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Boyle, Patrick EProvider Optimism About Consumer Recovery
Doctor of Philosophy, Case Western Reserve University, 2016, Social Welfare
The recovery model suggests that treatment goals should encompass more than the reduction of symptoms for people with serious mental and substance use disorders (Dumont, Ridgway, Onken, Dornan, & Ralph, 2006). Recovery perspectives encourage clients to work for improvements in many areas of their lives including housing, employment, education and social relationships. Providers who work in a recovery framework also need to have expectations that clients can and will experience improvements across these life dimensions (Grusky et al., 1989). Though there has been progress in developing recovery-oriented, evidence-based treatments for people with co- occurring disorders, there is a dearth of research examining the attitudes of providers who use such treatment approaches. Optimism for recovery is the provider’s attitude that clients can achieve recovery and integration into the community and achieve more than merely symptom reduction. Building on the recovery model, social learning and cognitive behavioral theories, the aims of this study are to explore individual and team characteristics that are associated with levels of provider optimism about consumer recovery. Methods: This study used a non-experimental, cross-sectional design to gather information from mental health providers working in intensive, multi-disciplinary teams in agencies using Integrated Dual Disorder Treatment (IDDT) and/or Assertive Community Teams (ACT) across five states. Data were collected using an anonymous self-report questionnaire with a convenience sample of 241 mental health providers working in 44 teams in five states (Ohio, Michigan, North Dakota, Wisconsin, and Colorado). Teams in the study were limited to those which had implemented IDDT and/or ACT, enrolled clients and completed a baseline fidelity assessment in the implementation of IDDT and/or ACT from the Center on Evidence Based Practices at Case Western Reserve University. The response rate from these surveys was 68%. Hierarchical linear modeling (HLM) was used to address a nested (clustered) structure to examine the impact of team membership on individual and team level perceptions of team cohesion, access to resources, and optimism about consumer recovery, controlling for age, gender, education, and job function. Findings: None of the specified hypotheses in this study were fully supported. The significant findings were limited to associations among selected variables and concept subscales. The hypothesis stating a positive relationship between optimism for consumer recovery and levels of team cohesion after controlling for age, gender, job function and educational level was not supported. However, at the individual analysis level, there were positive, statistically significant relationships between the subscales of newly created professional activities and provider optimism. At the team level of analysis, four of the subscales of team cohesion (newly created professional activities, flexibility, collective ownership of goals, and reflection on process) were significantly associated with levels of provider optimism. The hypothesis stating a positive relationship between individual tenure, team tenure and team cohesion controlling for age, gender, job function and educational level was not supported. However, job function of the case manager was significantly associated with a higher score on the team cohesion subscale of interdependence than the supervisor. Longer job tenure at the individual level was associated with lower scores on the team cohesion subscale of newly created professional activities. There was no difference in the mean scores on the 16-80 point scale for optimism for consumer recovery (44.42 for individuals and 44.26 for the teams). Strengths and Limitations: Strengths of the study include the use of standardized measures for the concepts of team cohesion and provider optimism and a sample of mental health providers known to work in intensive, multidisciplinary teams and to use IDDT and/or ACT recovery based model. The sample size of 241 met the requirements for the statistical analysis strategy. However, significant limitations to the generalizability of the results include the response rate of 68%, the inability to evaluate the differences between the sample responders and the non-responders and the fact the sample was drawn from a specific group of agencies working closely with one university center on evidence based practices and fidelity assessment. Implications: The study findings raise more questions for future explorations about the role of individual and team characteristics in levels of provider optimism for consumer recovery. The roles of individual and team characteristics provide some direction for additional studies that explore how providers think about consumer recovery, in general, and what role optimism about recovery may play in teams using the IDDT and/or ACT frameworks. The findings at the team level indicate that further explorations into the workings of the team process may be fruitful in understanding provider optimism towards consumer recovery in agency settings using IDDT and/or ACT models.

