Searching for a Shared Treatment Paradigm

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

2. 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

3. 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

4. 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

5. 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.

6. 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”.

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

8. 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

9. Project: Methods & Procedures

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

11. 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

12. 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

13. 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)

14. 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.

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

16. 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.

17. 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

18. 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.

19. 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%

20. Workforce Initiative Plan: In Progress

21. 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

22. “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

23. See the sparkle in their eyes! Disclaimer: Individuals seen here have signed consent for their images to be used in this presentation.

24. The End