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Drug Abuse Treatment and Assessment Resources (DATAR Project, Phase 3)
 
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DATAR Phases 1 & 2
 DATAR Phase 3
Phase 3 Supplements
DATAR Phase 4
Recent Research Activities
 Selected publications
 Newsletter Stories
Research Summaries

 Forms: DATAR data collection instruments for methadone treatment and technology transfer
Manuals: Group Educational Manuals and the Mapping manuals
 Presentations: Background and workshop presentations
Publications: Full list by Topic and by Year

Highlights

Current Title: Transferring Drug Abuse Treatment and Assessment Resources
Principal Investigator: D. Dwayne Simpson, Ph.D.
Co-Principal Investigator: George W. Joe, Ed.D.
Project Director: Grace A. Rowan-Szal, Ph.D.
Project Scientists: Patrick M. Flynn, Ph.D.; Jack M. Greener, Ph.D.
Research Associate: Norma G. Bartholomew, M.A., M.Ed., L.P.C.
Collaborating Scientists: Barry S. Brown, Ph.D.; Lois R. Chatham, Ph.D.
Funded by: National Institute on Drug Abuse (NIDA)

DATAR-Phase 1 Project Period: September 1989 to August 1995
DATAR-Phase 2 Project Period: September 1995 to August 2000
DATAR-Phase 3 Project Period: September 1999 to July 2004
DATAR-Phase 4 Period Period: September 2004 to August 2009

DATAR Project -- Phases 1 and 2 (1989-2000)

Large studies based on nationwide samples have repeatedly demonstrated the effectiveness of drug abuse treatment in natural settings and the importance of retention to posttreatment outcomes.   In response to recurring calls for studying “the black box” and the need to know more about how treatment works, completion of the 20-year DARP project was followed by a series of 4 phases of our DATAR project.  Its first phase, entitled Improving Drug Abuse Treatment for AIDS-Risk Reduction (DATAR-1), began in 1989 as a NIDA treatment research demonstration grant and in 1995 was continued for another 5 years, entitled Improving Drug Abuse Treatment Assessment and Resources (DATAR-2).   These projects were based on the premise that treatment services research should have practical objectives, be carried out in real-world settings, and include assessments for monitoring client progress over time (with routine feedback to treatment staff).   With the general goal of improving therapeutic interventions as well as understanding the treatment dynamics involved, over 1,500 opioid users were treated in four outpatient methadone treatment programs in Texas during 1990 to 1999, under DATAR-1&2.

These are the foundations for a body of research that now define elements of a model for effective drug treatment.   It is a framework for integrating findings about how client and program attributes interact to influence the degree to which clients becomeengaged in treatment and remain long enough to show evidence of recovery while in treatment and at follow-up.   This TCU Treatment Model likewise portrays how specialized interventions as well as health and social support services promote stages of change (see Figure 1).   The DATAR-1&2 Project phases have led to the development of a comprehensive set of cognitive and behavioral-based interventions with demonstrated effectiveness as part of a stage-based model of treatment. 

Particularly important for increasing early engagement in treatment is a set of TCU cognitive and behavioral-based interventions.   The cognitive interventions (especially those related to increasing levels of treatment readiness for low-motivated clients) have proven useful for improving therapeutic relationships and retention.   These have become the focus of another TCU project entitled “Cognitive Enhancements for theTreatment of Probationers” (CETOP; PI, Don Dansereau) for correctional populations where treatment readiness and motivation are commonly low.   TCU interventions are manual-driven and evidence-based, making them well suited for disseminating these innovations into field practice.

