Literature Review
Research on similar programs
Evidence concerned with the complex needs of pregnant women are increasing regarding dual diagnoses of substance abuse and mental health disorders. In the past, these women have been frequently underserved by their communities due to separating substance abuse and mental health programs. In recent years, it has become very evident that trauma is an important factor to consider when serving pregnant women with co-occurring disorders. According to a reviewed study, 55% to 99% of women with co-occurring disorders experienced trauma from abuse (Covington, Burke, Keaton, & Norcott, 2008). In the last decade research has demonstrated that integrated, trauma-informed treatment services promote successful
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recovery. Programs are currently considering a more integrated approach to addiction recovery such as the PPWC program at Nexus, who strive to consider trauma from abuse and clients with mental health disorders within their addiction services. Studies such as Covington et al.
(2008) have determined that women with co-occurring disorders whom have experienced trauma from abuse will often engage in self-destructive behaviors. This study further proposed an integrated model of treatment for addicted women who have co-occurring disorders and the experience of trauma. The treatment model is called Women's Integrated Treatment (WIT) and combines substance abuse and trauma which is explored in a residential facility where the model is applied (Covington et al., 2008). Covington et al. (2008) introduces Helping Women Recover and Beyond Trauma which are both implemented with integrated trauma-informed services. Beyond Trauma (BT) is provided in eleven sessions which include a focus on abuse and trauma, the impact of trauma, and healing from trauma (Covington et al., 2008). Helping Women Recover (HWR) has a duration of seventeen-session that involve concepts regarding self, relationships, sexuality, and spirituality (Covington et al., 2008). Both programs are designed for application with staff from various areas of training and offer manuals that deliver guidelines for each session. The WIT model provided evidence with positive outcomes and indicated reduced symptoms regarding trauma and depression as well as a reduction in substance …show more content…
use. A qualitative study of treatment needs among PPW with substance use and depression revealed the importance for social and sober support networks to aid in their recovery (Kuo et al., 2013). Additionally, participants suggest a crucial need for treatments to be aware of their challenges which can often hinder their recovery. PPW need mental health and substance abuse treatments that are sensitive to barriers such as childcare which encourages their engagement in treatment (Kuo et al., 2013). The program at Nexus takes this issue into account and offers childcare for the women that are being served. A study in Canada examined community-based, integrated, primary care maternity programs for pregnant women that had substance use issues (Marcellus et at., 2015). The programs offered have designed their services around the premise that pregnant women who abuse substances often have barriers with complexities and frequently lack resources to access services from numerous agencies (Marcellus et at., 2015). Single access or what is referred to as “one-stop shop” programs are developing in several Canadian regions to support these women in need. These programs were noted as effectively reducing substance use, engaging women for longer periods of time, and improving overall health outcomes for women and their children (Marcellus et at., 2015). Use of methodology The PPWC program at Nexus utilizes the BASIS-24 where items are rated on 5-point scales with a 1-week recall period, and the test takes approximately 5 to 15 minutes to complete. Professional organizations often emphasis the use of outcome measures to monitor treatment progress (Tarescavage & Porath, 2014). Outcome measures are used as a method to deliver feedback to clinicians on their client’s progress and gives us a more informed idea regarding psychological treatment. According to Tarescavage and Porath (2014) the strengths of the BASIS-24 include the following: reliable scores that are relatively free of cultural bias; widely researched; sensitive to change; adequate factorial validity; provides clinically significant change criteria; and has scales designed to measure broad and clinically relevant domains. However, it is not clear that these domains measure the intended concepts and suggest weaknesses regarding limits by a lack of relative information incorporated into the standard scoring protocol (Tarescavage & Porath, 2014). Tarescavage and Porath (2014) also evaluated other outcome measures which include: Clinical Outcomes in Routine Evaluation Outcome Measure; Health Survey Short Form-36; Depression Anxiety Stress Scales; Patient Reported Outcome Measurement Information System; Outcome Questionnaire-45; Symptom Checklist-90-Revised; and Brief Symptom Inventory. Each of the reviewed outcome measures are offered to assist practitioners when determining a preferred method of measure. The overall results for each outcome measure indicated general equality and numerous practical strengths but also identified a few practical concerns that may interfere with interpretation (Tarescavage & Porath, 2014). Improving the evaluation One of the barriers to conducting comparative effectiveness research on substance abuse treatment programs for PPW is stated by Cowger et al.
