Publications by authors named "George W Joe"

39 Publications

An evaluation of StaySafe, a tablet app to improve health risk decision-making among people under community supervision.

J Subst Abuse Treat 2021 May 14;130:108480. Epub 2021 May 14.

Texas Christian University, Institute of Behavioral Research, TCU Box 298740, Fort Worth, TX 76129, USA. Electronic address:

Background: A self-administered tablet app, StaySafe, helps people under community supervision to make better decisions regarding health risk behaviors, especially those linked to HIV, viral hepatitis, and other sexually transmitted infections. The multi-session StaySafe design uses an interactive, analytical schema called WORKIT that guides users through a series of steps, questions, and exercises aimed at promoting critical thinking about health risks associated with substance use and unprotected sex. Repetition of the WORKIT schema is designed to enhance procedural memory that can be rapidly accessed when individuals are faced with making decisions about risky behaviors.

Methods: A total of 511 participants under community supervision in community and residential treatment settings from three large Texas counties completed consent forms and baseline surveys, followed by randomization to one of two conditions: 12 weekly StaySafe sessions or standard practice (SP). The study also asked participants to complete a follow-up survey three months after baseline. Outcome measures included knowledge, confidence, and motivation (KCM) scales around HIV knowledge, avoiding risky sex, HIV services, and reducing health risks; decision-making; and reports of talking about issues such as making better decisions, avoiding HIV risks, and HIV prevention or treatment with others (probation officers, counselors, trusted friend or advisor, or family members).

Results: Participants in both community and residential settings voluntarily completed multiple StaySafe sessions, with those in the residential settings completing more sessions. When compared with SP participants, StaySafe participants showed greater improvement in the KCM measures-HIV knowledge, avoiding sex risks, HIV services, and risk reduction skills. In addition, greater improvements in the KCM measures as well as an increased likelihood to discuss issues with others were associated with completing more StaySafe sessions.

Conclusion: These results suggest that the StaySafe app is a feasible and potentially effective tool for improving health risk reduction decision-making for individuals under community supervision.
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http://dx.doi.org/10.1016/j.jsat.2021.108480DOI Listing
May 2021

The role of physical and psychological health problems in the drug use treatment process.

J Subst Abuse Treat 2019 07 30;102:23-32. Epub 2019 Mar 30.

Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA. Electronic address:

The role of physical and psychological health is examined as a predictor of client engagement in prison-based drug treatment. A treatment process model was expanded to include physical and mental health issues. The sample included 6009 offenders in prison-based drug treatment, comprised of 67% male, 26% African American, 51% white, and 22% Hispanic; average age was 34.6. Half reported "some physical health concerns" and mentioned a variety of ailments. A fifth reported moderate stress on the Kessler Psychological Distress Scale (K10) and 15% reported PTSD based on the PTSD Check List (PCL). Structural equation modeling was used to model treatment engagement in terms of demographics, physical health concerns, psychological distress, HIV risky behaviors, self-esteem, decision making, and treatment motivation. Two random samples were created, with one used for estimation and the other for cross-validation. The findings suggested physical health and HIV risky behaviors have effects on client engagement through psychological functioning, and that psychological functioning has direct effects on treatment engagement.
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http://dx.doi.org/10.1016/j.jsat.2019.03.011DOI Listing
July 2019

Treatment Retention Satisfaction, and Therapeutic Progress for Justice-Involved Individuals Referred to Community-Based Medication-Assisted Treatment.

Subst Use Misuse 2019 29;54(9):1461-1474. Epub 2019 Apr 29.

b Institute of Behavioral Research , Texas Christian University, Fort Worth, Texas, USA.