TCU Treatment ModelFigure 1.  TCU Treatment Model (Simpson, 2004)
   

DATAR Project -- Phase 3 (1999-2004)

Counselor attributes and skills likewise impact the client engagement process, along with other organizational factors that are recognized as needing additional research.   Thus, the third 5-year phase of our DATAR project, entitled Transferring Drug Abuse Treatment and Assessment Resources (DATAR-3), was funded in 1999. The literature identifies major factors seemingly involved in transferring new treatment innovations into practice, but understanding how to do it more effectively needs attention.  Incorporating these factors into an integrated framework is expected to help advance the scientific progress and practical contributions in this field, including development of assessments for client, staff, and organizational dimensions. Our studies, for example, document that organizational climate is predictive of treatment satisfaction and counselor rapport.   It is therefore important to address organizational climate issues, particularly in low climate programs, as well as identifying specific client needs and changes in treatment regimens to help improve client functioning in treatment programs.

The TCU Program Change Model integrates related observations from our research with the literature (see Figure 2).   At the core of this heuristic framework are action steps typically involved in the process of technology transfer.   Exposure to new ideas usually comes through lecture, self-study, workshops, or expert consultants.  The second stage, Adoption, represents an intention to try an innovation.  While this might be a “formal decision” made by program leadership, it also includes levels of commitment made by individual staff members about whether an innovation is appropriate at a more personal level and should be tried.   Implementation comes next, implying that there is a period of trial usage to allow testing of its feasibility and potential.   Finally, the fourth stage moves to Practice, reflecting the action of incorporating an innovation into regular useand sustaining it (even if it is in some modified form). 

Each of these stages admittedly involves a series of smaller interrelated steps, and the literature identifies several important factors that influence this process and determine ultimately the extent to which the intended program changes occur.   Simple innovations often can be adopted and successfully implemented in programs with only minor tremors in organizational functioning.   As innovations and new procedures become more complex and comprehensive, however, the process of change becomes progressively more challenging—especially in settings where staff communication, cohesion, trust, and tolerance for change are low.

Figure 2.  TCU Program Change Model (Simpson, 2002)

Organizational-level assessments are perhaps the most challenging because they require data to be taken from individuals within an organization (e.g., leaders, staff, clients) and then aggregated in ways that represent “the organization.”   Selection of appropriate scales, data collection format, reliability and validity of measures, selection or sampling of individuals to properly represent the organization, and methodological alternatives for aggregating data are issues that require attention.   TCU assessmentsof organizational needs and functioning have been created with these applications in mind.   The TCU Client Evaluation of Self and Treatment (CEST) is used to measure client-level and program-level performance indicators in treatment.   The TCU Organizational Readiness for Change (ORC) focuses on organizational traits that predict program change.   It includes scales from four major domains—motivation, resources, staff attributes, and climate.   Comparisons of scale scores from the CEST and ORC assessments with other programs are now being addressed by providing norms (e.g., 25th and 75th percentiles) based on large-scale databases at TCU (see “Assessment Fact Sheets” in the IBR Web site).   The TCU Program Training Needs (PTN) survey is used for identifying and prioritizing treatment issues that programs believeneed attention.   Its items are organized into domains focused on Facilities and Climate, Satisfaction with Training, Preferences for Training Content, Preferences forTraining Strategy, Barriers to Training, and Computer Resources.   This type of information helps guide overall training efforts as well as predicts which innovations participating programs are most likely to seek out and adopt.
  

DATAR Phase 3 Supplements

A series of supplements supported research on understanding of how organizational functioning may be related to health disparities among minority populations, crosscultural generalizability of the ORC in Italy and England, and the applicability of a revised ORC for assessment use for correctional settings.

With respect to health disparities, there were race-ethnic differences observed with regard to types of health problems reported.  More importantly, health problems were related to psychosocial functioning and to treatment engagement and these relationships held when adjusted for race, gender and age.  An Italian version of the ORC survey was administered, and surveys from 341 respondents (representing 64 programs) were completed, primarily via the Internet. Results in the Veneto Region revealed high similarities between organizational functioning profiles from U.S. and Italian programs.  Psychometric analyses also showed reliabilities of the ORC/Italian scales were consistent with U.S. findings, and appended comments collected from respondents confirmed interpretations of ORC profiles.