(2013) as the variation in the types of measures used to evaluate them (2013). The current study conducts a comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) to assess change in alcohol and other drug treatment outcomes for PPW. Both measures were compared on their ability to determine changes in substance use, medical and HIV risk, employment issues, legal problems, family and recovery environment characteristics, and psychological/emotional issues (Cowger et al., 2013). The measures were similar in their ability to perceive treatment outcomes, but the GAIN includes an additional HIV risk scale. The results of the study indicate that research involving the effects of drug use and treatment with PPW may find value in the GAIN because it will be more effective in finding vital individual differences within PPW (Cowger et al., 2013). Though the ASI measures many of the same ideas as the GAIN, such as items related to treatment, it lacks mixing score measures of substance abuse treatment, mental health treatment, physical health treatment, and HIV risk behaviors (Cowger et al., 2013). All of which are considered very relevant in treating this population. The GAIN's substance abuse treatment measure is noted as providing more valuable information regarding the urgent need for treatment and
the probability of successfully completing treatment.
Fortinash, K. M., & Holoday Worret, P. A. (Eds.). (2012). Substance-related disorders and addictive behaviors. Psychiatric mental health nursing (5th ed., pp. 319-362). St. Louis, MO: Elsevier Mosby.
The Addition Severity Index is a well-known and widely used tool for use in treating alcoholics and other addicts. It is an approximately 45 to 60 minute long interview comprised of questions about the patient’s life. The interview covers eight subscales focusing on many different parts of a person’s life which helps to provide a comprehensive understanding of their life. The severity is scored on a ten point scale ranging from no problem or treatment indicated to extreme problem, treatment absolutely necessary. The scale helps the interviewer determine the seriousness of a client’s problem and to plan an effective course of treatment. The ASI can also be found in a self-administered paper-and-pencil form and an interactive CD-ROM multimedia version for the computer (Maleka, 2004). This test has been found to be reliable by most but some others do not agree. It is difficult to say whether or not the test is a reliable and valid measure of treatment due to the complexity of the questions. Once a client’s psychosocial needs are identified it is easier to find treatment suitable for that client. There are some problems with the test such as it is not properly designed to cover such a wide population (Maleka, 2004). Other problems include irrelevant questions for alcoholics and other drug users, difficulty remembering relevant information, and lying and exaggerating information for the best interest of the patient (Maleka, 2004). Use of the ASI can be found to be particularly problematic when used with the homeless or double-diagnosis patients. The ASI can be used in a wide range of treatment settings including clinical, research, and administrative. This comprehensive evaluation is a useful tool that helps professionals understand the
Mangrum, L., Spence, R., & Steinley-Bumgarner, (2006). Gender Differences in Substance-Abuse Treatment Clients with Co-occurring Psychiatric and Substance-Use Disorders. Brief Treatment and Crisis Intervention, 6 (3), 255 - 267
... middle of paper ... ... Retrieved from Senia: http://www.senia.com/2007/09/24/5-specific-techniques-from-positive-psychology-more-productive-more-successful-happier/. Retrieved on 10/20/13. Network, F. R. (2010-2013). Trauma Abuse Treatment -.
A review of the literature reveals no clear-cut definition of harm reduction. Most experts are in agreement, however, that the primary emphasis of harm reduction strategies is to reduce the health, social, and economic consequences associated with alcohol and drug use. Implicitly or explicitly, complete abstinence is the goal of the vast majority of substance abuse service providers (MacMaster, 2004). Although harm reduction strategies value completely refraining from addictive substances, the approach embraces a wide range of goals not limited to abstinence. The harm reduction model employs strategies for extending the scope of treatment to substance users for whom abstinence oriented treatment may not be appropriate. When people are unwilling or unable to embrace abstinence, alternatives to abstinence based treatment have been shown to increase the well-being of both individuals and communities.
Children’s advocate and television personality Fred “Mister Rogers” Rogers (2003) mused, "The purpose of life is to listen--- to yourself, to your neighbor, to your world, and to God and, when the time comes, to respond in as helpful a way as you can find...from within and without." The human need to listen and to respond is at the core of supporting life. Born ready for mutual connection and responsiveness, human beings are primed for growth-fostering relationships with significant people in their early lives (Jordan, 2010). As social creatures, survival has been contingent upon the ability to connect, bond, and share with and receive from these people (Ludy-Dobson & Perry, 2010). Rooted in emotional accessibility, the brain, and the
Alcohol is the most commonly used addictive substance in the US. One in every 12 adults suffers from alcohol abuse. Alcohol addiction is very common in modern ...