: Limited research has examined factors associated with medication-assisted treatment for justice-involved individuals. : The current study used a mixed-method design to examine the influence of client- and counselor-level factors on 90-day treatment retention, satisfaction, and progress for justice-involved individuals referred to medication-assisted treatment. : The effects of co-occurring disorders (i.e., psychiatric symptoms, anxiety, depression), social functioning (i.e., social support, self-esteem), substance use severity, and treatment motivation on treatment retention, treatment satisfaction, and treatment progress while controlling for counselor-level variance were assessed through multilevel modeling. : Fewer co-occurring disorders and more social support were related to greater treatment satisfaction and progress. A higher level of treatment motivation was associated with greater treatment progress. Mediation of treatment satisfaction on the relationship between client-level factors and treatment progress also was tested. Depression was negatively associated with treatment satisfaction, which in turn led to lower ratings of treatment progress. Social support was positively correlated with treatment satisfaction, which in turn was positively correlated with treatment progress. The association of client substance use severity with treatment retention differed between counselors, so did the association of co-occurring disorders and treatment motivation with treatment satisfaction. Qualitative analyses that were derived from counselors' perception of factors relating to recovery success underscored the importance of integrated interventions, social support, treatment motivation, and therapeutic alliance, and their associations with treatment outcomes. : The current findings highlight the importance of integrated treatment services, collaborating with community corrections, and teaching clients strategies for dealing with deviant peers as to facilitating recovery.
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http://dx.doi.org/10.1080/10826084.2019.1586949DOI Listing
March 2020

Organizational Context and Individual Adaptability in Promoting Perceived Importance and Use of Best Practices for Substance Use.

J Behav Health Serv Res 2019 04;46(2):192-216

National Institute on Drug Abuse, Bethesda, MD, USA.

This study examines associations among organizational context, staff attributes, perceived importance, and use of best practices among staff in community-based, juvenile justice (JJ) agencies. As part of the National Institute on Drug Abuse's Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, 492 staff from 36 JJ agencies were surveyed about the perceived importance and use of best practices within their organization in five substance use practice domains: screening, assessment, standard referral, active referral, and treatment support. Structural equation models indicated that supervisory encouragement and organizational innovation/flexibility were associated with greater individual adaptability. Adaptability (willingness to try new ideas, use new procedures, adjust quickly to change), was positively correlated with importance ratings. Importance ratings were positively associated with reported use of best practices. Organizational climates that support innovation likely affect use of practices through staff attributes and perceptions of the importance of such services.
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http://dx.doi.org/10.1007/s11414-018-9618-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240508PMC
April 2019

A structural model of treatment program and individual counselor leadership in innovation transfer.

BMC Health Serv Res 2017 03 23;17(1):230. Epub 2017 Mar 23.

Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX, 76129, USA.

Background: A number of program-level and counselor-level factors are known to impact the adoption of treatment innovations. While program leadership is considered a primary factor, the importance of leadership among clinical staff to innovation transfer is less known. Objectives included explore (1) the influence of two leadership roles, program director and individual counselor, on recent training activity and (2) the relationship of counselor attributes on training endorsement.

Methods: The sample included 301 clinical staff in 49 treatment programs. A structural equation model was evaluated for key hypothesized relationships between exogenous and endogenous variables related to the two leadership roles.

Results: The importance of organizational leadership, climate, and counselor attributes (particularly counseling innovation interest and influence) to recent training activity was supported. In a subset of 68 counselors who attended a developer-led training on a new intervention, it was found that training endorsement was higher among those with high innovation interest and influence.

Conclusions: The findings suggest that each leadership level impacts the organization in different ways, yet both can promote or impede technology transfer.
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http://dx.doi.org/10.1186/s12913-017-2170-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364669PMC
March 2017

A Brief Assessment for HIV Risk: The TCU HVHP Form.

J Correct Health Care 2016 07;22(3):225-39

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA.

Targeted HIV screens may help identify some risk-related concerns of drug-using offenders. The present study describes the Texas Christian University HIV/Hepatitis Risk Assessment (TCU HVHP) form, a 19-item self-report instrument measuring HIV and hepatitis risks based on a sample (N = 1,056) of offenders in eight prisons. Principal components analysis indicated four scales (Injection Risk, Condom Attitudes, Sex Risk, and AIDS Concern) with reliable psychometric properties with coefficient α reliabilities ranging from .72 to .88. Concurrent validities indicated the four scales were related to motivation for treatment, level of drug use, psychosocial functioning, and criminal thinking, although the patterns varied by gender. The TCU HVHP Form should be attractive to programs needing a brief assessment measuring HIV risk behaviors, attitudes toward condom use, and concerns about acquiring and transmitting HIV.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080836PMC
http://dx.doi.org/10.1177/1078345816653871DOI Listing
July 2016

The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes.

