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This Spring-Summer 2003 issue is also available in Adobe(R) PDF format.
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User-friendly management systems for improving treatment
There are a myriad of factors known to influence drug treatment effectiveness and outcome. As discussed in previous issues of this newsletter, the TCU Treatment Process Model, based on over a decade of research, provides a conceptual framework for understanding how program and client influences operate sequentially during the stages of treatment (see Volume 9, Number 1). A key unanswered question is how best to establish feedback procedures so that information about treatment process and program operations can be effectively utilized. Findings suggest that monitoring reports based on routine assessments of client functioning and organizational climate can help improve both clinical care and program management. For this reason, we are eager to launch our new Treatment Costs and Organizational Monitoring (TCOM) project, a 5-year NIDA initiative to further develop assessment systems that can be used by drug abuse treatment providers. Our research will focus on measuring the association of organizational attributes and program resources with client and program operations.
In this issue of Research Roundup, we provide an overview of the TCOM project, including research methodology and long-range goals. Over 100 drug treatment programs from different regions in the U.S. will be invited to participate in these studies, which will test the reliability and feasibility of the TCOM assessments and examine the most useful ways to provide ongoing feedback about client functioning and organizational resources to program administrators. Bookmark our Web site (http://www.ibr.tcu.edu) so you can check back for TCOM announcements and updates as they become available. n
Treatment Costs and Organizational Monitoring: Taking a program's pulse
Past IBR research has explored treatment process and the development
of evidence-based interventions for clinicians and counselors (including
cognitive enhancements such as mapping and a variety of skills-based counseling
manuals). The new TCOM project will explore, through real-world
application, the best way to provide drug treatment managers and administrators
with meaningful, evidence-based information about their program’s
overall well being. Principal Investigator Dr.
Patrick M. Flynn will direct the central aims of the project, which
include developing an integrated set of instruments and procedures for
assessing organizational functioning and fiscal health and demonstrating
the feasibility of this system in field-based studies of 100 outpatient,
drug-free treatment providers in different regions across the U.S.
Dr. Danica K. Knight will be
working with Dr. Flynn to coordi-nate field logistics and data collection.
Dr. Kirk M. Broome, TCOM Project
Director, sees the project as “reflecting the reality that a treatment
program is focused on healthcare, but also has business responsibilities.
Counseling, services, and other activities take place before a complex
backdrop of policies and procedures, staff social norms, and financial
issues. Our goals are to illuminate and understand that backdrop,
and to use what we learn to develop tools for quality improvement and
better positioning in a competitive market.” Figure 1
(see below) shows a conceptual model of organizational foundations and
program change.
Figure
1. Conceptual
Model of Organizational Foundations for Treatment Process and Change
The TCOM assessment system will expand our TCU assessments on client and organizational functioning with a set of instruments that focuses on economic resources. These forms will be administered to selected staff and clients in participating programs over the length of the project, allowing researchers to monitor organizational changes and relate them to client-level indicators of program performance. This design sets up a natural study of the process of program change over time in order to establish the usefulness of long-term implementation of the TCOM system. Researchers also will implement and evaluate a training protocol for Program Directors on how to use the TCOM information system to best advantage for improving program management.
A centerpiece of the TCOM system is the development of a user-friendly and practical tool for allocating total costs to units of service. The end product will be an abridged cost allocation protocol that can be used by programs (beyond research-based applications) in the practical daily management of their clinics and treatment centers. For example, with data from the TCOM system, programs will be better able to price their services and have direct access to financial information that can be used to negotiate reimbursement rates.
During the first year of the project, Program Directors interested in participating in the research will be asked to complete a needs assessment survey for their program indicating their interest in participating in the project. From those programs completing this needs assessment, a sample of respondents will be invited to participate for the entire run of the project (approximately three more years). During this time, Program Directors, program financial officers, counseling staff, and clients in treatment will provide annual assessments. Program Director and counseling staff will complete a version of the Survey of Organizational Functioning, a proven instrument that measures perceptions of organizational climate, resources, and readiness for change. Clients will complete the Client Evaluation of Self and Treatment (CEST), which addresses psychosocial functioning, counseling rapport, and satisfaction with services. In addition, program administrators or financial officers will complete a more lengthy assessment (in workbook format based on Microsoft® Excel) to collect detailed information about revenues, funding, and costs of doing business.
Assessment instruments will be developed and field-tested in three evolving formats, beginning with paper-and-pencil surveys, followed by electronic versions that are completed on computer and e-mailed for analyses, and culminating with online, Web-based versions of the assessments completed via the Internet. With the Internet technology, automatic, instantaneous reporting upon completion of the assessments will be available. In addition, linked spreadsheets and workbooks for revenue reporting and cost allocation will be designed to produce tables and charts so that summary reports will be available automatically upon completion of the data input.
When sufficient numbers of programs have participated in the data collection and reporting activities, preliminary benchmarks will be developed for revenues, expenditures, and the relative costs of treatment services. With financial, performance, and progress data readily available, performance benchmarks will be developed for use in program quality control and improvement efforts. Programs will be able to compare their own revenues, costs, and relative performance with aggregated data from other treatment providers in their region and in other regions. To facilitate this, Program Directors and financial administrators will attend special training sessions (with travel and per diem expenses paid for by the project) in order to learn how to utilize information from the TCOM assessment system. In addition to the training, annual feedback, and benchmark reports, participating programs will be furnished with a desktop computer for use in the research activities (which they will be allowed to keep and use for other program functions as needed).
