Searching for a Shared Treatment Paradigm

Searching for a Shared Treatment Paradigm Presented by Holly Ann Kees, LCSW-C, LCADC C.A.M.E.O. House Program Coordinator

C.A.M.E.O. House : A History • Children And Mothers Experiencing Opportunities • Washington County Health Department Division of Addictions and Mental Health • Officially Opened in June of 2001

Project: Statement of Problem • Varying staff backgrounds and perceptions about what constitutes effective delivery of treatment services • The evolving field of addictions and it’s opposing treatment models • The need for a service delivery model to guide paraprofessional staff in the provision of direct client care

Project: Purpose • To assess the degree of variance among C.A.M.E.O. House staff’s perception on what constitutes effective residential treatment services for women and children • To determine if the degree of variance in staff perception is positively correlated with specific variables such as educational background, job function, or individuals identifying themselves as in recovery. • To develop a workforce initiative aimed at facilitating the development of a shared treatment paradigm among all C.A.M.E.O. House staff. • To pursue ongoing program evaluation and improvement efforts

Project Hypothesis • There is a positive correlation between residential treatment facility staff operating from a shared treatment paradigm and the delivery of effective residential treatment services.

Project: Literature Review • “Measuring Treatment Process Beliefs Among Staff of Specialized Addiction Treatment Services” • Identified models perceived as effective • Cognitive Behavioral, Disease Model, Eclectic • Identified models perceived as less effective • Pharmacological, Confrontation • “The study did not consider how respondents beliefs about the efficacy of specific treatment processes influenced treatment practice”.

Project: Literature Review • “Substance Abuse Treatment Workforce Environmental Scan” • Lack of uniformity • Scarce resources • Need to adopt evidence based practice • Approximately 50% not credentialed

Project: Literature Review • “It’s Time to Stop kicking People Out of Addictions Treatment” • Historical prevalence of administrative discharges • Arguments Against Administrative discharges • Illogical • Misunderstanding of the role of volition in recovery • Presents provider as persecutor • Negative countertransferance

Project: Methods & Procedures

Searching For A Shared Treatment Paradigm Did We Even Know What We Were Looking For?

Dimensions of a Shared Treatment Paradigm • Perception of Recovery • Perception of Teamwork • Perception of C.A.M.E.O. House’s Administrative Processes • Perception of Services • Staff/Resident Relationship

Dimensions of Effective Treatment • Increase in % of Women who remained in treatment 180 or longer • Decrease in non-compliant discharge • Increase in client satisfaction as evidenced by client satisfaction survey

Project: Project Implementation • Piloted Survey on 11 residents, 18 staff • Respondents represented included childcare workers, outreach workers, residents and senior staff • Scored questions • Interpreted data using SPSS Analysis of Variance • Confirmed internal consistency of questions (Reliability)

The Power of Observation: Increased Effectiveness Over Time • From January 2004 to June 2005 48% of our residents stayed in treatment less then 180 days. • From July of 2005 to December of 2006 43% of our residents stayed in treatment less then 180 days.

Dimension: Perception of Recovery • Staff (Child Care Workers & Outreach Workers) have a more unified perception of recovery than Senior Staff.

Dimension: Perception of Recovery More respondents (60%) agreed that relapse is part of recovery. The rest (40%) did not consider relapse as part of the recovery process. Most of the respondents (90%) agreed that the appropriate response to the relapse of a resident is always evaluated on a case to case basis.

Results: Scale of Agreement Perception of Teamwork • Outreach Workers strongly perceive (M=6.6) they are willing to use the CRSST Model but Residents’ perception (M=5.3) indicates they somewhat agree that Outreach Workers’ are willing to use the CRSSTT Model

Results: Scale of Agreement Perception of Staff-Resident Relationship • According to CCW’s perception (M=1.5), they do not supervise residents and tell them what to do, while residents’ perception (M=5.7) indicated that CCW indeed supervise them and tell them what to do. • Outreach Workers (M=3.2) and Senior Staff (M=3) somewhat disagree to offering friendship while Residents agree (M=5.5) that both Staff and Senior Staff provide friendship to them • Staff (M=2.4) and Senior Staff (M=2) disagree but Residents (M=4.8) somewhat agree that staff talk down or gossip about other staff with them.

From January of 2004 to June of 2005 our non-compliance discharge rate was over 40% From July of 2005 to December of 2006 in dropped to just over 20%

Workforce Initiative Plan: In Progress

Special Thanks • Addiction Technology Transfer Center Network • The Alcohol & Drug Administration • The Participants of this Years Leadership Institute • The Washington County Health Department Division of Addictions & Mental Health

“Leadership and learning are indispensable to each other” John F. Kennedy Speech prepared for delivery in Dallas the day of his assassination, November 22, 1963

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The End

Searching for a Shared Treatment Paradigm