Health Disparities Among Minority Treatment Clients
(October 2002 to September 2004)
This 2-year study was designed to develop a better understanding of how organizational factors may be related to health disparities among minority populations.  Clients in treatment from two states in the Gulf States Addiction Technology Transfer Center (GCATTC), which included a substantial percentage of Hispanics and African Americans, were surveyed to identify differences in program structure, organizational climate, training needs, and client functioning that might be related to disparities in services provided in minority versus non-minority programs.  A special version of the CEST that added questions to determine the incidence of 28 specific disease and health conditions among clients was used to survey treatment clients.  Initial analyses focused on client differences in the incidence of health problems, ancillary services needed and received, client psychosocial functioning, and client satisfaction with treatment to evaluate whether there were disparities between minority and non-minority clients with respect to treatment services received.

International Cross-Cultural Study of Organizational Functioning
(October 2002 to September 2004)
This study was carried out in collaboration with Dr. Lorenzo Rampazzo (Director of Social Services for Veneto Region, Italy) and his associates, culminating in a conference in Venice that included representatives from 64 programs that participated in the study.   The methodology was defined based on needs of the Veneto Region Social Services Division where drug abuse treatment is provided as part of the health service delivery system.  The TCU ORC survey was translated into Italian (and back translated) and data collection was carried out in early 2004.  Surveys from 341 respondents (representing 64 programs) were completed, primarily via the Internet.  Results of the ORC survey in the Veneto Region revealed high similarities between organizational functioning profiles from U.S. and Italian programs.  Psychometric analyses also showed reliabilities of the ORC/Italian scales were consistent with U.S. findings, and appended comments collected from respondents confirmed interpretations of ORC profiles.  Program diversity was identified (especially between “public versus private” programs in Italy), and specific program-level feedback was translated into Italian and provided to participating programs for carrying out applications in relation to program restructuring steps for the Veneto Region.  In addition to the Venice conference study findings have been presented at the Italian National Conference on Drug Addiction and Mental Illness in Sardinia, and the 47th International Conference of the International Council on Alcohol and Addiction (ICAA) in Venice.  Papers have been published in journals based on this work.

Development of an Organizational Readiness for Change Assessment for Correctional Substance Abuse Treatment Programs
(September 2003 to August 2004)
The primary purpose of this study is to revise and test the applicability of the TCU Organizational Readiness for Change (ORC) assessment with treatment program located within correctional facilities.  Specific objectives were to (1) develop a user-friendly correctional version of the ORC, (2) demonstrate the applicability of the revised ORC assessment within the correctional setting, and (3) begin developing profiles for organizational functioning.  This study provides the basis for an anticipated future study that will examine the relationship between clients' self-reported perceptions of the care they are receiving and their own psychosocial functioning with staff ratings of organizational factors associated with the utilization of treatment services.
 

DATAR Project -- Phase 4 (2004-2009)

In 2004, the fourth phase of DATAR was extended with funding from a NIDA MERIT Award (for recognizing distinctive and exceptional research projects).   It pursues three general goals.   First are studies for testing the conceptual model of program change using a longitudinal data collection infrastructure based on TCU assessments of client and program functioning.   This refinement work on the model emphasizes the “process” of change, continuing to focus on the treatment contextual role of organizational structure and functioning.   Second are enhanced feedback to counselors and program leadership on client progress that can be used for monitoring performance at the agency level.  Program leaders were also trained to use these TCU assessment-linked reports in workshops.   A third goal is integration of the TCU manuals into a sequence of treatment system modules that link together to sustain client progress through the major treatment stages.  The TCU treatment manuals developed in previous phases of DATAR have been shown to be effective in improving interim performance measures representing each stage of treatment engagement process, but their integrated applications in combination with client performance assessments need further evaluation.   Implementation of this goal therefore will be partially dependent on progress with the second goal involving MIS/performance feedback.

Strategic stage-based intervention

The collection of TCU Brief Intervention (BI) modules was finalized and added to the IBR Web site as part of the Internet-based Treatment Intervention Library.  Module topics include anger management, communication, social networking, HIV/AIDS, cognitive distortions, contingency management, and node link mapping.  These along with other materials produced through the past 16 years of the DATAR project are available for free download.
  