J Subst Abuse Treat 2016 Mar 26;62:20-7. Epub 2015 Nov 26.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX USA.

Treatment engagement is a primary pathway to change. Because motivation consistently predicts engagement and sustained recovery following treatment, targeted efforts at improving problem recognition (i.e., a significant ingredient in motivation) during early weeks of treatment are critical. The purpose of this study is to compare the effectiveness of Standard Operating Practice (SOP) versus SOP plus an 8-session Treatment Readiness and Induction Program (TRIP; delivered in the first weeks of treatment) on cognitive indicators and treatment engagement among youth in 5 residential substance use treatment settings. Structural Equation Modeling (SEM) documented higher problem recognition, decision making, and treatment engagement (participation, satisfaction, counselor rapport) among youth receiving TRIP (compared to SOP only), even when controlling for background characteristics such as age, race-ethnicity, gender, baseline drug use severity, etc. Findings suggest that TRIP is an effective induction tool that directly impacts targeted constructs (i.e., problem recognition, decision making), and also directly affects indicators of engagement.
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http://dx.doi.org/10.1016/j.jsat.2015.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724560PMC
March 2016

Predictors of Physical Altercation among Adolescents in Residential Substance Abuse Treatment.

Deviant Behav 2015;36(12):996-1018. Epub 2015 Oct 29.

Institute of Behavioral Research, Texas Christian University.

This study tested the hypothesis that basic social information-processing components represented by family conflict, peer aggression, and pro-aggression cognitive scripts are related to aggression and social problems among adolescents in substance abuse treatment. The sample consisted of 547 adolescents in two community-based residential facilities. Correlation results indicated that more peer aggression is related to more pro-aggression scripts; scripts, peer aggression, and family conflict are associated with social problems; and in-treatment physical altercation involvement is predicted by higher peer aggression. Findings suggest that social information-processing components are valuable for treatment research.
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http://dx.doi.org/10.1080/01639625.2014.982780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662565PMC
October 2015

Evaluation of WaySafe: A Disease-Risk Reduction Curriculum for Substance-Abusing Offenders.

J Subst Abuse Treat 2015 Nov 16;58:25-32. Epub 2015 May 16.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129.

With a focus on reducing disease risk behavior in the community, a six-session curriculum, WaySafe, was developed to increase positive decision-making skills among soon-to-be-released inmates participating in a therapeutic community substance abuse treatment program. The intervention used TCU Mapping-Enhanced Counseling as an approach to focus on cognitive aspects of risky sexual and drug use behaviors in an effort to improve problem recognition, commitment to change, and strategies for avoiding behavioral risks of infections. A total of 1393 inmates from eight different institutions in two states were randomly assigned to receive WaySafe or treatment as usual (TAU). Baseline and follow-up surveys measured knowledge, confidence, and motivation regarding general HIV information, risky sex and drug use, HIV testing, and risk reduction skills. WaySafe participants had significantly better scores on all measures at follow-up than did TAU participants, supporting the efficacy of WaySafe in improving knowledge, motivation, and confidence in avoiding risky behaviors.
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http://dx.doi.org/10.1016/j.jsat.2015.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581912PMC
November 2015

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change.

J Subst Abuse Treat 2015 Mar 14;50:38-49. Epub 2014 Oct 14.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA.

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (time 1) and 35 days after admission (time 2). The design consisted of a comparison sample (n=281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n=238). Repeated measures ANCOVAs were conducted using each time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation.
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http://dx.doi.org/10.1016/j.jsat.2014.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304896PMC
March 2015

Gender as a moderator in predicting re-arrest among treated drug-involved offenders.

J Subst Abuse Treat 2015 Feb 7;49:65-70. Epub 2014 Aug 7.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76109, USA.