Committee:

Kathleen Farkas, PhD (Committee Chair); David Biegel, PhD (Committee Member); Mark Singer, PhD (Committee Member); Christina Delos Reyes, MD (Committee Member)

Subjects:

Social Work

Keywords:

intensive case management; optimism; cohesion; attitudes; recovery; co-occurring disorders

Moore, Barbara ColinSTRESS, COPING, AND WELL-BEING AMONG FAMILY MEMBERS OF WOMEN WITH SUBSTANCE USE OR CO-OCCURRING DISORDERS
Doctor of Philosophy, Case Western Reserve University, 2007, Social Welfare
The effects of illness-related stressors on family members of women with substance use disorders or co-occurring mental illness and substance use disorders were examined, and the mediating or moderating role of family member adaptive or maladaptive coping strategies was assessed. 82 women in inpatient or outpatient treatment for substance use disorders in a Midwestern community were interviewed. Of these, 46 (56.1%) met diagnostic criteria for one or more additional psychiatric disorders: major depression, dysthymia, posttraumatic stress disorder, mania, hypomania, or generalized anxiety disorder. The women were predominantly African-American and of lower socioeconomic status. The women in treatment nominated the most supportive family member or a significant other for participation in the study. 82 family members, one for each woman in treatment, were also interviewed. Findings were that illness-related client behavioral problems and extent of client drug or alcohol use were significantly related to greater family member burden. At the bivariate level, greater client behavioral problems were also related to higher levels of family member depressive symptomatology. Family member maladaptive coping was found to completely mediate the relationship between client behavioral problems and the Stigma dimension of family member burden. Family member maladaptive coping was also found to partially mediate the relationships between client behavioral problems and family member burden (frequency of Impact subscale) and between extent of client drug or alcohol use and family member burden (frequency of Impact). Family member maladaptive coping functioned as both a moderator and a mediator in the relationship between extent of client drug or alcohol use and family member Impact. Adaptive coping was found to be a partial mediator between client behavioral problems and family member Worry, but increases in adaptive coping were associated with greater family member Worry, rather than less Worry as hypothesized. Possible links between specific family member behaviors and outcomes for both family members and individuals in treatment are examined. Implications for research and practice are also discussed.

Committee:

David Biegel (Advisor)

Keywords:

substance abuse; co-occurring disorders; women; family members; stress and coping; maladaptive coping

Montesano, Vicki L.Integrated Dual Disorder Treatment Team Leader Experiences of Implementing the Integrated Dual Disorder Treatment Model: A Grounded Theory
PHD, Kent State University, 2008, College of Education, Health, and Human Services / Department of Adult, Counseling, Health and Vocational Education

The purpose of the current study was to generate a grounded theory of program implementation based on the experiences of 6 Integrated Dual Disorder Treatment (IDDT) Team Leaders from community-based mental health agencies in Ohio who were charged with implementing the IDDT model and were working with the Ohio Substance Abuse Mental Illness Coordinating Center of Excellence (SAMI CCOE). The primary research question that guided the current study was: How do 6 IDDT Team Leaders in Ohio describe their experiences of implementing the IDDT model?

The study was designed to address the lack of research on implementation of evidence-based practice. Although efficacy of evidence-based practice is well established in the literature, little is known about how to implement such practices, specifically from the viewpoint of front-line clinicians. Therefore, an understanding of how IDDT Team Leaders prepared for and actually implemented the model would increase the knowledge base on implementation of an evidence-based practice.

Three main themes emerged from and were grounded in the data and included: (a) learning to be an IDDT Team Leader, (b) learning about and embracing the IDDT model, and (c) implementing the IDDT model. Results of the current study suggest the possibility of a model of implementation as a multi-dimensional process. This model builds on existing research on implementation at the macro level. It also builds on the limited research on implementation at the micro level while offering a new perspective on implementation. The framework of this model can be used to guide future research on implementation of the IDDT model from the perspective of front-line clinicians, specifically the IDDT Team Leader.

Additional findings that did not contribute to the main theme but were noteworthy are presented, and implications for counselor education, the field of counseling, and the Ohio Substance Abuse Coordinating Center of Excellence are discussed. Finally, limitations of the current study are presented, and recommendations for theory and research are provided.

