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PubMedDate not supplied

Family-focused substance abuse treatment: a program evaluation.

Until recently, few programs were available for children whose mothers are in recovery. A refinement of the gender-specific model of substance abuse treatment, the "family-focused" approach, has placed increased emphasis on the needs of children and other family members. However, because these programs are relatively new, little is known about the effectiveness of this type of treatment for either the mother or her children. This article presents findings from a three-year evaluation of a family-focused residential treatment program for women and their children. Longitudinal assessment of the mothers indicated that their psychosocial status and parenting attitudes improved over time. Additionally, the mothers remained in treatment longer. At intake, as a group, the children who were birth to three years of age did not exhibit developmental delay. However, developmental concerns were identified for some children in the areas of motor and/or language development. The results reported here provide beginning evidence that family-focused treatment improves retention, psychosocial functioning, and parenting attitudes of pregnant and parenting women. It also provides a mechanism for early identification and intervention for children.

Child Development↗

PubMed2001

Antisocial behavioral syndromes and return to drug use following residential relapse prevention/health education treatment.

This study compared residential addiction treatment clients meeting full DSM-III-R criteria for antisocial personality disorder (ASPD) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS) on time to and severity of first posttreatment drug use. Antisocial syndrome and selected other mental disorders were assessed using the Diagnostic Interview Schedule, Revised for DSM-III-R, and validity of self-reported posttreatment drug behavior was measured against results of hair analysis. Among subjects followed within 180 days after treatment exit, individuals with ASPD were at modestly increased risk of a first lapse episode compared to those with AABS. However, the two groups did not differ in severity of lapse. Participants with ASPD demonstrated poorer agreement between self-reported posttreatment drug behavior and hair data. These results add to the evidence suggesting that the DSM requirement for childhood onset in ASPD may be clinically important among substance abusers in identifying a severely antisocial and chronically addicted group at elevated risk for early posttreatment recidivism. Our findings support the importance of careful classification of antisocial syndromes among substance abusers and the identification of characteristics of these syndromes that underlie clients' risks for posttreatment return to drug use to provide optimally individualized treatment planning.

Adult↗

PubMedDate not supplied

Addressing trauma in substance abuse treatment with American Indian adolescents.

Substance abuse among American Indian adolescents is a serious problem that frequently continues into adulthood. Therefore, it is important to investigate all potential means of prevention and treatment of substance abuse that might improve the physical and psychological health it undermines. This paper examines the prevalence of substance abuse and its potential relationships with physical/emotional trauma or loss that occurs in American Indian adolescents' lives. The possible benefits of addressing trauma and posttraumatic stress as means of enhancing treatment is explored. An example of residential treatment that involved a focus on trauma and loss is included.

Adolescent↗

PubMed1998

Making a successful transition: effects of a treatment-based and school-based program on emotionally troubled children and their adjustment to new placements.

This study compares the outcomes of two groups of 12-to-13 year olds who were in their last year at a day or five-day residential treatment center for seriously emotionally troubled children. One group was enrolled in a treatment-based program; the second group participated in a school-based program designed to ease the transition to new placements. Each group was evaluated when discharged from the center and 6 weeks after entering their new placements. Interviews with parents and teachers indicated that the school-based children scored significantly higher on six of eight indicators of adjustment than did children in the treatment-based program.

Adolescent↗

PubMed2005

Severe obsessive-compulsive disorder with and without comorbid hair pulling: comparisons and clinical implications.

