The Influence of Client Risks and Treatment Engagement on Recidivism.

The current study modeled 12 month post-release re-arrest (recidivism) in terms of pretreatment risk factors (i.e., criminal history, criminal thinking,) and during-treatment engagement in a sample of 653 subjects admitted to four prison-based substance treatment programs.

Examining Concurrent Validity and Predictive Utility for the Addiction Severity Index and Texas Christian University (TCU) Short Forms.

Treatment providers need tools which are designed to identify risk, treatment needs, and monitor client engagement. These are essential components in substance abuse treatment for offender populations. This study evaluated a flexible set of 1-page modular assessments known as the TCU Short Forms and compared them with the measures of global domains contained in the Addiction Severity Index (ASI).

Brief Trauma and Mental Health Assessments for Female Offenders in Addiction Treatment.

Increasing numbers of women in prison raise concerns about gender-specific problems and needs severity. Female offenders report higher trauma as well as mental and medical health complications than males, but large inmate populations and limited resources create challenges in administering proper diagnostic screening and assessments. This study focuses on brief instruments that address specialized trauma and health problems, along with related psychosocial functioning.

Texas Christian University (TCU) Short Forms for Assessing Client Needs and Functioning in Addiction Treatment.

The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (1-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for treatment (MOTForm), psychological functioning (PSYForm), social relations and functioning (SOCForm), and therapeutic participation and engagement (ENGForm). These instruments facilitate optically-scanned data entry, computerized scoring, and rapid graphical feedback for clinical decisions.

Male methamphetamine-user inmates in prison treatment: during-treatment outcomes.

Psychosocial functioning and criminal thinking of methamphetamine-using inmates were examined before and after their completion of primary treatment in three in-prison drug treatment programs (one "outpatient" and two different modified therapeutic communities [TCs]). The sample consisted of 2,026 adult male inmates in 30 programs in Indiana. Data included background, psychosocial functioning, criminal thinking, and therapeutic engagement indicators.

During-treatment Outcomes among Female Methamphetamine-Using Offenders in Prison-based Treatments.

An increasingly important treatment group is the expanding population of methamphetamine-using female offenders. This study focused on women methamphetamine-using offenders (n = 359) who were treated either in a modified TC program (CLIFF-TC: n = 234) designed for non-violent offenders with significant impairment from methamphetamine use or the standard "outpatient" treatment (OTP: n = 125). All participants were assessed on motivation, psychological and social functioning, and treatment engagement before and during treatment.

Interaction of counseling rapport and topics discussed in sessions with methadone treatment clients.

Therapeutic rapport between counselors and clients in drug user treatment has been shown to be an important predictor of follow-up outcomes. This naturalistic study investigated the relationship of counseling rapport to drug-related topics discussed in counseling sessions in a sample of 330 clients and nine counselors. These voluntary clients had been admitted to a private, for-profit outpatient methadone treatment in Texas between September 1995 and August 1997 and received no-fee services for a year for participation in this study.

Relating counselor attributes to client engagement in England.

Client functioning and treatment engagement were examined in relation to staff attributes and organizational climate across a diverse sample of drug treatment and outreach programs in England. Self-rating assessments were obtained from 1,539 clients and 439 counselors representing 44 programs, and results were interpreted using comparable data from studies of treatment programs in the United States. Client scores on treatment participation and counseling rapport in England were directly related to their higher levels of motivation and psychosocial functioning, as well as to staff ratings of professional attributes and program atmosphere.

Counselor assessments of training and adoption barriers.

The prevailing emphasis on adopting evidence-based practices suggests that more focused training evaluations that capture factors in clinician decisions to use new techniques are needed. This includes relationships between postconference evaluations and subsequent adoption of training materials. We therefore collected training assessments at two time points from substance abuse treatment counselors who attended a training on dual diagnosis and another on therapeutic alliance as part of a state-sponsored conference.

Counselor perceptions of organizational factors and innovations training experiences.

Because work environment is central to understanding job performance, drug counselor perceptions of their programs and their skills were examined in relation to their attitudes about innovations training and its utilization. Latent profile analysis of measures on organizational climate and staff attributes for 1047 counselors from 345 programs defined three categories of counselors-labeled as isolated, integrated, and exceptional. All had generally positive views of their professional skills, although the isolated group scored lower on scales representing professional growth and influence on peers.