The primary aim of the current study is to explore gender differences on the relationships of pre-treatment risk factors and psychosocial functioning with time to re-arrest following termination from prison. The sample consisted of 384 males and 313 females who were admitted to four prison-based substance abuse treatment programs. Results showed that female inmates experienced a longer time to re-arrest than male inmates. Higher self-reported ratings of decision making confidence and peer support were associated with a lower likelihood of re-arrest for males. Males with higher self-esteem ratings were more likely to be re-arrested than males who reported lower self-esteem. Females with more self-reported criminal involvement had a higher rate of re-arrest than did those with less criminal involvement. In contrast to males, females with relatively high self-reported self-esteem had a lower rate of re-arrest than their counterparts who reported low self-esteem. Clinical implications include the importance of enhancing decision-making confidence and peer support for males and self-esteem for females.
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http://dx.doi.org/10.1016/j.jsat.2014.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985171PMC
February 2015

Screening and assessment tools for measuring adolescent client needs and functioning in substance abuse treatment.

Subst Use Misuse 2014 Jun 12;49(7):902-18. Epub 2014 Mar 12.

1Institute of Behavioral Research, Texas Christian University , Fort Worth, Texas , USA.

The purpose of this study is to establish the psychometric properties of a noncommercial, publicly available, modular screening and assessment system for adolescents in substance abuse treatment. Data were collected in 2011-2012 from 1,189 adolescents admitted to eight residential treatment programs in urban and rural locations in the United States. Results from three sets of analyses documented the instruments to be reliable. Females reported more problems than males, and younger adolescents reported more problems than older youth. Implications and limitations are discussed, and suggestions for future research are provided.
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http://dx.doi.org/10.3109/10826084.2014.891617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998717PMC
June 2014

Recovery among adolescents: models for post-treatment gains in drug abuse treatments.

J Subst Abuse Treat 2014 Mar 14;46(3):362-73. Epub 2013 Oct 14.

Texas Christian University, Fort Worth, TX 76129, USA.

Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.
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http://dx.doi.org/10.1016/j.jsat.2013.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947115PMC
March 2014

The Influence of Client Risks and Treatment Engagement on Recidivism.

J Offender Rehabil 2013 28;52(8):544-564. Epub 2013 Oct 28.

Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA.

The current study modeled 12 month post-release re-arrest (recidivism) in terms of pretreatment risk factors (i.e., criminal history, criminal thinking,) and during-treatment engagement in a sample of 653 subjects admitted to four prison-based substance treatment programs. Structural Equation Modeling was used to test during-treatment engagement as a mediator variable in explaining the relationship between the pretreatment risk factors and recidivism. Results indicated that (1) a long history of criminal conduct correlated with criminal thinking, which in turn had a significantly negative relationship with engagement in treatment; (2) the level of criminal involvement had a significant relationship with re-arrest, whereas the level of criminal thinking did not influence being re-arrested directly; (3) the relationship between criminal history and re-arrest was partially mediated by criminal thinking and treatment engagement, whereas the relationship between criminal thinking and re-arrest was fully mediated by treatment engagement. The findings suggest that it is important to design interventions targeting criminal thinking and monitor treatment engagement as an indicator of treatment performance. Clinical implications also include the importance of facilitating treatment engagement and the utility of conducting prognostic assessment to inform treatment.
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http://dx.doi.org/10.1080/10509674.2013.840353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773110PMC
October 2013

Examining Concurrent Validity and Predictive Utility for the Addiction Severity Index and Texas Christian University (TCU) Short Forms.

J Offender Rehabil 2012 Jan 7;51(1-2):78-95. Epub 2012 Mar 7.

Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA.

Treatment providers need tools which are designed to identify risk, treatment needs, and monitor client engagement. These are essential components in substance abuse treatment for offender populations. This study evaluated a flexible set of 1-page modular assessments known as the TCU Short Forms and compared them with the measures of global domains contained in the Addiction Severity Index (ASI). The sample was based on 540 adult males and females in corrections-based substance abuse treatment services located in Arkansas and Missouri. Results suggest the set of TCU forms and ASI both reliably represent core clinical domains, but TCU Short Forms explained more variance in therapeutic engagement criteria measured during treatment. Similarities and differences of the assessment tools are discussed, along with applications.
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http://dx.doi.org/10.1080/10509674.2012.633021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474351PMC
January 2012

Brief Trauma and Mental Health Assessments for Female Offenders in Addiction Treatment.