Committee:

Jason McGlothlin, PhD (Committee Co-Chair); Marty Jencius, Ph.D. (Committee Co-Chair); Autumn Tooms, Ph.D. (Committee Member)

Subjects:

Mental Health

Keywords:

Integrated Dual Disorder Treatment; co-occurring disorders

Keene, Katie AnneCo-occurring Disorders and Treatment Completion: Comparison with the Criminal Justice System
Master of Science in Criminal Justice, Youngstown State University, 2015, Department of Criminal Justice and Forensic Science
Co-occurring disorders became a growing concern in the United States beginning in the early 1980s. This research is a secondary analysis of data derived from the Substance Abuse & Mental Health Data Archive (SAMHDA) Treatment Episode Data Set— Discharges (TEDS-D), 2011. Findings are based on 343,430 individuals with co-occurring substance abuse and mental health problems. I test the following hypothesis: Individuals with co-occurring disorders who are allotted to a program through the criminal justice system are more likely to complete treatment programs rather than those referred through non-criminal justice settings. In addition, I explore the type of referrals within the criminal justice system to see which referral source yields a better outcome than other criminal justice referrals by containing more supervision. The findings indicate that criminal justice referrals have high completion rates relative to non-criminal-justice referrals. It was also found that among the criminal justice referrals the highest completion rates were associated with DUI/DWI, diversion, and prison/jails and the lowest with probation.

Committee:

Richard Rogers, Ph.D. (Committee Chair); John Hazy, Ph.D. (Committee Member); Derick Young (Committee Member)

Subjects:

Criminology; Mental Health; Rehabilitation; Statistics

Keywords:

Co-occurring disorders; Criminal Justice System; Drug and Alcohol Abuse; comparison; treatments; barriers

Burkhead, Nitisha Y.Service Needs of Offenders with Co-Occurring Substance Abuse and Mental Health Problems
Master of Social Work, The Ohio State University, 2011, Social Work
In, 2009, over 2 million people were held in the nation’s jails, prisons, and community based correctional facilities (Glaze, Lauren, 2010; Scott, et al., 2006). At least 70% of inmates in prison report substance abuse issues (Hartwell, 2004). Furthermore, jails and prisons have reported that between 50% and 64% of inmates experience mental health problems (James & Glaze, 2006). The co-occurring substance abuse and mental health problems (COD) are a third of the incarcerated population which is disproportionately higher than the general population (James & Glaze, 2006). This study was driven by three questions: (1) Will individuals with either co-occurring substance abuse and mental health problems face more barriers than those with either substance abuse or mental health only problem, or neither problem? (2) Are prisoners with co-morbidity more likely to be on post-release control? (3) Are prisoners with co-morbidity more likely to serve more time and have been in correctional custody more time than prisoners with one problem and neither problem? This study was based on secondary data from a repeated measures longitudinal study that included three interviews: one while incarcerated in the correctional facility and two post-incarceration. Gathered data included demographics, mental health, substance abuse, and service barriers from 308 individuals leaving correctional custody facilities. Men and women with (1) neither mental health nor substance abuse problems, (2) either problem, and (3) both problems were compared. Analysis of post-release data included t-tests and One-way ANOVAs to compare expected and actual barriers faced during a two month period after reentry into the community. Comparisons of specific barriers to treatment by gender and between groups were analyzed. Results indicated that 40% of the sample had COD, while 47% had either a substance use or a mental health problem. Women constituted 52% of the COD population. The COD group anticipated facing more barriers to substance abuse treatment than the one problem only group. At pre-release, four barrier factors were found to be significant for the COD population: poor treatment availability, negative social support, fear of treatment, and stigma. The results indicated a significant difference with the number of anticipated barriers between persons with COD and the single problem group. At post-release, men were more likely to experience time conflict as a barrier to mental health treatment than women. Individuals with neither problem were likely to have been incarcerated at least 4.1 years at the time of the first interview. Persons with co-occurring problems were more likely to have a history of repeated periods of incarceration. Individuals with either or both problems were more likely than people with neither problem to be expecting mandated treatment at release. Increased access to substance abuse services is needed and appropriate for individuals with co-occurring problems, especially for men. Programming must be tailored to the needs of the co-occurring problem group.

