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.

Factors associated with HIV/AIDS high-risk behaviours among female injection drug users.

This study examined factors associated with reporting engaging in HIV/AIDS high-risk behaviours at two different time points spaced one year apart for a sample of 185 women who were active injection drug users (IDUs). The high-risk behaviours included injecting drugs in the past six months, having shared needles in the past six months and having engaged in unprotected sexual activity in the past thirty days. Through logistic regression modelling it was identified that living with a spouse at year one was significantly and positively associated with high-risk behaviours at both time points. Being prescribed medications for psychological or emotional problems as well as testing positive for the HIV/AIDS virus were significantly and negatively associated with reporting high-risk behaviours at both time points. These results suggest that spousal relationships may play an important role in HIV/AIDS high-risk behaviours of women drug users. An implication of this study is the need to focus on how spousal relationships and issues such as gender and empowerment should be incorporated into the design and implementation of HIV/AIDS prevention and treatment programs. The benefits of comprehensive mental health diagnosis and treatment services as well as HIV testing in reducing harm to female IDUs and their partners are also discussed.

The home care satisfaction measure: a client-centered approach to assessing the satisfaction of frail older adults with home care services.

OBJECTIVES: The Home Care Satisfaction Measure (HCSM) is an easy to administer, psychometrically sound instrument based on consumer-defined notions of satisfaction, including perspectives of ethnic minorities. The HCSM provides an overall home care satisfaction score and subscale scores for 5 common services, all on a 0-100 scale. METHODS: Focus groups with African American, Hispanic, and non-Hispanic White older adults were audiotaped. Tapes were transcribed and analyzed with grounded theory methods. Correlational and common factor analyses were conducted to select items, and the instrument was field tested with 228 frail, low-income, older home care recipients. RESULTS: Test-retest reliabilities ranged from .68 to .88, with high internal consistency reliabilities. Substantial concurrent validity was achieved for subscale and overall HCSM scores. Home care satisfaction was not related to gender, age or race but was negatively associated with physical disability. Significant social desirability effects were found. DISCUSSION: In the increasingly important area of home care, the HCSM is the first measure developed on the basis of the views of older consumers that also meets standard psychometric criteria. The HCSM provides a consumer-based indicator of quality and can be used to examine changes in satisfaction over time and differences among providers or within a single agency.

Advancing the state of the art: establishing guidelines for long-term care case management.

This article describes the results of a 15-month project, supported by a grant from The Robert Wood Johnson Foundation, to develop case management practice guidelines for long-term care. Connecticut Community Care, Inc. (CCCI), a nationally recognized case management agency, was the primary contractor for the grant. CCCI established and convened the National Advisory Committee on Long-Term Care Case Management, a group of case management experts from academia, provider organizations, and state and federal government. CCCI facilitated the work of the committee and had overall responsibility for financial management, data processing, and staff support. The committee's work culminated in a definition of long-term care case management, a set of principles underlying its practice, and the formulation of guidelines. Results and recommendations from the National Advisory Committee will be disseminated to government officials, policymakers, administrators, academicians, geriatricians, care providers, and long-term care community-based case managers.

The quest for uniform guidelines for long-term care case management.

This article presents proceedings and preliminary findings from the National Advisory Committee on Long-Term Care Case Management, a group of nationally recognized case management experts from academia, provider organizations, and state and federal governments. The National Advisory Committee, supported by a grant from The Robert Wood Johnson Foundation, was created to achieve consensus about case management and explore the feasibility of developing case management practice guidelines for long-term care. Preliminary findings include endorsement of the need for guidelines, identification of core and ancillary functions of case management, and agreement to limit the scope of guidelines to the long-term care populations of frail elders and adults with chronic functional limitations. Final results and recommendations from the National Advisory Committee will be disseminated to government officials, policymakers, administrators, academicians, geriatricians, care providers, and long-term care community-based case managers.