OBJECTIVE: Chronic hair pulling and trichotillomania are putative obsessive-compulsive spectrum disorders. This study determined the prevalence of hair pulling in an inpatient obsessive-compulsive disorder (OCD) population and compared clinical characteristics and treatment response between subgroups with and without comorbid hair pulling. METHOD: Patients with severe DSM-IV-diagnosed OCD (N = 154) who were consecutively admitted to an OCD residential treatment facility between August 2000 and July 2003 were included. Clinician-rated (Yale-Brown Obsessive Compulsive Scale) and patient-rated (Massachusetts General Hospital Hairpulling Scale, Beck Depression Inventory, and Posttraumatic Diagnostic Scale) measures were administered at index evaluation. OCD patients with and without moderate to severe hair pulling were statistically compared on clinical and treatment characteristics and treatment response. RESULTS: Of the OCD subjects, 18.8% (N = 29) endorsed any hair pulling, 15.6% (N = 24) had moderate to severe hair pulling, and 7.8% (N = 12) had severe hair pulling comparable to that of a specialty trichotillomania clinic population. OCD patients with moderate to severe hair pulling were more likely to be women (p < .001), endorse > 1 comorbid tic (p < .05), and have earlier-onset OCD (p = .001). This cohort also had fewer contamination obsessions (p = .04) and checking compulsions (p = .04) and was more likely to be receiving stimulant (p = .006) or venlafaxine (p = .02) medication than those patients without hair pulling. Posttraumatic Diagnostic Scale scores were nearly significantly higher in the OCD + hair pulling group (p = .08). OCD treatment response was unaffected by the presence of comorbid hair pulling. CONCLUSION: Hair pulling is a highly common comorbidity in severe OCD. Women and early-onset OCD patients appear to be more vulnerable to comorbid hair pulling. OCD sufferers with comorbid hair pulling also exhibit an increased risk for tics and may present with different OCD symptomatology.

Adolescent↗

PubMed2003

DATStats: results from 85 studies using the Drug Abuse Treatment Cost Analysis Program.

The Drug Abuse Treatment Cost Analysis Program (DATCAP) was developed and launched in the early 1990s to help addiction researchers and administrators estimate the economic costs of substance abuse interventions. This paper presents summary results from 85 DATCAPs completed over the past 10 years. After first grouping the DATCAPs into 9 treatment modalities, cost measures (normalized to 2001 dollars) are reported along with client caseload information. Additionally, the distribution of costs across 6 resource categories is presented for each of the treatment modalities. The average weekly economic cost per client ranged from 82 US dollars per week for outpatient drug court interventions to 1,138 US dollars per week for adolescent residential treatment. As expected, labor was overwhelmingly the most utilized resource across all modalities, ranging from 48% to 88% of total economic cost. Addiction researchers, program administrators, and policymakers now have cost estimates and resource distribution information for various treatment modalities serving diverse populations.

Adolescent↗

PubMed2004

Criminal recidivism in three models of mandatory drug treatment.

Although research has generally been supportive of compulsory treatment programs for drug abusers, findings remain mixed, and few studies have assessed the impacts of different coercive program elements. This study compared criminal recidivism outcomes of 350 clients mandated to the same long-term residential treatment facilities from three different legal sources. On several measures of recidivism, including long-term re-arrest rates that controlled for time at risk, clients mandated from two highly structured programs were found to recidivate at less than half the rate of comparison group clients. This group effect was upheld in multivariate models that controlled for pre-treatment differences and other factors related to recidivism. Combined with results of a previous retention study involving these clients, the findings provide support for the use of structured protocols for informing clients in mandatory programs about legal contingencies of participation and enforcing contingencies through frequent contact between legal agents and treatment staff.

Adult↗

PubMedDate not supplied

Implementation of a family-centered treatment program for substance-abusing women and their children: barriers and resolutions.

Recent federal health financing and health care delivery programs have increased access to alcohol and other drug abuse treatment programs for low-income women, and have provided intervention and prevention services for their children and families. The Village South Families in Transition (FIT) in Miami, Florida, implemented a residential treatment program for women and their children that aims to decrease alcohol and other drug use, reduce reliance on social and health welfare systems, improve functioning in specific life-skill and vocational areas, improve parenting techniques and maternal/child relations, and provide intervention and prevention services for the clients' children in a safe and supportive environment. Program implementation required resolutions to numerous barriers, including securing a facility for women and children; recruiting, hiring and training of staff; establishing and maintaining community linkages; treatment considerations; balancing treatment versus evaluation/research; and critical decisions faced by treatment staff as they modify client-centered programs to incorporate gender-specific and family-centered programs.

Adult↗

PubMed2002

Young female sex offenders: assessment and treatment issues.

