Assessing state substance abuse prevention infrastructure through the lens of CSAP's Strategic Prevention Framework

Although the organizational structures and operating procedures of state substance abuse prevention systems vary substantially across states, there is scant empirical research regarding approaches for rigorous assessment of system attributes and which attributes are most conducive to overall effectiveness. As one component of the national cross-site evaluation of the SPF State Incentive Grant Program (SPF SIG), an instrument was developed to assess state substance abuse prevention system infrastructure in order to measure infrastructure change and examine the role of state infrastructure in achieving prevention-related outcomes. In this paper we describe the development of this instrument and summarize findings from its baseline administration. As expected, states and territories were found to vary substantially with respect seven key characteristics, or domains, of state prevention infrastructure. Across the six domains that were assessed using numeric ratings, states scored highest on data systems and lowest on strategic planning. Positive intercorrelations were observed among these domains, indicating that states with high capacity on one domain generally have relatively high capacity on other domains as well. The findings also suggest that state prevention infrastructure development is linked to both funding from state government and the presence of a state interagency coordinating body with decision-making authority. The methodology and baseline findings presented will be used to inform the ongoing national cross-site evaluation of the SPF SIG and may provide useful information to guide further research on state substance abuse prevention infrastructure.     

REVISITING THE AGENT OF SOCIAL CONTROL ROLE: IMPLICATIONS FOR SUBSTANCE ABUSE TREATMENT

The agent of social control role and its responsibilities and goals provide an important function in social work practice. Workers in varied positions often combine this role with others that define the profession. Yet in the not too distant past, a debate arose as to whether this role, focusing on promoting and protecting the general welfare of society, could be congruent with also fostering the improved functioning and self‐determination of individual clients. Periodically, this topic emerges to challenge the appropriateness of these dual activities in satisfactorily and equitably serving both constituents.

Within the field of substance abuse, court‐mandated referrals have established a need for practitioners to perform social control tasks to monitor and report clients' compliance with and progress in treatment. This has created a conflict for many who consider their practice to be client‐centered. This article will explore the dilemmas experienced in attempting to simultaneously carry out both roles and the guidance provided from the National Association of Social Workers (NASW) Code of Ethics. In addition, proposed strategies to reduce the duality of difficulties will be summarized.     

Predictors of treatment outcome in a child and adolescent psychiatry clinic: A naturalistic exploration

We present data on predictors of treatment outcome for 3200 consecutive referrals to a child and adolescent psychiatry clinic. Using Reliable Change Index (RCI) methodology, we divided children into those who, between intake and discharge, improved, stayed the same, or got worse according to clinician-rated impairment. Most predictors of improvement were related to parent variables (marital status, maternal anxiety, and ethnicity), while those associated with deterioration were tied to child status (extent of psychiatric comorbidity, history of placement in a self-contained classroom, and a prior trial of psychotropic medications). The implications of these findings for data-driven program development, clinic management, treatment planning, and systems of care are discussed.     

Trauma and Bowen Family Systems Theory: Working with Adults Who were Abused as Children

Working with survivors of trauma is mostly challenging, exhausting, long‐term and often ‘messy’, when interventions that ‘should’ work, don't, or the unexpected arises. Nevertheless, explanations that speak to recovery from trauma more and more rely on neurobiological concepts to account for any positive change. Combining the family systems approach of Murray Bowen and recent research on the brain and trauma, post trauma symptoms are viewed as part of the ‘family emotional process’ even when traumatic events have emanated from outside the family system itself. Variations in responses to trauma, including dissociation and self‐harm are discussed in relation to chronic anxiety and ‘differentiation of self’.     

Participation for children exposed to domestic violence? Social workers' approaches and children's strategies

This article explores social workers' approaches to children exposed to domestic violence and children's strategies in encounters with these professionals in the context of family law proceedings. Investigator approaches as well as child strategies are reconstructed from children's narratives. Furthermore, possible links between the social worker's approach described by a particular child, and the child's own strategies are outlined. Participation can offer children validation of their experiences and support their recovery after exposure to violence. However, it is suggested that it seems to be a challenging task for social workers to both validate children's experiences of violence and simultaneously offer them participation in the investigation process.     

Characteristics and Outcomes of College-Age Adults Enrolled in Private Residential Treatment: Implications for Practice

Substance use among college-age adults is of interest due to high levels of use and low levels of treatment access and engagement relative to other adults. Data collected from 1,972 clients in residential services were analyzed to investigate differences in use patterns, treatment outcomes, and other life area problems. Participants completed an Addiction Severity Index (ASI) and the University of Rhode Island Change Assessment (URICA) at baseline, and an ASI and Treatment Services Review at 1-month and 6-month postdischarge interviews. Almost a quarter (24.1%) of participants were college age (18–25 years old). They were more likely to be White and male, and less likely to complete treatment although they had a longer average length of stay. College-age adults improved on all outcome measures, and posttreatment service use shows significant difference between college-age and older participants. Implications for practice are discussed.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

The Relationship Between Online Sexual Compulsivity,Dissociation, and Past Child Abuse Among Men Who Have Sex with Men

The objective of this study was to measure the relationships between online sexual compulsivity, three dimensions of dissociation (absorption, depersonalization, and amnesia), and past child abuse among men who have sex with men (MSM). A total of 517 MSM, recruited from Internet chat rooms, completed the survey. Results indicated that past child abuse was significantly related to dissociation but not online sexual compulsivity. It was also found that the amount of time MSM spent online in a one-week period, in general and specifically engaged in sexual activity, was significantly related to online sexual compulsivity and three dimensions of dissociation. Online sexual compulsivity was a significant predictor of absorption, depersonalization, and amnesia. Implications for clinicians and future research are presented.     

Relationship Churning and Parenting Stress Among Mothers and Fathers

Researchers have documented the consequences of relationship instability for parenting stress but have given little attention to within‐partner relationship instability. In this study, the authors used data from the Fragile Families and Child Wellbeing Study (N = 3,544) to estimate the association between within‐partner relationship instability (known as churning or on‐again/off‐again relationships) and parenting stress. First, they found that by the focal child's 5th birthday about 16% of biological parents experience churning. Second, compared to being stably together with or stably separated from the child's other parent, churning is associated with greater parenting stress for both mothers and fathers. Because parenting stress is the same or higher among churners compared to their counterparts who stably separate, this suggests that, more than a change in partner, relationship instability—whether within or across relationships—is tied to parenting stress.     

A consortium approach for child and family practice education

Child and family practice and child protection are extraordinarily complex. They require in-depth understanding of intra- and inter-personal skills and intricate service systems, and capacity to operate in a constantly changing policy environment. One way of meeting the needs of such practitioners is facilitating their access to experts working across direct practice, management and leadership and policy-making contexts. This article discusses the rationale for collaboratively delivered post-qualifying courses for child and family practitioners, and discusses a highly successful example of such courses delivered through La Trobe University. It outlines the unique developmental process and model of delivery adopted by the consortium responsible for the postgraduate programme. It concludes with reference to early evaluative findings indicating it as a promising pedagogical model.