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PubMed1980

Adolescents in transition: a look at a transitional treatment center.

This article describes the structure, philosophy, and goals of a high expectations halfway house program for adolescents. The Transitional Treatment Center (TTC) is a residential treatment program for emotionally disturbed adolescents making the transition from institutionalization to independent community life. Topics covered are specification of the TTC program objectives, methods for monitoring residents' progress towards resocialization and plans for future programming.

Adolescent↗

PubMed2004

The structural coherence of clinically derived dynamic indicators of reoffending risk.

BACKGROUND: Forensic psychiatrists aim to reduce the risk of reoffending through treatment. With few exceptions, research evidence tends to favour risk assessment aids reliant on fixed historical rather than clinical data, but transparency in the making of clinical judgements is lacking. AIMS: To evaluate further a clinically derived 47-item dynamic risk assessment checklist; specifically to test first whether it has a meaningful dimensional structure and, second, the extent to which items and underlying dimensions are associated with a separate, direct clinical judgement of risk of reoffending. METHODS: Data sets from four previous studies on the reliability and validity of the Clinical Inventory of Dynamic Reoffending Risk Indicators (CIDRRI) were merged, yielding 370 cases. The resulting data set was analysed using principal axis (common) factor analysis, with orthogonal (varimax) rotation. In addition, receiver operating characteristic (ROC) curves were calculated. RESULTS: The model of best fit depended on treatment stage; for those in residential treatment it was a six- factor model (responsibility, self-reliance, antisocial/narcissistic traits, treatment compliance, goal attainment and avoidance); for those back in the community a five-actor model in which, effectively, the compliance and goal attainment factors became one, provided a better fit. These dimensions and some individual scale items were associated with clinical judgement of risk of reoffending. CONCLUSIONS AND CLINICAL IMPLICATIONS: This study provides evidence that the CIDRRI is an adequate operationalization of underpinnings of clinical risk assessment, and that these underpinnings are part of meaningful higher-order dimensions. The CIDRRI is a viable instrument for clinical use, taking only 15 minutes to complete and identifying dynamic risk factors, the validity of which needs to be further established.

Adult↗

PubMed1995

Culture in treatment, culture as treatment. A critical appraisal of developments in addictions programs for indigenous North Americans and Australians.

Indigenous people in Australia and in North America have been creating innovative interventions in the addictions field for several years now--incorporating traditional healing practices and cultural values into otherwise western programs--although this process is more developed in Canada and the U.S. than it is in Australia. Through a process of cultural diffusion, Australian Aborigines have incorporated many ideas from Native Canadian treatment models. As a result, residential treatment utilizing adapted forms of the 12 steps of Alcoholics Anonymous is being promoted by indigenous Australians. This paper examines comparative material on the uses of culture as a form of healing and traces the rationale for the argument that cultural wholeness can serve as a preventive, or even curing agent in drug and alcohol abuse. This is a qualitative leap from the now universally accepted notion that treatment and rehabilitation for native people should be culturally appropriate. There are, however, certain dilemmas confronting native treatment directors attempting these syncretic approaches, given aspects of cultural contexts which can serve to foster drug and alcohol use rather than discourage it. Additionally, North American Indians have at their disposal a rich heritage of communal healing techniques; some (such as the sweat lodge) have been adapted and incorporated into the treatment both of solvent abuse by adolescents, and alcohol abuse by adults. In Australia on the other hand, traditional healing techniques have been less amenable to adaptation. On neither continent are indigenous people attempting to adapt recent mainstream models of intervention to suit their needs (such as Brief Intervention) which is currently receiving international attention in addictions research and treatment.

Australia↗

PubMed2006

Long-term evaluation of multi-disciplinary treatment of morbid obesity in low-income minority adolescents: La Rabida Children's Hospital's FitMatters program.

PURPOSE: Long-term evaluation of an empirically based program for the treatment of morbidly obese, low-income, minority adolescents. METHODS: In the first year, 150 participants received cognitive-behavior therapy, nutritional education, medical monitoring, and structured exercise training. Weights and heights were collected at follow-up. Successful and Less Successful groups were delineated based on change in body mass index z-scores. Medical record review provided weight and height data one year before treatment for a subset of participants (comparison group). Analyses of variance examined differences between groups. Discriminant function analyses examined predictors of success in the domains of socioeconomic status, individual factors and psychological functioning, family factors, and prior weight loss behaviors. Correlates of success were explored. RESULTS: Eighty-three adolescents participated in the follow-up, on average 23 months (SD = 3.8) after initial assessment. Nineteen (23%) participants achieved clinically meaningful weight change (-.70 z-scores or better). Discriminant function analyses, correlations, and direct comparisons showed that the Successful group, compared with the Less Successful group, on average, attended 50% more sessions over 84% more weeks, were heavier initially, had somewhat better critical weight control skills (e.g., self-monitoring) before and during the program, and were somewhat more psychologically and intellectually challenged before treatment. CONCLUSION: Although some of these very high risk adolescents made clinically significant progress, more intensive treatments, like long-term residential treatments and bariatric surgery, may produce even more favorable outcomes.