Research on the characteristics and treatment of juvenile female sex offenders is limited. This article reviews the literature on female offenders and presents the results of a nationwide survey by mail of 250 mental health providers in private settings and residential treatment centers (RTCs), on approaches to diagnosing prior sexual abuse history and/or perpetration among juvenile females. Nineteen of the most experienced practitioners were also interviewed by telephone to provide further insight to the issues highlighted by the surveys. Key findings include the lack of research, tools, and literature on young female sex offenders and perceived differences between male and female offenders including history, treatment, and characteristics. Further study and awareness of this population is encouraged to address clinical needs.

Adolescent↗

PubMedDate not supplied

[Inpatient treatment of a child with elective mutism--a case report].

The paper presents the case of a 10-year-old, electively mute boy, who had stopped talking with all persons outside his immediate family about four years ago. Therapeutic interventions had so far brought no change in his speech behavior. Within a short time (2 months) of residential treatment in a child care unit, his mutistic disorder and social behavior could be normalized and the child even managed to speak in this former school class where nobody had ever heard his voice. The multitude of possible reasons for the mutistic behavior and reinforcing environmental facts are reviewed, the symptom's meaning for the family system considered. The plan of treatment (mostly a combination of behavioral and systemic family therapy) is presented.

Behavior Therapy↗

PubMed2004

A review of treatments for people with severe mental illnesses and co-occurring substance use disorders.

Several interventions for people with co-occurring severe mental illnesses and substance use disorders have emerged since the early 1980s. This paper reviews 26 controlled studies of psychosocial interventions published or reported in the last 10 years (1994-2003). Though most studies have methodological weaknesses, the cumulative evidence from experimental and quasi-experimental research supports integrating outpatient mental health and substance abuse treatments into a single, cohesive package. Effective treatments are also individualized to address personal factors and stage of motivation, e.g., engaging people in services, helping them to develop motivation, and helping them to develop skills and supports for recovery. Accumulating evidence from quasi-experimental studies also suggests that integrated residential treatment, especially long-term (one year or more) treatment, is helpful for individuals who do not respond to outpatient dual disorders interventions. Current research aims to refine and test individual components and combinations of integrated treatments.

Comorbidity↗

PubMed1976

Responses of disturbed adolescent on the Kahn Test of Symbol Arrangement.

Responses to the Kahn Test of Symbol Arrangement (KTSA)by 22 adolescents in residential treatment center and 22 adolescents living at home were examined for differential reactions in 6 scoring classifications. The disturbed group did not differ in the relationships of objects in their arrangements, in objects liked and disliked, or in numbers of objects grouped by category. Reasons given for their arrangements by several members of the disturbed group held pathological implications, and significant differences were found between the two groups in the directional consistency in their arrangements. The kinds of objects sorted into good, bad, and hate by both boys and girls in the disturbed group differed significantly from the norms. It was concluded that level of symbolization, consistency in arranging, and the kinds of objects sorted into the categories should be useful in the assessment and treatment of adolescent problems.

Adolescent↗

PubMed2005

Role of physical activity and eating behaviour in weight control after treatment in severely obese children and adolescents.

AIM: To investigate the role of physical activity and eating behaviour in weight control 1.5 y after a weight-reduction programme in severely obese children. METHODS: Forty-seven children (13.4 +/- 2.1 y) were measured 1.5 y after the completion of a 10-mo residential treatment programme. Stature and body mass were measured; physical activity, fat and fibre intake, and self-efficacy in relation to physical activity and healthy eating behaviour were assessed using validated structured interviews. The total sample was divided into four subgroups according to unhealthy versus healthy physical activity and eating behaviour at follow-up. RESULTS: One-and-a-half years after treatment, subjects had regained 34 +/- 19% overweight, but were on average still 20 +/- 19% less overweight than before treatment (p < 0.001). The four subgroups did not differ in level of overweight at the beginning or end of treatment. At follow-up, there was a significant difference in overweight between the four subgroups (p < 0.05). The least healthy group (unhealthy physical activity and unhealthy eating behaviour) had a significantly higher level of overweight 1.5 y after treatment (183 +/- 36%) in comparison with the other groups (unhealthy physical activity and healthy eating: 150 +/- 21%; healthy physical activity and unhealthy eating: 156 +/- 14%; healthy physical activity and healthy eating: 138 +/- 16%) (p < 0.05), whilst the healthiest group showed the lowest level of overweight after treatment when compared to the other groups (p < 0.05). CONCLUSION: Results suggest that both physical activity and nutritional habits play an important role in weight maintenance after initial weight loss in obese children and that one healthy behaviour can not compensate for another unhealthy behaviour.