Recent DATAR Research Activities

As part of the research activities, the DATAR data system has undergone further development to capture data needed to address hypotheses with regard to the change model (Simpson & Flynn, 2007).  This model, portrayed in Figure 3 below, has several components representing strategic planning, organizational needs, and program improvement. The set of forms includes the Program Training Needs (PTN), the Organizational Readiness for Change (ORC), the Workshop Evaluation Form (WEVAL), the Workshop Assessment Follow-up Assessment (WAFU), and the Client Evaluation and Satisfaction of Treatment forms at intake (CEST-Intake) and during treatment (CEST). 

Figure 3. Modified TCU Program Change Model
Figure 3.  Modified TCU Program Change Model

A series of studies were completed as part of a concerted effort to address implications suggested in the conceptual framework for transferring technology to clinical practice as proposed by Simpson (2002) and are now published in a 2007 special issue of Journal of Substance Abuse Treatment.

Study 1 (Rowan-Szal et al.) addressed issues in Strategic Planning.  It found the Program Training Needs survey (PTN) to be psychometrically sound and results of a validity analysis confirmed strong relationships between the PTN and the Organizational Readiness for Change survey (ORC).  The study indicated that the PTN is useful as a strategic planning tool for guiding overall training efforts as well as in predicting the types of innovations that participating programs are likely to adopt.

Study 2 (Courtney et al.) used logistic regression analysis to examine attributes related to program-level decisions to engage in a structured process for making organizational changes.  Findings showed that programs with higher needs and pressures, and those with more limited institutional resources, and poorer ratings of staff attributes and organizational climate were most likely to engage in a change strategy.

Study 3 (Bartholomew et al.) examined the hypothesized relationships between Training and Adoption Decisions.  It showed that counselor ratings of their workshop trainings predicted subsequent use of those trainings.  In addition, favorable post-training attitudes toward the workshop (indicators of comfort with material, interest in more training, program resources, and workshop satisfaction) were related to later trial use.

Study 4 (Joe et al.) addressed the role of the counselor in workshop training utilization through their perceptions of work environments and perceived abilities.  Three classes of counselors were identified through latent profile analysis using the measures of organizational climate and staff attributes.  These classes were found to be related to utilization of workshop training; namely counselors who perceived themselves as being better integrated into their programs were more likely to use training than those who perceived themselves as more isolated.

Study 5 (Greener et al.) examined the relationship of organizational functioning to program improvement.  Using three measures of client engagement in treatment (rapport, satisfaction, and participation) as process outcomes in a sample of 531 clinical staff and 3475 clients from 163 substance abuse treatment programs located in 8 states from three Addiction Technology Transfer Centers (ATTC), it was found that engagement was higher in programs with more positive indicators of organizational functioning.

Study 6 (Simpson et al.) investigated stages in the evaluations of the overall technology model in Figure 2.  As part of that study, it examined current adoption of workshop training in terms of the ORC instrument, which addresses issues in Technology Needs using the technology transfer framework (Figure 1).  Organizational climate, treatment program resources, and staff attributes predicted adoption; openness to change, autonomy, opportunities for growth, and training resources were the most salient predictors.  Additionally, the study integrated findings from the previous studies by showing how each fit within the evaluations model (Figure 2), and presented results showing that workshop training based on strategic planning was related to adoption of that training and that implementation of training was related to program improvements in client engagement.