Simpson, D., Joe, G. W., Dansereau, D. F., & Flynn, P. M. (2011). Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University. Addiction, 106(10), 1733-1740.
Women who suffer from substance abuse also have a higher rate of traumatic stressors and events. These events include sexual and physical abuse, accidents, disruption in family life, and sudden physical illnesses (Bradley, Ashley, Department of Health and Human Services, 2008). Women are also more likely than men to have recent physical, sexual, or mental abuse. Female treatment clients report more proble...
On a boring Wednesday afternoon, I sat in a brightly lit CPR classroom listening to the instructor drone on and on. I began to wonder if I would ever actually need to use these skills. I highly doubted it. The past two years I have worked at the "little-kid-infested" North Fork Swimming Pool, where there have been absolutely no emergencies. A bloody nose or a stubbed toe here or there but never any serious traumas.
The contrast between the mental health and substance abuse systems regarding convictions, preparing, conduct, and belief system posture critical boundaries to the viable treatment of co-occurring patients. Mental health regularly has been contended that substance abuse issues are side effects of more deep mental trouble and that when those different issues are legitimately treated, substance abuse problems will decrease or die down. The existence of substance abuse issues and mental health disorders are associated with adverse outcomes of treatment including a decrease in emotional functioning, increased amount of time in treatment, increased depreciation regarding care, increased inpatient stays, and an increase in medical illness from both mental health and substance abuse (Wüsthoff, Waal, & Gråwe, 2014). This conceptualization fortifies a progression in which substance abuse issue and their treatment at times, is viewed as less real and less meriting consideration and assets. In the meantime, the substance abuse treatment field every now and again is belief system driven, and its conflicts with the emotional wellness field on fitting finding and treatment regularly have been
Dr. Shindler stated that most of these women are incarcerated at some point in their lives. While this is an interesting fact, I think the thought behind it is unsettling because these women are being stereotyped. As usual, nurture affects our lives in many different ways, and yet each of us responds to it differently. The program put an emphasis on educating these patients as well as helping them to understand the trigger of their behavior a long with the biological basis of their family heritability. The approach of the program is so different in such that it doesn’t focus on correcting their addicting behavior. Instead, it allows physicians work collaboratively with the patients to investigate the root of the problem. I think this approach allows the patients to feel comfortable in sharing their stories as well as actively involve in what the program has to offer. They probably have been criticized by many others about their behavior before and obviously don’t need more people to judge them. Therefore, what they need is a listener and an educator that welcome them with an open arm. Understanding the cause of the problem enables these patients to effectively change their
The depression seen in victims is often associated with other life stressors that tend to accompany domestic violence situations such as childhood abuse, daily stressor, many children, residential changes, rape, marital separation, child behavior problems, and negative life events. The depression may be chronic and worsened by abuse events, but there is also evidence of violence triggering the first depressive episode with depression lessening with decreased violence. Post-traumatic stress disorder is also much more prevalent in women who have been abused than women who have not, with a weighted ratio of 3:74. How severe the abuse was, previous instances of trauma, and partner dominance are all important precursors of post-traumatic stress disorder that results from domestic violence. Suicide and suicidal thoughts are also prevalent in domestic violence situations. Women were also found to suffer anxiety, insomnia, and social dysfunction in higher numbers than women who had not been abused. Physical violence was also shown to have a more profound impact than psychological violence in these instances. Alcohol and substance abuse is, along with depression, the most frequently observed issue in
Trauma is a physical or emotionally damaging event, or series of events that are experienced by an individual and have lasting detrimental effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being (SAMHSA, as cited Wall, Higgins, & Hunter, 2016). Considering that trauma can result in psychological issues, such as, recurrent traumatic dreams, isolation, anxiety, hyperactivity, depression, and even suicide, trauma-informed care is a very important concept (Caltabiano, Sarafino, & Byre, 2008). Wall, Higgins, and Hunter (2016) explain that trauma-informed care is lacking a clearly articulated definition, however, do define trauma-informed care as a framework for a human service delivery which is based on knowledge and understanding of trauma, how it affects and influences peoples lives, and what services are required to
The effects of trauma, specifically sexual trauma, on victims’ physical, psychologists, and social well-being was first explored in the early 1970s (Harner). Teenage mothers are at risk of doing drugs, running away, joining a gang, and dropping out of school (De Genna). If sexually abus...