J Offender Rehabil 2012 Jan 7;51(1-2):57-77. Epub 2012 Mar 7.

Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA.

Increasing numbers of women in prison raise concerns about gender-specific problems and needs severity. Female offenders report higher trauma as well as mental and medical health complications than males, but large inmate populations and limited resources create challenges in administering proper diagnostic screening and assessments. This study focuses on brief instruments that address specialized trauma and health problems, along with related psychosocial functioning. Women from two prison-based treatment programs for substance abuse were assessed (N = 1,397), including one facility for special needs and one for regular female offenders. Results affirmed that admissions to the special needs facility reported more posttraumatic stress symptoms, higher rates of psychological stress and previous hospitalizations, and more health issues than those in the regular treatment facility. Findings supporting use of these short forms and their applications as tools for monitoring needs, progress, and change over time are discussed.
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http://dx.doi.org/10.1080/10509674.2012.633019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474366PMC
January 2012

An Evaluation of Six Brief Interventions that Target Drug-Related Problems in Correctional Populations.

J Offender Rehabil 2012 7;51(1-2):9-33. Epub 2012 Mar 7.

Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA.

Finding brief effective treatments for criminal justice populations is a major public need. The CJ-DATS Targeted Intervention for Corrections (TIC), which consists of six brief interventions (Communication, Anger, Motivation, Criminal Thinking, Social Networks, and HIV/Sexual Health), were tested in separate federally-funded randomized control studies. In total, 1,573 criminal justice-involved individuals from 20 correction facilities participated (78% males; 54% white). Multi-level repeated measures analyses found significant gains in knowledge, attitudes, and psychosocial functioning (criteria basic to Knowledge, Attitude, and Practices (KAP) and TCU Treatment Process Models). While improvements were less consistent in criminal thinking, overall evidence supported efficacy for the TIC interventions.
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http://dx.doi.org/10.1080/10509674.2012.633020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338318PMC
March 2012

Texas Christian University (TCU) Short Forms for Assessing Client Needs and Functioning in Addiction Treatment.

J Offender Rehabil 2012 Jan 7;51(1-2):34-56. Epub 2012 Mar 7.

Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA.

The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (1-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for treatment (MOTForm), psychological functioning (PSYForm), social relations and functioning (SOCForm), and therapeutic participation and engagement (ENGForm). These instruments facilitate optically-scanned data entry, computerized scoring, and rapid graphical feedback for clinical decisions. The present study (based on 5,022 inmates from eight residential prison treatment programs) examines evidence on scale reliabilities and measurement structures of these tools. Results confirmed their integrity and usefulness as indicators of individual and group-level therapeutic dynamics.
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http://dx.doi.org/10.1080/10509674.2012.633024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325103PMC
January 2012

Treatment program operations and costs.

J Subst Abuse Treat 2012 Mar 5;42(2):125-33. Epub 2011 Dec 5.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

This study investigates how average costs for an episode of care in outpatient drug-free (ODF) treatment relate to clinical intensity (length of stay and weekly counseling hours) and program structure (e.g., size, staffing), controlling for prices paid and selected clientele measures. Based on cost assessments from a naturalistic sample of 67 programs located across the United States (using the Treatment Cost Analysis Tool), robust regression techniques showed that programs having 10% longer treatment stays had episode costs 7% higher; those having 10% more weekly counseling hours per client had 4% higher episode costs. Other important factors included wages, amount of counselors' time conducting sessions, and serving more clients referred from the criminal justice system. The study provides valuable information on treatment program features that relate to costs. Most importantly, cost differences associated with longer stays or more intensive counseling protocols appear modest and may be justified by improved client outcomes.
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http://dx.doi.org/10.1016/j.jsat.2011.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268841PMC
March 2012

Resources and training in outpatient substance abuse treatment facilities.