Figure 4.  Program Needs, Functioning, and Innovation Implementation
  

International collaborations

IIn March 2005, the IBR hosted a prominent delegation of 11 leaders representing treatment delivery, research, and policy making from England. Much like our international work in the Veneto region of Italy in previous years, this collaboration with England’s National Treatment Agency for Substance Misuse (NTA) has now budded into a significant activity. Streamlining access to drug misuse services in England is the focus of a multi-phase initiative to address the country’s need for more treatment services and improved quality of care. NTA is at the helm of this endeavor, and the results, so far, have been on target. Treatment slots have opened up and waiting list times have been reduced, such that drug misusers secure quicker access to treatment than ever before. For NTA, the current emphasis involves the implementation of a national treatment effectiveness strategy to improve client retention and outcomes once drug misusers enter treatment. The Strategies for Improving Treatment Effectiveness (SITE) collaboration, a scientific partnership between TCU, NTA, and the National Addiction Centre (NAC) in London, provides foundational support and guidance for this effort. Materials from the TCU Treatment System are being adapted as part of the transfer, utilization, and evaluation of evidence-based resources and procedures for clinical practice and program management. The primary objectives, based on exposure and trial adoption of organizational and treatment program improvement strategies, will help further the explorations of cross-national technology transfer of the TCU Treatment System.

In collaboration with the NTA in England, selected TCU Brief Intervention materials were used to create a manual for the International Treatment Effectiveness Project (ITEP) designed to address early engagement and cognitive readiness for treatment.  The ITEP manual incorporated materials from the Brief Interventions (BI) on mapping (“Mapping Your Journey”) and thinking errors (“Unlock Your Mind”).  Subsequently, DATAR staff conducted a train-the-trainers event for 40 drug treatment counselors in the Greater Manchester region of England where the ITEP manual is being piloted in 25 programs.  In addition, the ORC and CEST surveys were administered to assess organizational functioning and treatment progress of service.  Similar research is now in progress in Birmingham, England.  This international effort presents both scientific opportunities and challenges for advancing our current understanding of factors that drive the transfer of treatment effectiveness innovations.

New research initiatives

A project undertaken with MHMR in Fort Worth addresses the goal of creating shorter, targeted assessments based on the CEST. The reliability and validity of one of these short forms (CEST-TNM) as a stand-alone instrument for investigating treatment motivation and the utility of using client profiles to provide timely feedback to counselors are being assessed. Another new research collaboration involves the Cenikor drug treatment programs, with the research objectives of: (a) introducing a method for assessing organizational effectiveness and generating client profiles within Cenikor drug treatment programs using evidence-based assessments developed at TCU (PTN, ORC, and CEST), (b) training Cenikor drug treatment staff who work directly with drug users on how to implement a series of counseling enhancements and interventions that focus on treatment planning and engagement, life and social skills, and improving retention and (c) conducting evaluations of the above referenced series of counseling enhancements and interventions.

A project undertaken with MHMR in Fort Worth addresses the goal of creating shorter, targeted assessments based on the CEST.  The reliability and validity of one of these short forms (CEST-TNM) as a stand-alone instrument for investigating treatment motivation and the utility of using client profiles to provide timely feedback to counselors are being assessed. Another new research collaboration involves the Cenikor drug treatment programs, with the research objectives of: (a) introducing a method for assessing organizational effectiveness and generating client profiles within Cenikor drug treatment programs using evidence-based assessments developed at TCU (PTN, ORC, and CEST), (b) training Cenikor drug treatment staff who work directly with drug users on how to implement a series of counseling enhancements and interventions that focus on treatment planning and engagement, life and social skills, and improving retention and (c) conducting evaluations of the above referenced series of counseling enhancements and interventions.

Another collaboration involves secondary analysis of data collected by the state of Indiana Department of Corrections (IDOC) as part of their Offender Information System (OIS).  The research focus is on utility of the Substance Abuse Intake (SAI), Client Evaluation of Self at Intake (CESI), and the effectiveness of the treatment plans in predicting client engagement and their perceptions of care received, their psychosocial functioning, and changes made during treatment (as measured in the Client Evaluation of Self and Treatment, CEST).   Offender records include information concerning criminal and medical history, behavior while in custody, and treatment records including session attendance, urine tests, requested time cuts, time in treatment, compliance with treatment plan activities, and program completion.   These secondary information being made available to the IBR will be devoid of any prisoner identification.   Post-incarceration rates for rearrest will also be obtained from the Indiana Department of Corrections.

