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7	An Example with Gender Differences It is widely believed that males and females have very different drug/alcohol use patterns, histories and problems.
8	Gender Differences?
9	Did You Know? Among substance abusers entering treatment, divided by gender, differences in substance use variables are the least impressive. More impressive are differences in Lifetime and Past 30 days data - personal health and social functioning variables.
10	Gender Differences
11	Gender Differences
12	"Compared to What?" Compared to What? What if you didn’t treat? What if clients are not motivated?
13	No Treatment Tracking HIV seroconversion rates among 2 groups of heroin users
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15	Role of Motivation IV Drug Users Seeking HIV Testing Pregnant Cocaine Users in Prenatal Care
16	Un-Motivated Drug Users Booth et al. University of Denver 4,000 IV Drug Users in 15 cities Seeking HIV testing - Not Treatment Randomly assigned to: HIV Testing Only HIV Testing PLUS MET Counseling Six Month Follow-Up Results
17	Drug Injection at Six Months HIV Testing Only 45% HIV Test + MET *20%
18	"HIV Testing Only" HIV Testing Only 11% HIV Test + MET 42%
19	Arrest Rate at Six Months HIV Testing Only 24% HIV Test + MET 14%
20	UNMOTIVATED DRUG USERS Svikis et al. Johns Hopkins 146 Cocaine Abusing, Pregnant Women Seeking Pre-Natal Care - Not Treatment 100 Received - 1-Week Residential Tx. 46 Received - Standard Pre-Natal Care Costs and Complications of Delivery
21	Cocaine in Urine at Delivery 46 Control Women 63% 100 Treated Women 37%
22	NICU Stay and Costs 46 Control Women 39 days $46,700 100 Treated Women 7 days *$14,500
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25	The Treatment System 1975 1990 2004
26	Change Over Time: 1996-2005 Criminal Justice System Involvement
27	Heroin: Percent Injecting By Age Group * Over Time
28	Percent Injecting Heroin: 17-25 Year Olds
29	% Repeat Treatment Receivers
30	% of Patients on Medical Assistance?
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32	OxyContin® work OxyContin®, the brand name of a time-release prescription opioid has a similar active ingredient found in several other prescription (Rx) opioids and in heroin. However, the media portrays users of OxyContin® as being more “drug naïve”, younger and more educated than individuals using other opioids such as heroin.
33	Media Stereotypes Rx opioid User Younger White Higher SES Drug naïve
34	Media Stereotypes
35	Significant Differences Heroin users: Were older & more likely to be unemployed, male, and non-white Had significantly fewer family problems Had longer periods of cocaine and amphetamine use Had higher employment and drug composite scores
36	Significant Differences Prescription opioid users: Were younger & more likely to be white and employed full-time Had more medical hospitalizations and more family problems Were more likely to be awaiting legal charges Had longer histories of alcohol, sedative, and cannabis use
37	Amphetamine Data
38	Amphetamine Data
39	Amphetamine Data – Percent Using
40	How To Get There… Given the overwhelming burden of current “Paperwork” demands
41	Reporting Demands or “Paperwork” Federal – TEDS, NOMS, Grant specific, etc. State licensure requirements City or Single County agency requirements JCAHO, CARF, other accrediting requirements Status updates EAP, employer, welfare, child protective services, court system or probation status updates
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46	Purpose of collecting standardized data Standardize and simplify the information gathered at treatment intake To be able to give a unified and comparable picture of people coming into treatment Quickly gather questions of current interest (Changes since 9/11, treatments needs after Katrina) AND to inform program, county and state directors
47	An example of non-standardized reporting Blood Pressure Nurse 1 – It’s getting better (better than what??) Nurse 2 – It’s much lower than before (too low??) Nurse 3 – The patient is in denial (???) Nurse 4 – The patient is non-compliant, lets not treat him until he’s really ready (malpractice?)
48	An example of standardized reporting Blood Pressure Nurse 1 – It’s 120/80 Nurse 2 – It’s 116/78 Nurse 3 – It’s 122/82 Nurse 4 – The patient is non-compliant, lets not treat him until he’s really ready (malpractice?)
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52	"The ASI has been studied..."
53	"The ASI interview produces reliable..."
54	"The ASI can be collected..."
55	Reason # 7
56	Reason # 6
57	Reason # 5
58	Reason # 4
59	Reason # 3
60	Reason # 2
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62	Program “Turnover” 8 % had closed altogether 7 % had changed service operation RESULT – 15% no longer providing SA Treatment
63	"28%" 28% Were NOT Working Full Time Who is our Director?
64	"How do they spend their..." How do they spend their day? 3 - 4 Hours – Group Counseling 1 - 2 Hours – Individual incl Intakes 2 - 3 Hours – “Paperwork”
65	Intake/Admission Process: 30% only collect information mandated by city, state, federal regulations. ASI was most used assessment (35%) 15 – 20% Don’t Do Assessment No Perceived Value for Assessment “Simply Paperwork” - Not Related to Treatment Plan or Services Delivered
66	Reason # 1
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69	Background Wrap-Around social services have been shown to improve treatment outcomes. But…… Identifying problems and finding “wrap-around” services can be time-consuming and costly for counselors.
70	ASI and Resource Guide We developed a computer assisted assessment system and resource guide (RG). The RG provided information from agencies that provided free or low-cost services in Philadelphia.
71	Findings
72	Hypothesis 1 Patients whose counselors receive the EA Training will receive Treatment Plans that better match their problems identified at admission.
73	% Matched: ASI to TCP
74	Hypothesis 2 Patients whose counselors receive the EA Training will receive more services
75	Number of Services Received
76	Hypothesis 3 Patients whose counselors receive the EA Training will receive Treatment Services that better match their problems identified at admission.
77	% Matched: ASI to Services Received
78	Hypothesis 4 Patients whose counselors receive the EA Training will remain in treatment longer and be more likely to complete treatment.
79	Percent Retained at 45 Days
80	Percent Retained at 90 Days
81	Percent Completed
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