outcomes

Focus group data was collected from 28 substance abuse treatment counselors employed in rural and urban areas to examine their perceptions of factors influencing treatment outcomes. The influence of the counselor characteristics (i.e., education, experience, and recovery status) on client outcomes and geographic differences are explored. Focus group data was analyzed by three raters using line-by-line coding, focused coding, and memoing. This analytic approach revealed geographic differences in the counselors' perceptions of the effect of counselor education, experience, and recovery status on client outcomes. Recommendations for treatment planning and future research are provided.     

The Influence of Rural and Urban Substance Abuse Treatment Counselor Characteristics on Client Outcomes

ABSTRACT

Focus group data were collected from 28 substance abuse treatment counselors employed in rural and urban areas to examine their perceptions of factors influencing treatment outcomes. The influence of the counselor characteristics (i.e., education, experience, and recovery status) on client outcomes and geographic differences is explored. Focus group data were analyzed by three raters using line-by-line coding, focused coding, and memoing. This analytic approach revealed geographic differences in the counselors’ perceptions of the effect of counselor education, experience, and recovery status on client outcomes. Recommendations for treatment planning and future research are provided.     

“She was accused of colluding with the mother”; the training and support needs of parent‐and‐child foster carers: A qualitative study

Parent‐and‐child foster placements are used to accommodate parents with their children, either when the mother is a looked‐after child or as a setting for a parenting assessment. Despite this being a specialized role with significant potential for affecting outcomes for disadvantaged families, there is currently a lack of accessible learning opportunities for foster carers on the physical and mental well‐being of women with complex needs such as a history of domestic abuse, substance abuse, perinatal mental ill‐health, or having a learning disability. Parent‐and‐child carers experience some unique stresses and value the support of others with similar experiences; this kind of peer support is currently largely absent. This qualitative study has used ten focus groups with foster carers, eight interviews with mothers, and nine interviews with supervising social workers, to inform the development of an online learning resource and a social media‐based peer support network for parent‐and‐child foster carers.     

Noncompletion of Evidence-Based Parent Training: An Empirical Examination Among Families of Children in Foster Care

Child welfare have historically experienced high dropout rates. As evidence-based interventions (EBIs) spread to the child welfare field, treatment noncompletion could interfere with successful outcomes. Using a mixed methods approach, this study investigated the differences between completers and noncompleters, and reasons for treatment noncompletion of an EBI for families of children in foster care. The sample comprised 315 families randomized to receive Parent Management Training, Oregon Model (PMTO). Researchers examined clinicians' discharge notes to explore reasons for noncompletion. Using data collected from a battery of assessments, bivariate logistic regression compared completers and noncompleters on demographics, socioeconomic factors, children's social-emotional functioning, and parents' functioning. About one third of families were noncompleters. Single fathers and parents with lower socioeconomic status were more likely to drop out. By contrast, parents with lower functioning on child behavior and parenting trended toward higher completion rates. Formidable challenges were parental substance abuse and mental illness. Results suggest parent training may require tailoring for specific subgroups and pairing with strategies for enhancing early engagement and reducing treatment barriers. Future research is needed to include parents' views on noncompletion and to more closely examine the influence of specific factors, such as severity of parental mental illness and substance abuse.     

Increasing Client Voice within Involuntary Groups

Partners for Change Outcome Management System (PCOMS) is a client-driven outcome management system that has been proven effective with engaging voluntary mental health client populations through several randomized clinical trials. Little is known, however, about PCOMS application to clients who are court ordered or pressured to attend group programs. This study (N = 10) interviewed group facilitators who use PCOMS with involuntary groups. Participants strongly endorsed the use of the instruments to increase client voice, respond supportively to client incongruence, and focus on client responsibility for change. Guidelines for application to involuntary groups and research and practice implications are discussed.     