J Subst Abuse Treat 2012 Mar 5;42(2):169-78. Epub 2011 Dec 5.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

The exposure to new clinical interventions through formalized training and the utilization of strategies learned through training are two critical components of the program change process. This study considers the combined influence of actual program fiscal resources and counselors' perceptions of workplace resources on two mechanisms of training: exposure and utilization. Data were collected from 323 counselors nested within 59 programs located in nine states. Multilevel analysis revealed that training exposure and training utilization represent two distinct constructs that are important at different stages in the Program Change Model. Training exposure is associated primarily with physical and financial resources, whereas utilization is associated with professional community and job burnout. These results suggest that financial resources are important in initial exposure to new interventions but that successful utilization of new techniques depends in part on the degree of burnout and collaboration experienced by counselors.
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http://dx.doi.org/10.1016/j.jsat.2011.10.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268892PMC
March 2012

Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University.

Addiction 2011 Oct 15;106(10):1733-40. Epub 2010 Sep 15.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices.
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http://dx.doi.org/10.1111/j.1360-0443.2010.03121.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003748PMC
October 2011

Male methamphetamine-user inmates in prison treatment: during-treatment outcomes.

J Subst Abuse Treat 2010 Mar 3;38(2):141-52. Epub 2009 Oct 3.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

Psychosocial functioning and criminal thinking of methamphetamine-using inmates were examined before and after their completion of primary treatment in three in-prison drug treatment programs (one "outpatient" and two different modified therapeutic communities [TCs]). The sample consisted of 2,026 adult male inmates in 30 programs in Indiana. Data included background, psychosocial functioning, criminal thinking, and therapeutic engagement indicators. Multilevel repeated measures analysis was used to evaluate changes during treatment, and multilevel covariate analysis adjusted for sample differences in tests of between-treatment differences. Significant improvements were found for all three treatments, but the two modified TCs showed significantly better progress than did outpatient treatment housed among the general prison population. Significant predictors of treatment progress included baseline psychosocial functioning and background, wherein higher psychosocial functioning and lower criminal thinking orientation predicted stronger therapeutic engagement. However, treatment engagement level was found to mediate during-treatment improvement and initial criminal thinking.
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http://dx.doi.org/10.1016/j.jsat.2009.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814961PMC
March 2010

During-treatment Outcomes among Female Methamphetamine-Using Offenders in Prison-based Treatments.

J Offender Rehabil 2009 Jul;48(5):388-401

An increasingly important treatment group is the expanding population of methamphetamine-using female offenders. This study focused on women methamphetamine-using offenders (n = 359) who were treated either in a modified TC program (CLIFF-TC: n = 234) designed for non-violent offenders with significant impairment from methamphetamine use or the standard "outpatient" treatment (OTP: n = 125). All participants were assessed on motivation, psychological and social functioning, and treatment engagement before and during treatment. A multilevel repeated measures analysis examined changes between intake and end of Phase 2 treatment. Both CLIFF-TC and the traditional OTP treatments were shown to improve psychosocial functioning, with significant changes on measures of self esteem, depression, anxiety, decision making, hostility, risk taking, and criminal thinking errors. Effect size comparisons indicated treatment gains were larger in the CLIFF-TC than in the OTP group. Both groups rated treatment engagement measures of participation, satisfaction, and counselor rapport to be very high. These results have positive implications for managing and improving treatment of methamphetamine-using women offenders because psychological improvements during treatment have been linked to better post release outcomes.
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http://dx.doi.org/10.1080/10509670902979496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731425PMC
July 2009

Interaction of counseling rapport and topics discussed in sessions with methadone treatment clients.

Subst Use Misuse 2009 ;44(1):3-17

Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA.

Therapeutic rapport between counselors and clients in drug user treatment has been shown to be an important predictor of follow-up outcomes. This naturalistic study investigated the relationship of counseling rapport to drug-related topics discussed in counseling sessions in a sample of 330 clients and nine counselors. These voluntary clients had been admitted to a private, for-profit outpatient methadone treatment in Texas between September 1995 and August 1997 and received no-fee services for a year for participation in this study. The data were gathered using forms in the TCU community treatment assessments (www.ibr.tcu.edu) that measured intake information, counseling session topics, and counselor evaluation of the client. A majority were males, Hispanic, had a pending legal status and the average age was 39. Co-occurring drug dependence for these heroin users included cocaine (38%) and alcohol (31%). The results supported the hypothesis that higher rapport would be associated with addressing clients in a more "supportive approach" that emphasized relapse prevention and strengths-building while lower rapport would be associated with a punitive counseling style that stressed program rules and compliance. The influences of client background, counselor differences, and during-treatment positive urines were also examined. Although counselors differed in their general manner of dealing with clients, each also showed flexibility determined in part by client behavior (such as continued cocaine use). The findings indicate that focusing on constructive solutions is the preferred counseling approach.
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http://dx.doi.org/10.1080/10826080802525876DOI Listing
March 2009

Relating counselor attributes to client engagement in England.