Committee:

Audrey Begun, Dr. (Advisor); Theresa Early, Dr. (Committee Chair)

Subjects:

Social Work

Keywords:

co-occurring disorders; offenders; reentry; barriers to treatment; women

Stevenson, Lauren DeMarcoThe Influence of Treatment Motivation, Treatment Status and Social Networks on Perceived Social Support of Women with Substance Use or Co-Occurring Disorders
Doctor of Philosophy, Case Western Reserve University, 2009, Social Welfare

This study examined predictors of perceived social support and support forrecovery of women with substance use disorders or co-occurring substance use and mental disorders. The sample consisted of 136 adult women; 86 women were engaged in inpatient and outpatient substance abuse treatment programs, and 50 women were recruited from a study of mothers with cocaine exposed infants.

The women in the study were predominantly African American (82.4%) and of low income status with 80% of the women reporting an annual family income below $15,000. All of the women had a current substance use disorder and 77 (56.6%) of the women also had a co-occurring mental disorder including: Major Depression, Post Traumatic Stress Disorder, Mania, Generalized Anxiety Disorder, Hypomania, and Dysthymia. On average, women reported having a social network comprised of 10.73 members.

A significant relationship was found between critical members (those who provide negative support) within women’s social networks and perceived social support, with a higher percent of critical network members predicting lower perceived social support. Perceived social support scores were also significantly lower for women with a co-occurring mental disorder. Indirect relationships were found for women’s perceived social support. The percent of professionals within women’s social networks moderated the relationships between women’s treatment motivation and treatment status with perceived social support. The percent of substance users in women’s networks moderated the relationship between treatment motivation and perceived social support.

A sub sample analysis of 86 women in substance abuse treatment explored predictors of support for recovery. A significant relationship was found between the percent of members who support sobriety and support for recovery. This finding provides construct validity for the support for recovery measure.

Practice implications as well as directions for future research are included in this study. Findings suggest that clinicians should work with social network members and clients on improving communication and eliminating critical support to improve social support. Future research should focus on the impact of social relationships on treatment outcomes.

Committee:

Elizabeth Tracy, PhD (Committee Chair); David Biegel, PhD (Committee Member); Kathryn Adams, PhD (Committee Member); Sonia Minnes, PhD (Committee Member)

Subjects:

Social Research; Social Work

Keywords:

Social Support Networks; Social Support; Substance Use Disorders; Dual Disorders; Co-Occurring Disorders; Treatment Motivation; Social Networks; Substance Abuse; Women

Sherba, R. ThomasAssociations among Violence Exposure, Mental Disorder, SUD and HIV
Doctor of Philosophy, Case Western Reserve University, 2009, Social Welfare
While research has established violence exposure, mental disorder and SUD as independently associated with HIV infection, there is a paucity of research studies that examine the impact of violence exposure and co-occurring mental and substance use disorders (COD) with HIV infection. This study’s primary aim was to provide COD prevalence data as well as additional epidemiologic data needed to more firmly establish violence exposure and COD as principally associated with HIV infection. This study’s secondary aim was to provide epidemiologic data which could be used to inform HIV prevention efforts: primary, secondary and tertiary. Participants were clients assessed for alcohol and other drug (AOD) treatment through the 40 adult AOD treatment providers in the network of providers overseen by the Alcohol and Drug Addiction Services Board of Cuyahoga County (Ohio) from December 12, 2001 through July 18, 2007. Study design was a matched comparison of two subgroups of clients stratified by HIV-serostatus: HIV-infected clients and HIV-uninfected clients (N = 638). The prevalence of COD with HIV infection was determined to be 26.3%. Through logistic regression modeling, both violence exposure and COD were found to be significantly associated with HIV infection. As the HIV epidemic in the United States continues to progress, interventions continuously need to be tailored according to prevention needs.

Committee:

Mark I. Singer, PhD (Committee Chair); Elizabeth M. Tracy, PhD (Committee Member); Kathleen J. Farkas, PhD (Committee Member); Sonia Minnes, PhD (Committee Member); Thomas G. Williams, MA, MAEd (Committee Member)

Subjects:

Social Research

Keywords:

Violence Exposure; Mental Disorder; Substance Use Disorder; SUD; Co-occurring Disorders; COD; HIV