Adolescent↗

PubMed2003

Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project.

The Soteria project (1971-1983) compared residential treatment in the community and minimal use of antipsychotic medication with "usual" hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976, N = 79) or randomly (1976 to 1979, N = 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N = 160), for completing subjects (N = 129), and for completing subjects corrected for differential attrition (N = 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD, p =.03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD, p =.02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.

Adolescent↗

PubMed1980

The use of computers in the treatment of children.

A relatively inexpensive method for cross-confirming information about the functioning of youths was developed and used in a residential treatment program. With modification, the procedure can be employed in other settings to support and enhance social treatment.

Adolescent↗

PubMed2005

The impact of contracting and prompting substance abuse treatment entry: a pilot trial.

Contracting and prompting clients to attend substance abuse treatment aftercare substantially improves treatment adherence and outcome. However, this approach has not been evaluated for improving entry into initial treatment. We recruited 102 individuals scheduled to begin a 28-day substance use disorder (SUD) residential treatment program and randomly assigned them to receive either our standard treatment (STX) or STX plus attendance contracting and prompting (CP). CP participants showed fewer subsequent hospitalization days, lower hospitalization costs, greater improvement in alcohol problem scores, and lower legal problem scores at a 3-month follow-up than the STX group. The two groups did not differ on treatment entry rate, time in treatment, or drug use problem scores. The clinical utility of CP procedures and areas for future research are discussed.

Alcoholism↗

PubMed1979

The failure of therapeutic communities, drug treatment, and rehabilitation programs.

A positive behavioral modification program is described. This program has been useful in dealing with "Borderline Personality Organization" in residential treatment centers. It is pointed out that behavioral modification programs are more effective if designed around an analytically-based understanding of the developmental dynamics which contributed to the behavior.

Behavior Therapy↗

PubMed1998

Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial.

AIMS: To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment. DESIGN AND SETTING: A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to the intervention or control condition. PARTICIPANTS: Approximately 50 adult residents (inpatients) from each site were followed for 12 months after treatment discharge. INTERVENTION: Participating residents in the six intervention centers received a 4-part, individually tailored, smoking cessation program while those in the six control sites received usual care. FINDINGS: Both moderate and heavy drinking rates were reduced in the intervention group. Intervention site participants were significantly more likely than controls to report alcohol abstinence at both the 6-month (OR = 1.59, 95%CI: 1.09-2.35) and 12-month assessment (OR = 1.84, 95%CI: 1.28-2.92). Illicit drug use rates were comparable. Effect of the intervention on tobacco quit rates was not statistically significant. CONCLUSIONS: Counseling alcoholics in treatment to quit smoking does not jeopardize the alcohol recovery process. However, low-intensity tobacco interventions are unlikely to yield high tobacco quit rates.

Adult↗

PubMed2005

Incarcerated clients' perceptions of therapeutic change in substance abuse treatment: a 4-year case study.

Therapeutic communities (TCs) are a primary approach for treating substance abusers in the criminal justice system. The transformation from residential treatment to a TC marked a significant change in the service delivery and organizational culture for one in-prison substance abuse treatment program. This longitudinal case study examines how clients perceived their treatment as a result of treatment and organizational changes. This is important because the scientific literature shows that client perceptions of their treatment impacts treatment retention and the benefit they gain from treatment. Data that were collected over 5 years are presented. Implications, including how the program's interim therapeutic milieu eased the transition to a therapeutic community, are discussed.

Adult↗

PubMed1997

Predictors of adolescent psychopathy: oppositional and conduct-disordered symptoms.

Psychopathy is an important clinical construct in the evaluation and treatment of adolescent offenders. In this study, predictors of adolescent psychopathy are explored in 81 adolescents from a residential treatment program for dually diagnosed offenders. The number of aggressive conduct disorder symptoms and total rate (number x frequency of symptoms) of deceit/theft symptoms are predictive of adolescent psychopathy. Although age of onset for conduct disorder symptoms is associated with psychopathy, its interpretation appears to be confounded by gender and ethnicity correlates. Unexpectedly, adolescent psychopathy was only modestly associated with institutional infractions. Past research and current findings are summarized with reference to their forensic implications.

Adolescent↗

PubMed1979

Clinical and administrative synthesis in adolescent treatment: search for a sane integration of thought and action.

In working as administrator and clinician (co-director and head psychologist) of a day and residential treatment facility for disturbed adolescents, I have become acutely aware of some of the difficulties of integrating both roles. To keep rooted in the concrete, I have described the program with which I am involved in particular as to crucial client and staff dynamics. By drawing on concepts from systems theory (as system integrity and cross-boundary interactions) and psychoanalytic theory (unconscious testing), I have tried in this paper to sketch a framework for bringing the two separate roles into a single way of thinking and give some examples of how this kind of synthesized approach can be useful and powerful. The two concrete examples focus (1) on the more administrative issue of program design, and (2) on a more clinical case of child abuse.

Adolescent↗

PubMed2006

Exacerbation of psychiatric symptoms during substance use disorder treatment.

