Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Chapter 13--Implementing the vision
Chapter 13--Implementing the vision
Pages 329-343
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From page 329... ...
(Some proportion of persons with alcohol problems will, of course, enter the treatment process after identifying themselves as having alcohol problems.) Those persons who are identified are dealt with through brief interventions provided by the various community agencies if their problems are mild or moderate or are referred for specialized treatment if their problems are substantial or severe.
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From page 330... ...
Where treatment is indicated, they are matched to the most appropriate specialized type of intervention. The outcome of treatment is determined and feedback of outcome information is used to improve the matching Guidelines.
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From page 331... ...
However, because the most prevalent approach is to assign the role of continuity assurance to an individual or individuals, the committee's discussion will continue in this vein. In recent years the provision of continuity assurance has received increased emphasis because of the growth in size and complexity of treatment services.
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From page 332... ...
14. perseverance-an ability to follow through; comfort in working with difficult, marginally motivated patients; knowledge about and comfort in a supportive counseling role; knowledge about community resources; comfort in working in a secondary capacity with other treatment staff; relative ease in handling crises; an ability to relate to and cope with many people and problems simultaneously; thoroughness, organization and responsibility in the area of recordkeeping; willingness to get involved in a relatively unstructured and evolving work role; flexibility in terms of relating differentially to patients in a less formal, structured manner than is characteristic of psychotherapy; patience and a sense of humor; some knowledge of alcohol and drug dependency and the pharmacology of alcohol and drug abuse; an ability to formulate and sustain realistic expectations for self and patient; and ease in shifting among the various roles and functions inherent in the primary care role-counselor, ombudsman, facilitator, problems solver, and coordinator.
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From page 333... ...
Research on the impact of continuity assurance has been limited to the study of case management in the aftercare of the chronically mentally ill. One review noted mixed results: some studies had positive outcomes while others showed no significant addition to outcome over customary mental health altercate services (Anthony et al., 1988~.
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From page 334... ...
a community component, consisting of identification followed by brief intervention or referral for specialized treatment; and a specialized treatment component, consisting of comprehensive pretreatment assessment, matching to a variety of treatment options, assurance of continuity of care, determination of outcome, and the effective feedback of outcome information. It now seems in order to audit the degree to which the system has been implemented in practice, and the existing evidence that, taken as a whole, it works.
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From page 335... ...
Oklahoma State System This system is basically for outcome monitoring, and was discussed earlier (see page 315; see also Paredes et al., 1981~. The system collects initial data on individuals, but the data are gathered after admission to treatment programs and are not used to determine which treatment is to be delivered.
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From page 337... ...
is uncertain. Although in the course of its usual operations CATOR, like the Oklahoma State system, obtains staff-generated information on individuals after admission to treatment, the Cleveland criteria are clearly intended to be used prior to treatment and to match individuals to the appropriate "level of care." Minnesota State System In the state of Minnesota the legislature has mandated a pretreatment assessment to determine the appropriate treatment setting through matching guidelines that are required by law and specified in explicit regulations (see Chapter 10~.
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From page 338... ...
Regional Youth Substance Abuse Project A United Way program located in Bridgeport, Connecticut, this project recently received a grant from the Robert Wood Johnson Foundation to set up the Youth Evaluation Service (YES) in cooperation with the Alcohol Research Center at the University of Connecticut (Babor and Del Boca, 1988~.
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From page 339... ...
The Northern Additions Centre and the Regional Youth Substance Abuse Project will determine outcomes in individual cases; however, a comparison with alternative approaches is not contemplated in either project at present. Because the Penn-VA project was a prospective study of the effectiveness of an approach resembling that of the committee, a brief summary of it seems in order.
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From page 340... ...
Unfortunately, health services research, the name given to the kind of research aimed at studying questions of this kind, is not currently considered to be of unusual urgency; At the present time, research on alcohol service systems receives a relatively low priority within the Federal Government and in the alcoholism field generally" (Wallen, 1988:605~. Conclusions and Recommendations The committee views the treatment of alcohol problems as evolving toward a system in which an active component of care undertaken by community agencies and consisting of identification, brief intervention, and referral is closely coupled with a specialized treatment sector that includes a comprehensive pretreatment assessment, the matching of individuals to a variety of treatment interventions, the assurance of continuity of care, the regular determination of outcome, and the feedback of outcome information.
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From page 341... ...
1988. Evaluation of Regional Youth Substance Abuse Project.
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From page 342... ...
1980a. An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index.
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From page 343... ...
1988. Alcoholism treatment service systems: A health services research perspective.
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