“Organizational-level assessments have always presented a challenge to researchers,” notes Dr. Flynn, “and we are hopeful that what we learn from the TCOM project will help set a new standard for program management information systems that are practical and meaningful for drug treatment providers as they struggle to maintain program quality and integrity in an ever-changing funding and revenue environment. As with our other TCU resources, we expect to make all TCOM assessments available without charge to interested, nonprofit users.”
If your program is interested in com-pleting the initial needs assessment
survey and possibly participating in the TCOM project, contact Dr.
Kirk Broome, Project Director, by e-mail at tcom@tcu.edu
or by phone at (817) 257-7226. n
An upcoming issue of Journal of Substance Abuse Treatment features a special section reporting on the 5-Year Follow-up Outcome Studies from DATOS (Drug Abuse Treatment Outcome Studies), with an introduction by Dwayne Simpson (the Guest Editor) on a series of collaborative studies undertaken by TCU, UCLA, NDRI, and NIDA. Articles with TCU authors include:
Patient and Program Factors in Obtaining Supportive Services in DATOS (Fletcher, B. W., Broome, K. M., Delany, P. J., Shields. J., & Flynn, P. M.) – A study of 2,932 patients in long-term residential, outpatient, and methadone treatment programs examined patient and program factors that influenced the receipt of scheduled supportive services (e.g., medical, legal, educa-tional, vocational). Hierarchical regression analysis of patient and program factors revealed that long-term residential patients received more services than those in outpatient or methadone treatment. In general, however, patients received few services in the first months of treatment regardless of modality. Being female and having a higher level of problem severity at intake were related to a higher likelihood of receiving services. At the program level, patients with higher problem severity entering an outpatient program whose enrolled patients were less troubled on average received more services.
Recovery
from Opioid Addiction in DATOS
(Flynn, P. M., Joe, G. W., Broome, K. M., & Simpson, D. D.)
– Factors influencing the long-term recovery of 432 patients in 18
outpatient methadone treatment programs were examined using the patient’s
own attributions. Subjects were classified as recovering or non-recovering
based on abstinence from opioid and cocaine use, less than daily use of
alcohol, and no arrests or illegal activity during the previous year.
At Year 5, 28% of patients met these strict criteria for recovery.
These subjects reported they had relied on motivation, treatment experiences,
religion/spirituality, family, and work to maintain recovery. Of
note, support from family and close friends was seen as particularly valuable,
reinforcing the importance of social networks for encouraging drug-free
functioning.
What's New on the Web
At the IBR site,
http://www.ibr.tcu.edu
Forms: Several of the IBR Core Set of Forms have been updated and new forms added, including a Spanish version of the popular TCU Drug Screen. Additional information is provided in the Assessment Systems resource collection.
Projects: IBR’s newest multi-year project focuses on developing the Treatment Costs and Organizational Monitoring (TCOM) information system for drug treatment providers. (See feature article in this newsletter.) The new TCOM Project is listed under a new category of IBR Projects called “Organizational Costs and Functioning.” The CETOP Project is moved from “Criminal Justice Evaluations” to a new area called “Cognitive Interventions.”
Resource Collections:
The Technology Transfer
resource collection has been renamed as Organizational Functioning
and includes information on DATAR-3
and the new TCOM project.
Check out all seven resource collections for in-depth IBR Web site information
on special topics.
At the DATOS site, http://www.datos.org
Publications: This section is updated with new DATOS publications and abstracts, and includes “in press” information for an upcoming Journal of Substance Abuse Treatment special issue. n
IBR Newsletters
Research
Summaries on
Special Topics
Treatment
Process
and Outcomes
(September 2002)
(PDF;
240K/4 pgs)
Organizational
Change
(September 2002)
(PDF; 251K/4 pgs)
Treatment
Assessment
(September 2002)
(PDF; 270K/4 pgs)
Counseling
Manuals for
Special Interventions
(September 2002)
(PDF; 99K/4 pgs)
Treatment
Mapping
(September 2002)
(PDF; 411K/4 pgs)
Treatment
Readiness
and Induction
Strategies
(September 2002)
(PDF; 99K/4 pgs)
Correctional
Treatment
(December 2002)
(PDF; 664K/4 pgs)
Using the
TCU Drug Screen (TCUDS)
(December 2002)
(PDF; 451K/4 pgs)
Contingency
Management
(June 2000)
(PDF; 113K/4 pgs)
Research Reports from IBR
(updated newsletter)
Summer 2008
(PDF; 422K/4 pgs)
Spring 2008
(PDF; 181K/4 pgs)
Winter 2006-07
(PDF; 154K/4 pgs)
Fall 2006
(PDF; 290K/4 pgs)
Spring-Summer 2006
(PDF; 202K/4 pgs)
Research Roundup (back issues and archives)
Winter 2005-06
HTML (PDF; 518K/6 pgs)
Fall 2005
HTML (PDF; 131K/6 pgs)
Spring-Summer 2005
HTML (PDF; 301K/6 pgs)
Fall-Winter 2004-05
HTML (PDF; 546K/6 pgs)
Summer 2004
HTML (PDF; 121K/4 pgs)
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