Abstract
| This program serves the entire family unit as a continuous part of the treatment planning and programming. It requires that family members commit to being involved as part of the criteria for enrollment into the program (as distinguished from other programs that seek to involve the Significant Other, but typically just involvement in some activities and perhaps in individual cases with the individual treatment). |
Objectives
Process Objectives
Objective 1:1: To design and implement home-based model of outpatient care designed around a System of Care model of service delivery to meet the complex needs of substance abusing families within 3 months of grant award. Measure: Compliance with Work Plan
Objective 1:2 To coordinate care through Case Management and formalized MOA?s and joint case conferences, as designated by ?Care Coordinators?. Measures: State MIS (Referral Log), MOA
Objective 1:3: To serve 48 patients in home-based outpatient care during a one-year period. Measures: State MIS Client Admission Enrollment Form
Objective 1:4: To demonstrate the effectiveness of home-based outpatient care through positive client outcomes. Measures: Outcomes listed in Outcome Objectives.
Objective 1:5: To achieve a treatment completion rate of 65%. Measure: MIS.
Outcome Objectives All measures are at 6 and 12-month follow-up post- treatment
Objective 1: To decrease alcohol and drug use as measured by self-reported use. Instruments: Screening (SASSI) and Psychosocial Assessment (which includes Drug Use History), Treatment Completion and Follow-up Interviews.
Objective 2: To improve mental health as measured by self-reported status, number of hospitalizations, number of suicide attempts, depressive symptomatology, and post-traumatic stress pre-/post-treatment, as well as quality of life and spirituality. Instruments: Assessment, Treatment Completion and Follow-up Interviews, Suicide Ideation Questionnaire, Multidimensional Measurement of Religiousness/Spirituality (J.E. Fetzer Institute, 1999), Center for Epidemiological Studies Depression Scale (CESD)
Objective 3: To reduce child abuse and neglect of children in DFYS supervision as measured by ?reports of harm? to DFYS and self-report. Instruments: Assessment, Treatment Completion and Follow-up Interviews; DFYS records
Objective 4: To reduce out of home placement of children as measured by foster care placement. Instruments: Assessment, Treatment Completion and Follow-up Interviews; DFYS Records
Objective 5: To improve health as self-reported and number of visits to doctor or emergency room. Instruments: Assessment (Health Assessment), Treatment Completion and Follow-up Interviews; records of Anchorage Primary Care Center, Alaska Native Medical Center, MOS 36-Item Short-Form Health Survey (SF-36)
Objective 6: To reduce legal involvement as self-reported and number of arrests post-treatment. Instruments: Assessment, Treatment Completion Interview and Follow-up Interviews.
Objective 7: To improve family and living conditions as self-reported and homelessness: Instruments: Assessment, Treatment Completion and Follow-up Interviews.
Objective 8: To improve level of self-sufficiency through employment, education or income as self-reported earning income, school enrollment, removal from Alaska Temporary Assistance Program (ATAP). Instruments: Assessment, Treatment Completion Interview & Follow-Up Interviews, CITC ATAP records.
Objective 9: To decrease level of domestic violence as self-reported by both partners. Instruments: Assessment, Treatment Completion Interview & Follow-Up Interviews; AWAIC records
Indian Nation Served
Key Components
?Home Visits
?Family involvement
?Case management
Recognizing that substance abusers live in families and that sustained recovery requires working with families we developed a ?family? treatment outpatient model which also integrates home-visits. Recognizing the extended Native family system, ?family? is defined as: a participant who has any significant other or secondary adult that can support him or her in treatment and who has at least one child he or she is involved with even if that child does not physically live in the home. A ?significant other? or secondary adult can be defined as spouse, boy/girlfriend, friend, sibling, close neighbor, parent, grandparent or other relative. It can be anyone who is willing to learn about and be involved in the participant?s recovery, who has some role in the child?s life or who will be with the participant in a supportive capacity. The program requires that this individual participate in the admission process and at least one group (usually Family group) and/or home visit per week. The individual can attend more if he/she desires and can also benefit from any counseling or case management he/she requests either individually or through couples or family therapy.