OBJECTIVE: This study examined psychiatric symptom exacerbation (or deterioration) among patients treated for substance use disorders. The study examined several questions. What is the prevalence of deterioration during residential treatment? Compared with patients who show improvement in psychiatric symptoms, do those with deterioration of symptoms report poorer functioning during treatment and one year after treatment entry? Do patients who experience deterioration of symptoms one year after treatment entry enter treatment with more problems and poorer coping skills? Is the prevalence of deterioration associated with treatment orientation, and do patients whose psychiatric symptoms deteriorate view the treatment environment more negatively than patients whose symptoms improve? METHODS: A total of 3,322 male patients were recruited at 15 residential substance abuse treatment programs in the Department of Veterans Affairs health care system between 1992 and 1995. On the basis of changes in psychiatric symptoms during treatment, these patients were categorized as having either deteriorated or improved psychiatric symptoms. Patients whose symptoms deteriorated were compared with a matched group of patients with improved symptoms. RESULTS: A total of 426 patients (13 percent) reported a worsening of psychiatric symptoms during treatment. Compared with patients in the improved group (N=426), patients in the deteriorated group reported more psychiatric problems and substance use one year after treatment. Patients in the deteriorated group were more likely to have a psychotic diagnosis, lower self-efficacy, and more reliance on coping by expression of emotions and to view the treatment experience more negatively. CONCLUSIONS: Thirteen percent of the patients experienced an exacerbation of psychiatric symptoms during residential substance use disorder treatment. Improved monitoring procedures, such as regular assessments for changes in psychiatric symptoms, are needed to routinely obtain information about declines in psychiatric conditions during treatment.

Adaptation, Psychological↗

PubMed2001

Predictors of program completion for women in residential substance abuse treatment.

Although there is increasing emphasis on providing drug treatment programs for women that address their specific needs (including parenting and childcare), some women still fail to complete treatment. Because of the limited information about the barriers involved, this study examines pretreatment characteristics as predictors of program completion for 87 women who were pregnant or who entered residential treatment with their children. By using a multivariate prediction model, three significant predictors of treatment completion were identified: education level, recent arrests, and peer deviance. Women who completed program requirements were more likely to have a high school degree or equivalent, no arrests in the 6 months before admission, and friends who were less deviant. These findings support the need for specialized education and services that address social deviancy of pregnant and/or parenting women. Other predictors that approached significance and deserve further study include marital status, number of children in treatment, child welfare involvement, cocaine use, and psychological depression.

Adolescent↗

PubMed1998

The relationship between lethality of attempted suicide and prior suicidal communications in a sample of residential youth.

Some type of suicidal communication precedes 80% of attempted and completed suicides in adolescents. This study investigates the relationship between the number of suicidal communications prior to an attempt and the lethality of the attempt in a sample of adolescent youth residing in a residential treatment facility. The sample consisted of 46 youth who had a suicide attempt while in a large group home residential facility over a 9-year period. Results indicated that attempters who made fewer suicidal communications beforehand tended to use more lethal methods in their attempts. Attempters with two or more preceding suicidal communications had significantly lower lethality in their attempts than did those with fewer suicidal communications. Few differences emerged between the groups in regards to demographic or psychosocial variables.

Adolescent↗

PubMed1991

The impact of time in treatment on the employment and earnings of drug abusers.

We use data from a longitudinal survey to estimate the effects of time in drug abuse treatment on post-treatment weeks worked and earnings for 2,420 clients in three treatment modalities. The regression analysis shows that time in treatment had a positive and statistically significant impact on these labor market outcomes, but the effects were small for all modalities. Although residential clients experienced the largest relative changes in weeks worked and real earnings, a benefit-cost calculation suggests that additional residential treatment cannot be justified from earnings improvements alone. These results may indicate a need for more employment services while in treatment.

Cost-Benefit Analysis↗

PubMed2006

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes.

AIM: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up. DESIGN AND SETTING: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs. PARTICIPANTS: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated. MEASUREMENT: Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use. FINDINGS: Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs. CONCLUSIONS: The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.

Adult↗

PubMed2000

Predictors of treatment outcomes in men and women admitted to a therapeutic community.

This study compared factors that predict treatment outcomes in men and women randomly assigned to two therapeutic communities differing primarily in length of inpatient and outpatient treatment. Based on the prior research literature comparing treatment outcomes of men and women, we formulated the following research question: Do factors that predict drug use at follow-up, postdischarge arrest, and employment at follow-up differ for men and women? Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews. Separate regression analyses were conducted for men and women for each of the three outcome variables. The results showed that the predictors of outcome for men and women were similar. Clients who completed the 12-month treatment programs had better outcomes regardless of gender. Men and women who completed treatment were characterized at follow-up by substantial reductions in drug use and arrests and by increased employment. Results further suggested that the longer residential treatment program had a particularly beneficial impact on women. Number of prior arrests was also associated with postdischarge outcomes for women. Women with more arrests at admission were more likely to have a postdischarge arrest and less likely to be employed at follow-up. This finding provides invaluable information about which women may be at greater risk for relapse and in need of additional services. We conclude that completion of treatment is the key predictor of treatment outcomes for both men and women.

Adult↗