Implementation of SAMHSA-funded Offender Re-Entry Programs Addressing Substance Use and Co-occurring Disorders among Justice Involved Latino Adults

Objectives: Racial and ethnic minorities have high rates of incarceration and persons entering the criminal justice system have disproportionate rates of mental health and substance use disorders Justice involved individuals do not receive adequate treatment resulting in greater risk of recidivism and relapse. This study examines the facilitators and barriers to implementing a SAMHSA-funded Offender Re-Entry Program (ORP) to better understand the factors that influence successful implementation of integrated bilingual/bicultural treatment, recovery, and re-entry services for recently incarcerated adult Latino individuals with substance use and co-occurring behavioral health disorders. Methods: Structured interviews were conducted with leadership, direct staff, and non-direct staff involved in the development and implementation of the Rumbo a Casa ORP at Casa Esperanza, Inc. Using the Consolidated Framework for Implementation Research (CFIR), we investigated the domains and constructs that were critical to successful implementation. Interviews were analyzed using NVivo 11 software. Results: Qualitative analyses show that across all domains, inner setting, particularly the implementation climate of an organization, is reported most often as influencing (positively or negatively) the implementation of the program. Findings show that the current process structure and the characteristics of individuals are greatly impacting program implementation as reported by direct staff. These findings demonstrate that the process of implementation which includes planning, engaging, executing, reflecting and evaluating constructs is essential for the successful implementation an offender-reentry program. Dedicated leadership is necessary to enhance implementation of fundamental program activities using a Plan-Do-Study-Act (PDSA) quality improvement cycle. Conclusion: An established implementation research framework can identify key issues critical to the implementation and evaluation processes. This study provides a deepened understanding of components critical to the successful implementation of an ORP and adds to the limited implementation research knowledge on evidence-based care approaches for justice involved Latino adults

Community advisory board members’ perspectives on their contributions to a large multistate cluster RCT: a mixed methods study

BACKGROUND: Community advisory boards (CABs) are an established approach to ensuring research reflects community priorities. This paper examines two CABs that are part of the HEALing Communities Study which aims to reduce overdose mortality. This analysis aimed to understand CAB members’ expectations, experiences, and perspectives on CAB structure, communication, facilitation, and effectiveness during the first year of an almost fully remote CAB implementation. Current literature exploring these perspectives is limited. METHODS: We collected qualitative and survey data simultaneously from members (n = 53) of two sites’ CABs in the first 9 months of CAB development. The survey assessed trust, communication, and relations; we also conducted 32 semi-structured interviews. We analyzed the survey results descriptively. The qualitative data were analyzed using a deductive codebook based on the RE-AIM PRISM framework. Themes were drawn from the combined qualitative data and triangulated with survey results to further enrich the findings. RESULTS: CAB members expressed strong commitment to overall study goals and valued the representation of occupational sectors. The qualitative data described a dissonance between CAB members’ commitment to the mission and unmet expectations for influencing the study within an advisory role. Survey results indicated lower satisfaction with the research teams’ ability to create a mutually beneficial process, clear communication, and sharing of power. CONCLUSION: Building a CAB on a remote platform, within a study utilizing a community engagement strategy, still presents challenges to fully realizing the potential of a CAB. These findings can inform more effective operationalizing of community-engaged research through enhanced CAB engagement.Published versio

The Oracular Abject: An Aut0theoretical Approach to Theory and Process in the Noracle

The Noracle is an experimental memoir as well as a version of the ancient Chinese book of divination the I Ching. In sixty-four concrete prose poems I follow the six-stanza, varying broken/solid line shapes of the original I Ching hexagrams to tell stories from my painful childhood and early adulthood in New York City; the vertigo the combination of form and content produces is meant to recreate a sense of trauma, reflection and finally repositioning, inviting the reader to maintain mindful poise while experiencing confusion and pain. The subject matter, like the original I Ching, is occupied with meaning, morals and fate. The writing, though lyrical, has a quality of inescapable density, relying heavily on personal symbolism and an internal logic that is not always easy for the reader to grasp; this produces an intentional fug meant to mimic the drug-infused atmosphere of my upbringing. Like the original, the Noracle can be ‘consulted’ as an oracle, i.e. read randomly from any page. Further, each line has an individual negative or positive connotation, that if approached in the fashion of the I Ching will give an answer that I tried to align with the original ‘fortune’. When read through from beginning to end, the Noracle aims to tells a story of hope that isn’t reliant on happy endings or justice, but rather on being in the present and appreciating every instant of being alive, no matter how disorienting or frightening. ‘The Oracular Abject’ is a reflection on the themes of the Noracle, and to a lesser extent my other works to date. Using Julia Kristeva’s feminist psychoanalytic concept of the developmental stage of abjection, I examine how my dissociation from childhood trauma has made me the anti-form writer I am in style, practice and end product. Looking at the prevalence of the Hero’s Journey story as our hegemonic model of meaning-making and utilising Laura Fournier’s theory of autotheory, I use Barthian mini-essays and an emphatic Kristevan tone to build on/unearth the topic of what writing about my past has been for me, and how it is, to quote the epigraph I’ve chosen by Jabès, ‘the opposite of imagining’

The Association Between Self-Reported Mental Health Status and Alcohol and Drug Abstinence 5 Years Post-Assessment for an Addiction Disorder in U.S. and Swedish Samples

This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally

Barriers to implementing evidence-based practices in addiction treatment programs: Comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy

Purpose This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT).Methods The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952).Results Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources.Discussion EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected.Evidence-based practice Community-based substance abuse treatment Motivational Interviewing (MI) Adolescent Community Reinforcement Approach (A-CRA) Assertive Community Treatment (ACT) Cognitive-behavioral Therapy (CBT)

Integrating addiction and mental health treatment within a national addiction treatment system : Using multiple statistical methods to analyze client and interviewer assessment of co-occurring mental health problems

AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data from the ASI Interviewer Severity Rating (ISR) score were used to develop a K-means cluster analysis with three client cluster profiles: Narcotics (n=4795); Alcohol (n=4380); and Alcohol and Psychiatric Problems (n=3658). Chi-square and one-way ANOVA analyses identified self-reported mental health problems for these clusters. RESULTS - 44% of clients had a history of using outpatient mental health treatment, 45% reported current mental health symptoms, and 19% reported significant mental health problems. Women were 1.6 times more likely to report significant mental health problems than men. Staff assessed that 74.8% of clients had current mental health problems and that 13.9% had significant mental health problems. Client and staff results were congruent in identifying that clients in the Alcohol profile were less likely (5%) to report having significant mental health problems compared to the other two profiles (30% each). CONCLUSIONS - About 19% of clients with SUDs reported significant mental health problems, need integrated addiction and mental health treatment, and these clients are clustered in two population groups. An additional 25% of the addiction treatment population report current mental health symptoms and have at some point used mental health treatment. This national level assessment of the extent and severity of co-occurring disorders can inform decisions made regarding policy shifts towards an integrated system and the needs of clients with co-occurring disorders