Evaluation Design
We have developed a participant centered, multidimensional ?Partnership Evaluation? model over the past ten years working with Alaska Native programs. Partnership evaluation views the evaluation staff as program partners, both working towards the same end result, an effective program that meets the needs of the population it serves. In the partnership evaluation model, the evaluation staff is not seen as external, ?observers? but rather equal partners in day-to-day program operations. Additionally extensive opportunity and weight is given to participant input. The Evaluators and the Data Center Manager are integral members of the Management team of Substance Abuse Services. Partnership evaluation uses input from both process and outcome evaluation to adjust the program as evaluation findings become available. Evaluation findings guide ongoing project development. The end result is a program that can evolve into a ?best practice.?
The Substance Abuse Services Division strongly believes in program evaluation and the continuous collection, analysis and reporting of appropriate data. We have our own database and analysis systems and have been developing our own Management Information System, which is a web-based case management model. Our assessment summary will be generated by the MIS system to improve objectivity and consistent use of the information collected. Our progress notes, treatment plans and discharge summaries will also be included in the web-based system. We have extensive experience collecting and reporting federal GPRA data and data required by the State however we additional collect data needed to conduct quality assurance reviews and basic evaluation comparisons to national research studies.
We have put extensive resources into data and evaluation with an on-site Data Center and two external evaluators on contract. Our Data Center employs 1 Manager, 4 Data Specialists and 2.5 Follow-Up Specialists who work collaboratively with the evaluators. Our evaluators focus on process and outcomes with Dr. Spero Manson responsible for Outcome data and Jodi Trojan, M.CJ, responsible for Process Evaluation.
The process evaluation is the primary avenue for determining the fidelity of the program practices to what was proposed. Process questions the evaluation answers are:
?How closely did implementation match the implementation plan
?What types of deviation from the plan occurred
?Are services occurring when and where planned
?Is group content accurate and up to date
?What services are provide to whom
Outcome evaluation involved the assessment of a person as they present, baseline, and comparison their status as some point in the future, after exposure to the treatment intervention. Outcome evaluation questions include:
?What overall effect the programs have on participants?
?What program/contextual factors were associated with the outcomes?
?What individual factors were associated with outcomes?
?How long-lasting were the effects?
Evaluation Results
We have developed a participant centered, multidimensional ?Partnership Evaluation? model over the past ten years working with Alaska Native programs. Partnership evaluation views the evaluation staff as program partners, both working towards the same end result, an effective program that meets the needs of the population it serves. In the partnership evaluation model, the evaluation staff is not seen as external, ?observers? but rather equal partners in day-to-day program operations. Additionally extensive opportunity and weight is given to participant input. The Evaluators and the Data Center Manager are integral members of the Management team of Substance Abuse Services. Partnership evaluation uses input from both process and outcome evaluation to adjust the program as evaluation findings become available. Evaluation findings guide ongoing project development. The end result is a program that can evolve into a ?best practice.?
The Substance Abuse Services Division strongly believes in program evaluation and the continuous collection, analysis and reporting of appropriate data. We have our own database and analysis systems and have been developing our own Management Information System, which is a web-based case management model. Our assessment summary will be generated by the MIS system to improve objectivity and consistent use of the information collected. Our progress notes, treatment plans and discharge summaries will also be included in the web-based system. We have extensive experience collecting and reporting federal GPRA data and data required by the State however we additional collect data needed to conduct quality assurance reviews and basic evaluation comparisons to national research studies.
We have put extensive resources into data and evaluation with an on-site Data Center and two external evaluators on contract. Our Data Center employs 1 Manager, 4 Data Specialists and 2.5 Follow-Up Specialists who work collaboratively with the evaluators. Our evaluators focus on process and outcomes with Dr. Spero Manson responsible for Outcome data and Jodi Trojan, M.CJ, responsible for Process Evaluation.
The process evaluation is the primary avenue for determining the fidelity of the program practices to what was proposed. Process questions the evaluation answers are:
?How closely did implementation match the implementation plan
?What types of deviation from the plan occurred
?Are services occurring when and where planned
?Is group content accurate and up to date
?What services are provide to whom
Outcome evaluation involved the assessment of a person as they present, baseline, and comparison their status as some point in the future, after exposure to the treatment intervention. Outcome evaluation questions include:
?What overall effect the programs have on participants?
?What program/contextual factors were associated with the outcomes?
?What individual factors were associated with outcomes?
?How long-lasting were the effects?
Products Developed
None to date other than brochures and treatment scheduled. Program has been operational for 10 months