Adolescent↗

PubMed1997

Homeless mentally ill veterans: race, service use, and treatment outcomes.

Comparisons of service use and treatment outcomes for 145 black and 236 white homeless veterans with mental disorders showed few differences. A greater improvement in psychiatric symptoms and alcohol problems among white than black veterans did not hold true when black veterans had participated in the residential treatment component of the program. The implications of the findings for the successful treatment of homeless black veterans are discussed.

Adult↗

PubMed1977

Children's rights on entering therapeutic institutions.

The authors delineate aspects of adolescent psychological development that should be considered in decisions regarding psychiatric residential treatment, reviewing the issue of consent to treatment in the context of developmental psychology. They state that rather than jettisoning the whole system of placing treatable disturbed young people in residential facilities without their explicit consent, the court should take as its proper role to ensure that adolescents placed in residential psychiatric facilities receive adequate treatment.

Adolescent↗

PubMed2005

Reducing adolescent clients' anger in a residential substance abuse treatment facility.

BACKGROUND: Sundown Ranch, a residential behavioral health care treatment facility for adolescents, tracked the progress and results of treatment by selecting performance measures from a psychosocial screening inventory. The temper scale was one of the two highest scales at admission and the highest scale at discharge. A clinical performance improvement (PI) project was conducted to assess improvements in clients' ability to manage anger after the incorporation of Rational Emotive Behavior Therapy (REBT) into treatment. METHODS: Eighteen months of baseline data (July 1, 1999 - February 1, 2001) were collected, and 20 months of data (May 1, 2001 - December 31, 2002) were collected after the introduction of the PI activity. In all, data were collected for 541 consecutive admissions. RESULTS: A comparison of five successive quarterly reviews indicated average scores of 1.4 standard deviations (SDs) above the mean on the temper scale before the PI activity and .45 SD above the mean after. The performance threshold of reduction of the average temper scale score to < or =1 SD was met for 17 of 20 months. DISCUSSION: The fact that the PI activity reduced the temper scale elevations by almost one full SD is highly suggestive of the efficacy of REBT with the treatment population. After the project was completed, REBT was promoted as an additional therapeutic modality within the treatment program.

Adolescent↗

PubMed2006

Contextual barriers to successful reentry of recovering drug offenders.

Recidivism among recovering ex-offenders is usually conceptualized as an outcome of the interplay between personal traits and treatment interventions. This focus on the individual, to the exclusion of the sociolegal context in which recovery and reintegration take place, has limited extant policy initiatives. Recidivism data from 440 drug-abusing felons who had successfully completed long-term residential treatment were examined. All else being equal, recovering offenders who began their reentry during times of high unemployment, low risk of incarceration for new offenses, or both, were found to be more likely to recidivate during their first year in the community. These findings highlight the promise of blending effective drug abuse treatment with credible sanctions against drug offenses as well as the need for job training, placement, and advocacy services.

Adult↗

PubMed2003

Family caregivers' perceptions of barriers to and supports of participation in their children's out-of-home treatment.

OBJECTIVE: Although the importance of family caregivers' involvement in their children's mental health treatment is increasingly recognized, factors that influence caregivers' participation are not clearly understood. This study examined the views of family caregivers whose children received out-of-home treatment to determine the amount and types of family caregivers' participation in their children's treatment, the caregivers' perceptions of barriers and supports to participation, and the relationship of barriers and supports to caregivers' participation and satisfaction with care. METHODS: As part of a national survey, a subsample of 102 family caregivers from 31 states whose children were in a residential treatment center, psychiatric unit, or group home answered a questionnaire that included questions about their participation in their children's treatment and about barriers and supports to their participation. RESULTS: Family caregivers identified as barriers concrete factors such as cost of transportation and distance from service providers as well as more intangible factors such as lack of communication between staff members of different programs and negative attitudes of staff members. CONCLUSIONS: Programs seeking to create a more supportive environment for family caregivers' involvement in out-of-home care will need to seek out family members' perceptions of their experience with their children's treatment and their views about factors that would help increase their participation.

Attitude↗