Measuring the Effectiveness of Substance Abuse Treatment

Building systematic knowledge about the treatment of alcoholism and substance abuse is constrained by the scarcity of refined measurement instruments that have been developed from a base in theory. A five dimensional index was constructed from a basic set of characteristics of substance abuse problems. Preliminary field testin with 51 clients at three stages of treatment revealed strong reliability estimates as well as evidence of construct and differential validity. Further refinements and uses in program evaluation and knowledge building are discussed.     

Criteria for Admission to Detoxification Treatment

This paper examines the formal triage process used by an alcohol/drug detoxification center to determine a client's need for treatment. The analysis tests various types of client characteristics for their influence on admission decisions. In accord with the policy of the agency and the medical model of addiction, symptoms of acute physiological withdrawal should determine whether a client is admitted for treatment during the triage period. Societal reaction theory presents an alternative perspective suggesting that a person's history of substance abuse and socio-demographic characteristics will influence the likelihood of admission into a treatment program. Results offer support for both a medical model and societal reaction approach in that physiological withdrawal symptoms, history of abuse characteristics, and socio-demographic makeup each independently influence staff's assessment of the need for treatment.     

Client Experiences of Trauma-Informed Care in Social Service Agencies

This paper describes a qualitative study of individual client interviews (n?=?26) from four social service agencies to understand how clients experience trauma-informed care services and implementation challenges. We used the Fallot and Harris framework to explore client experiences of the five core concepts of trauma-informed care (safety, trustworthiness, choice, collaboration, and empowerment) using semi-structured interview questions with each client. The four agencies consisted of: refugees (n?=?4), substance abuse (n?=?8), older adults (n?=?12), and maternal/child health (n?=?2), and the agencies varied in size, service goals, and clientele. The results of the study suggest that clients’ experience of these concepts was shaped by the actions of other clients, and these experiences were either mitigated or hindered by actions of the agency employees. Agency policies either supported or enhanced their experiences as well. The results also suggest that it was challenging for agencies to provide for all of the trauma-informed care (TIC) concepts at the same time. We discuss the implications of these findings for social service delivery in a range of agency types. Future research should examine the effects of trauma-informed policies on client experiences of each TIC domain.     

Client-oriented Quality Assessment within Municipal Social Services

The hypothesis of this article is that quality assessment, despite the fact that it has now become a part of social services, has largely occurred without taking clients into consideration. There are supposed to be at least three possible explanations for this: organizational structures and professionalism, the difficulty in defining client needs, and the opinion that a client is not an equal companion in social service organizations. The research method entailed a questionnaire which was sent to 60 managers working within municipal social administration during the periods of construction (1950–1965), supplementation (1966–1983) and reform and redistribution (1984 onwards) of the Finnish welfare state and a questionnaire for 146 public social welfare organizations in Finland. Fewer than 30% of the social managers of the construction (1950–1965) and supplementation (1966–1983) periods and fewer than 50% of the managers of the last period (1984 onwards) said that clients really had assessed quality. The needs of clients and client feedback were said to be important during all three periods but the managers did not include them in the most important tasks. The managers of the period of supplementation did this the least. The managers from the period of reform and redistribution (1984 onwards) were more likely to trust the ability of clients to assess quality of social services and they also gave more opportunities to do so. The most important reasons for neglecting client needs and feedback in quality assessment were organizational structures and difficulties in defining client needs. There also seem to have been some methodological difficulties in assessing social services. Statistics are still largely in use and concrete criteria related to quality are missing. More specific questionnaires, cross-experimental designs and interviews, more possibilities for clients to describe needs in their own words, and the specification of general concepts in more concrete terms of quality are needed in order to avoid abstract and general assessments.     