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DATAR Publication Lists

Special Issue of Journal of Substance Abuse Treatment (2007)

Simpson, D. D., & Flynn, P. M. (Guest Eds.).  (2007).  Organizational Readiness for Change (Special Issue).  Journal of Substance Abuse Treatment, 33(2).  [Journal Website]
  

2007 DATAR Publications

Joe, G. W., Flynn, P. M., Broome, K. M., & Simpson, D. D.  (2007).  Patterns of drug use and expectations in methadone patients.  Addictive Behaviors, 32, 1640-1656.  [Abstract]

Knight, D. K., Bartholomew, N. G., & Simpson, D. D.  (2007).  An exploratory study of “Partners in Parenting” within two substance abuse treatment programs for women.  Psychological Services, 4(4), 262-276. 

Simpson, D. D., & Dansereau, D. F.  (2007).  Assessing organizational functioning as a step toward innovation.  Science & Practice Perspectives, April, 20-28 (full text available electronically at http://www.drugabuse.gov/PDF/Perspectives/vol3no2/Assessing.pdf).  [Abstract]

Summary Publications

Simpson, D. D. (2004).  A conceptual framework for drug treatment process and outcome.  Journal of Substance Abuse Treatment, 27, 99-121.  [Abstract]

Simpson, D. D., & Joe, G. W. (2004).  A longitudinal evaluation of treatment engagement and recovery stages.  Journal of Substance Abuse Treatment, 27, 89-97.  [Abstract]

Simpson, D. D. (2002).  A conceptual framework for transferring research to practice.  Journal of Substance Abuse Treatment, 22(4), 171-182.

Joe, G. W., Broome, K. M., Rowan-Szal, G. A., & Simpson, D. D. (2002).  Measuring patient attributes and engagement in treatment.  Journal of Substance Abuse Treatment, 22(4), 183-196.  [Abstract]

Lehman, W. E. K., Greener, J. M., & Simpson, D. D. (2002).  Assessing organizational readiness for change.  Journal of Substance Abuse Treatment, 22(4), 197-209.

Simpson, D. D., Joe, G. W., Dansereau, D. F., & Chatham, L. R. (1997).  Strategies for improving methadone treatment process and outcomes.  Journal of Drug Issues, 27(2), 239-260.  [Abstract]

Selected DATAR Publications

Simpson, D. D., & Joe, G. W. (1993).  Motivation as a predictor of early dropout from drug abuse treatment. Psychotherapy, 30(2), 357-368.

Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1994).  A visual representation system for drug abuse counselors.  Journal of Substance Abuse Treatment, 11(6), 517-523.

Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. M. (1995).  Client engagement and change during drug abuse treatment.  Journal of Substance Abuse, 7(1), 117-134.

Simpson, D. D., Joe, G. W., & Rowan-Szal, G. A. (1997).  Drug abuse treatment retention and process effects on follow-up outcomes.  Drug and Alcohol Dependence, 47, 227-235.  [Abstract]

Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. M. (1997).  Drug abuse treatment process components that improve retention.  Journal of Substance Abuse Treatment, 14(6), 565-572.  [Abstract]

Dansereau, D. F., & Dees, S. M. (2002).  Mapping training:  The transfer of a cognitive technology for improving counseling.  Journal of Substance Abuse Treatment, 22(4), 219-230.  [Abstract]

Czuchry, M., & Dansereau, D. F. (2003).  A model of the effects of node-link mapping on drug abuse counseling.  Addictive Behaviors, 28(3), 537-549.  [Abstract]

Joe, G. W., Simpson, D. D., Greener, J. M., & Rowan-Szal, G. A. (2004).  Development and validation of a client problem profile and index for drug treatment.  Psychological Reports, 95, 215-234.  [Abstract]

Other DATAR publications

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DATAR Newsletter Stories


DATAR Research Summaries

See also the Research Summaries on these special topics:

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