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Treatment Process  

Clinical and field-based studies that indicate “treatment works” have led to questions about the active ingredients or components that determine its effectiveness. Understanding treatment dynamics is essential to issues of quality control and improvement.  The TCU Treatment Model, as described in this section, provides a conceptual framework for describing stages of treatment and how they relate to recovery.  This research has yielded a broad array of assessment instruments for assessing client and program performance, established foundations for systematic treatment monitoring and management strategies, and developed evidence-based interventions that improve treatment quality.


  

Mapping-Based Counseling  

Mapping-based counseling is a cognitive strategy shown to be useful in increasing client motivation, engagement, and participation in treatment.  It also promotes more positive interactions with other clients and treatment staff, both in community-based and correctional settings.  TCU manuals provide guidance on the use of mapping techniques (a visual representation and communication strategy for group and individual counseling) using a variety of structured and free-flow formats, as well as a related series of motivational readiness interventions.  Other TCU Counseling Manuals also use these techniques as a basis for improving psychosocial and related decision-making skills.
  

Counseling Manuals  

TCU counseling manuals focus on treatment readiness and motivation, client assessment applications for care planning and progress monitoring, behavioral techniques for improving treatment participation, therapeutic engagement strategies, emotional self-management, dealing with negative (e.g., criminal) thinking patterns, communication skills, developing healthy relationships, sexuality, parenting, HIV/AIDS awareness, and preparing for relapse risks.  Evaluations of these manuals—designed within the framework of the TCU Treatment Process Model—indicate they improve treatment participation and engagement, knowledge levels, prosocial attitudes, and retention in outpatient and residential settings.  In recognition of counselor preferences and implementation principles, they feature pragmatic step-by-step layout guides (usually for leading 4-8 counseling sessions on each topic), handouts and worksheets, ideas for presenting key concepts, and discussion questions, along with appendices that contain valuable resources.  Although most are designed for leading group sessions, they can be adapted to individual counseling and also allow flexibility in their sequential delivery to accommodate client needs.  The TCU manuals incorporate mapping-based counseling as a fundamental communication and decision-making tool.
 

Corrections-Based Treatment   

American attitudes regarding offender rehabilitation in correctional populations and community reentry policies reflect high public safety concerns over the release of 700,000 prisoners annually (Krisberg & Marchionna, 2006).  Rehab services for prisoners were favored by a margin of 8 to 1 (versus “punishment only”), and 70% supported the use of addiction treatment during prison and after release.  A leading factor in the high re-arrest rates following prison release was believed to be offenders’ lack of life skills.  Research shows return to prison is less likely for offenders treated for drug addiction, but there is growing interest in how to provide more effective treatment to a higher proportion of offenders with drug-related problems (Belenko & Peugh, 2005).  Feedback from over 600 treatment counselors working in correctional and community programs located in three different states and involved in TCU research projects address this question.  Over 70% of these treatment professionals believe there is a need for more instruction on new medications, better interventions to deal with special populations (e.g., women, adolescent, and mentally ill offenders), more efficient tools for diagnostic and performance assessments, and a conceptual guide for managing treatment stages.  Three out of four also wanted training on innovations designed to help improve offender cognitive skills (thinking styles and problem solving) and direct access to user-friendly treatment delivery resources via the Internet. 


  

National Evaluations of Treatment Effectiveness  

The National Institute on Drug Abuse (NIDA) funded three large-scale national treatment evaluations covering 3 decades, the 1970s, 80s, and 90s. Collectively, these naturalistic studies—known as DARP, TOPS, and DATOS, respectively—examined during treatment performance and predictors of follow-up outcomes for stratified samples of 65,000 admissions to major types of treatment in 272 community-based programs throughout the U.S.  Findings from approximately 250 publications based on this research give broad support for the effectiveness of treatment, particularly for those with an adequate length of stay.  In addition, these treatment evaluation projects contributed directly to research initiatives focused on therapeutic process as well as organizational functioning.
   

Organizational Readiness for Change  

Findings from clinical and natural evaluations for the effectiveness of treatment interventions—especially cognitive and behavioral strategies—have led to renewed calls for transferring these “evidence-based” techniques into practice.  This is a complicated task, however, which is itself in need of systematic study.  Organizational climate and readiness for change are believed to be especially important, and the TCU Program Change Model provides a conceptual framework to summarize these and other sources of influence on this stage-based process.  Promising new analytic strategies and assessment instruments for studying organizational functioning have been developed for this work.
  

Assessment Fact Sheets  

As the TCU assessments become more widely used and studied, their applications also are becoming better established.  The TCU/IBR data repository from primary and secondary data collection initiatives continue to grow and serve as a basis for making comparative interpretations of assessment results.  Especially important are normative comparisons of score profiles, based on large-scale cumulated data files for each set of assessment scales (including male and female subgroups).     

Brief “fact sheets” summarize the TCU assessments, their reliability and validity evidence, and the norms for 25th-75th and 33rd-67th percentiles (with means).  These are charted graphically to serve as interpretative frameworks based on national (but non-random) treatment samples.

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