Validation Study: The Iranian Version of Caregiver Abuse Screen (CASE) among Family Caregivers of Elderly with Dementia

Since abuse screening is difficult among the elderly with dementia, detection of elder abuse is a serious issue; meanwhile, the number of available tools to assess elder abuse by caregivers is limited. The aim was to evaluate validity and reliability of the Iranian version Caregiver Abuse Screen (CASE) tool. After the translating process of the tool to the Farsi language for 236 dementia participants ≥60 years old and their informal caregivers’ from outpatient’ clinics, in a cross-sectional method then the validity, reliability and factorial structure of the CASE was evaluated. The translated Iranian version CASE reveals a good psychometric property (α = 0.868) with strong internal consistency and reliability. Some variables (depression, burden, dementia intensity, and ADLs) were associated with abuse in dementia elderly. The two-factor structure was obtained in exploratory factor analysis labeled interpersonal abuse and neglect. Generally, the Iranian version of CASE approved with sufficient validity and reliability as a suitable instrument to find the risk of elder abuse among dementia caregivers.     

Perspectives of Taiwanese practitioners on therapeutic reactions to disclosure of childhood sexual abuse

Disclosure of childhood sexual abuse (CSA) is a difficult decision, because CSA is a traumatic experience. Because of the sensitive nature of CSA in Taiwan, reactions to disclosure of CSA in treatment contexts can be challenging for practitioners. Little is known about Taiwanese practitioners' reactions to disclosure that occurs while they are working with CSA survivors. In-depth, phenomenological interviews were used to fully explore three practitioners' clinical reactions to disclosure of CSA. The significant categories and themes that emerged from the study are discussed. Limitations and implications of the present study and recommendations for future research are addressed.     

An inquiry into the significance of nail‐biting 1

Substance abuse is connected to considerable suffering and symptoms. Neuropsychological assessment supports understanding of the distress and the symptoms of the individual client and therefore is increasingly requested in substance abuse treatment. Substances, however, influence neuropsychological functions and emotional states. Therefore, assessment often needs to be postponed. Conducted at a suitable point of time, with respect to abstinence and treatment planning, assessment might provide understanding of the needs and possibilities of the client. This work contributes with suggestions on how neuropsychological assessment might be conducted in substance abuse treatment. Because the effects of substances are considerable, an overview of the effects of varying substances on neuropsychological functioning is presented. It is also suggested that assessment should be understood as a collaborative process that should support clients’ understanding of themselves.     

Family Placements for People with a Learning Difficulty: A Study using Time Budgets

Correspondence to Dr R. F. Drewett, Department of Psychology, University of Durham, Science Building, South Road, Durham DH1 3LE. Summary The Durham County Council Family Placement Scheme offers long-termcare in families for adults with learning difficulties. Theactivities of the twenty-four clients in family placements werestudied using interviews and diaries kept by carers. Althoughmost of the clients were only mildly handicapped three wereseverely disabled. Most of the carers have either professionalor voluntary experience of work with people with learning difficulties.Although four of the placements have broken down, the levelsof activity of the clients still in their families were similarto those found in other types of community-based care, and werejust as extensive in the more disabled. The previous experienceof the carer had no clear relationship with the activity levelsof the client.     

What might Normalisation Process Theory bring to policy implementation studies? Learning lessons and uncovering questions through a case study of the profound implementation failure of a new policing policy

Normalisation Process Theory (NPT), used nationally and internationally to explore implementation within health services research, is used for the first time within policing to understand profound policy implementation failure and to generate broader discussion of policy implementation theory. The policy in question (Police to Primary Care [P2PC]) was an intervention designed to notify GPs when women are assessed by police as at high risk of future domestic abuse. Designed to improve interagency communication, it took place amidst radical organisational change. Using qualitative interviews with domestic abuse specialist and frontline officers, this paper addresses how NPT helps to explain the (non)implementation of P2PC, how such an analysis differs from other policy implementation approaches, and what this means for our understandings of policy implementation more broadly. NPT proved useful in understanding mechanisms leading to (non)implementation of the intervention: fuzzy alignment with existing practice, faulty communication of purpose, and inattention to discretionary implementation spaces. It helped us understand why the intervention came to be invisible. Dwarfed by its organisational context, made institutionally hard to read by a lack of formal protocols, and given restricted view to police officers, it was compromised by a failure to instigate systems of organisational learning. More broadly, NPT helped reveal practices intersecting top‐down and bottom‐up implementation theory. The paper concludes by asking how NPT and theories of street‐level bureaucracy might be better used in tandem and, particularly, how this might help explorations of policy implementation where human actors are joined by technological actors in interpreting and making policy in vivo.     