Assessing program needs and planning change.

Assessments of treatment staff training needs, preferences, and barriers can help guide and improve training activities and transfer evidence-based technologies into clinical practice. The Texas Christian University (TCU) Program Training Needs (PTN) assessment consists of 54 items organized into seven domains: Program Facilities and Climate, Program Computer Resources, Staff Training Needs, Preferences for Training Content, Preferences for Training Strategy, Training Barriers, and Satisfaction With Training. Data collected from 589 counselors representing 194 treatment programs showed that the PTN was psychometrically sound and predictably associated with results from a more comprehensive assessment of organizational functioning.

Influence of organizational functioning on client engagement in treatment.

This study focused on the relationship between organizational functioning factors measured in a staff survey using the Texas Christian University (TCU) Organizational Readiness for Change assessment and client-level engagement measured by the TCU Client Evaluation of Self and Treatment in drug treatment programs. The sample consisted of 531 clinical and counseling staff and 3,475 clients from 163 substance abuse treatment programs located in nine states from three regional Addiction Technology Transfer Centers. Measures of client engagement in treatment (rapport, satisfaction, and participation) were shown to be higher in programs with more positive staff ratings of organizational functioning.

Linking the elements of change: Program and client responses to innovation.

The process of innovation adoption was investigated using longitudinal records collected from a statewide network of almost 60 treatment programs over a 2-year period. Program-level measures of innovation adoption were defined by averaged counselor ratings of program training needs and readiness, organizational functioning, quality of a workshop training conference, and adoption indicators at follow-up. Findings showed that staff attitudes about training needs and past experiences are predictive of their subsequent ratings of training quality and progress in adopting innovations a year later.

Using organizational assessment as a tool for program change.

Organizational functioning within substance abuse treatment organizations is important to the transfer of research innovations into practice. Programs should be performing well for new interventions to be implemented successfully. This study examined the characteristics of treatment programs that participated in an assessment and training workshop designed to improve organizational functioning.

Sexual abuse history and treatment outcomes among women undergoing methadone treatment.

Women entering drug abuse treatment programs who report a history of sexual abuse are also likely to report poorer psychosocial functioning, more drug-related problems, and more family-of-origin problems. This study investigates outcome differences at follow-up between women with and those without sexual abuse histories who were treated at an outpatient methadone treatment program. Follow-up interviews were conducted with 98 women, 40% of whom reported prior sexual abuse.

A combined cognitive and behavioral intervention for cocaine-using methadone clients.

Treating cocaine use by opiate-dependent clients in methadone programs is a well-documented challenge. Both behavioral (contingency management) and cognitive (relapse prevention) interventions have shown promise in helping engage these clients in treatment. In this study, the effectiveness of combining contingency management with a cocaine-specific relapse prevention counseling module was examined.

Development and validation of a Client Problem Profile and Index for drug treatment.

The development of the Client Problem Profile and Index are described, and initial concurrent and predictive validity data are presented for a sample of 547 patients in outpatient methadone treatment. Derived from the TCU Brief Intake for drug treatment admissions, the profile covers 14 problem areas related to drug use (particularly cocaine, heroin/opiate, marijuana, other illegal drugs, and multiple drug use), HIV risks, psychosocial-functioning, health, employment, and criminality. Analyses of predictive validity show the profile and its index (number of problem areas) were significantly related to therapeutic engagement, during-treatment performance, and posttreatment follow-up outcomes.

Sexual abuse among women entering methadone treatment.

Women who enter drug abuse treatment programs are likely to report histories of sexual abuse that may impact psychosocial functioning, retention, and outcomes. This study investigates differences at admission between women with and without sexual abuse histories who entered an outpatient methadone treatment program in Texas. In a sample of 137 women, 39% reported prior sexual abuse.

Measuring patient attributes and engagement in treatment.

Brief but comprehensive instruments measuring patient motivation, psychosocial functioning, treatment process, social network support, and services received are needed for monitoring drug abuse treatment delivery and patient progress. Combining this information across patients within a program also provides useful indicators about institutional composition and functioning. Consequently, the same assessment tools can be used to identify areas where treatment protocols need to be changed, and to monitor improvements following such changes.