Social support available for substance‐dependent mothers from families with parental substance abuse

Substance‐dependent mothers, who have grown up with parental substance abuse, struggle during and after treatment to abstain from substances while trying to process traumatic experiences and integrate their family into society. The aim of this study was to explore the social support available for these mothers to help them stay abstinent and create safe family environments for themselves and their children. Using purposeful sampling, we approached nine mothers admitted for 1 year to a family ward at a substance abuse clinic and their significant others. Through in‐depth, qualitative interviews, first with the mothers, later with their significant others, we investigated characteristics of the available social support. The findings indicated that the significant others had limited resources and were themselves exposed to adverse and cumulative psychosocial and socioeconomic risk factors. Their relationships with the mothers were, nevertheless, close, consistent and reliable. Supporting the existing social network should be an integrated part of the work of family welfare services aiming to help substance‐dependent mothers from families with parental substance abuse to rehabilitate and to integrate successfully into local communities.     

The Substance Abuse Treatment Self-Efficacy Scale

Abstract

Evaluating substance abuse services in ordinary treatment environments requires the use of instruments to measure various dimensions of the intervention process in order to link those processes with client outcomes. This paper reports on the further validation of the Alcohol and other Drug Self-Efficacy Scale (AODSES), designed to measure social workers' perceived self-efficacy with regard to the implementation of substance abuse services. In the first validation study, Kranz (2003) employed exploratory factor analysis to reduce the original 98 items to six factors (43 items) that accounted for 76% of the variance, and demonstrated excellent internal consistency. The current study is a reanalysis of the same data using confirmatory factor analysis, a more stringent test of construct validity. Results were strongly supportive of a 5-factor model with seven of eight indices showing excellent fit of the observed data to the model, and high internal consistency for all subscales. Potential practical applications for clinical evaluation in substance abuse environments and limitations of the study are discussed.     

Boomer Matters: Responding to Emotional Health Needs in an Aging Society

This study explores baby boomer-aged adults’ experiences accessing an emotional health program (EHP) in a community-based seniors’ center, examining differences between it and an older cohort of users. Data generation includes client-based surveys (n=118), in-depth qualitative interviews (n=20) with client users and professionally-trained counselors (n=2), and a focus group with peer support service worker (n=14). Key findings suggest EHPs as a preventative strategy to address familial abuse, the need for education and support on sexual health and dating, and the need to combat ageism to improve access. Community-based seniors’ centers as a cost-effective approach to health promotion is also highlighted.     

Psychosocial Interventions for Maltreated and Violence-Exposed Children

Child sexual, physical, and emotional abuse as well as child neglect and domestic violence, community violence, and Childhood Traumatic Grief may result in significant and long-lasting emotional and behavioral difficulties. This article reviews randomized controlled studies that have assessed child mental health outcomes for maltreated and violence-exposed children. Key points of this review include the following: (1) maltreated and violence-exposed children typically experience more than one of these types of traumas; (2) effective psychosocial treatments are available to address Posttraumatic Stress Disorder (PTSD), depression, anxiety, and behavioral problems in these children; (3) it is likely that treatments which effectively reduce mental health symptoms in children exposed to one type of child maltreatment or violence exposure will also be effective for other or multiple types; and (4) mental health outcomes are not the only important outcomes to address in future treatment or intervention efforts. These future directions for treatment intervention research are addressed.