J Subst Abuse Treat 2009 Apr 5;36(3):313-20. Epub 2008 Oct 5.

Client functioning and treatment engagement were examined in relation to staff attributes and organizational climate across a diverse sample of drug treatment and outreach programs in England. Self-rating assessments were obtained from 1,539 clients and 439 counselors representing 44 programs, and results were interpreted using comparable data from studies of treatment programs in the United States. Client scores on treatment participation and counseling rapport in England were directly related to their higher levels of motivation and psychosocial functioning, as well as to staff ratings of professional attributes and program atmosphere. By linking records from English clients with their counselors in each program, findings also indicate these relationships are rooted in the personal interactions between clients and their counselor. Standardized assessments of treatment structure, process, and performance used across therapeutic settings and national boundaries show there is generalizability in the pattern of clinical dynamics, including the relationships between organizational functioning and quality of services.
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http://dx.doi.org/10.1016/j.jsat.2008.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697954PMC
April 2009

Counselor assessments of training and adoption barriers.

J Subst Abuse Treat 2007 Sep 16;33(2):193-9. Epub 2007 Apr 16.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

The prevailing emphasis on adopting evidence-based practices suggests that more focused training evaluations that capture factors in clinician decisions to use new techniques are needed. This includes relationships between postconference evaluations and subsequent adoption of training materials. We therefore collected training assessments at two time points from substance abuse treatment counselors who attended a training on dual diagnosis and another on therapeutic alliance as part of a state-sponsored conference. Customized evaluations were collected to assess counselor perceptions of training quality, relevance, and resources in relation to its use during the 6 months after the conference. Higher ratings for relevance of training concepts and materials to service the needs of clients, desire to have additional training, and level of program support were related to greater trial use during the follow-up period. Primary resource-related and procedural barriers cited by the counselors included lack of time and redundancy with existing practices.
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http://dx.doi.org/10.1016/j.jsat.2007.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1989156PMC
September 2007

Counselor perceptions of organizational factors and innovations training experiences.

J Subst Abuse Treat 2007 Sep 16;33(2):171-82. Epub 2007 Apr 16.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

Because work environment is central to understanding job performance, drug counselor perceptions of their programs and their skills were examined in relation to their attitudes about innovations training and its utilization. Latent profile analysis of measures on organizational climate and staff attributes for 1047 counselors from 345 programs defined three categories of counselors-labeled as isolated, integrated, and exceptional. All had generally positive views of their professional skills, although the isolated group scored lower on scales representing professional growth and influence on peers. They were less positive about the "climate" of programs in which they worked and were higher on stress. Program resources predicted the counselor groups, with the isolated having more limited resources. Counselor categorizations also differed in terms of workshop training experiences, with the isolated group of counselors reporting significantly less exposure, satisfaction, and program-wide use of workshop training.
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http://dx.doi.org/10.1016/j.jsat.2006.12.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993834PMC
September 2007

Assessing program needs and planning change.

J Subst Abuse Treat 2007 Sep 16;33(2):121-9. Epub 2007 Apr 16.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

Assessments of treatment staff training needs, preferences, and barriers can help guide and improve training activities and transfer evidence-based technologies into clinical practice. The Texas Christian University (TCU) Program Training Needs (PTN) assessment consists of 54 items organized into seven domains: Program Facilities and Climate, Program Computer Resources, Staff Training Needs, Preferences for Training Content, Preferences for Training Strategy, Training Barriers, and Satisfaction With Training. Data collected from 589 counselors representing 194 treatment programs showed that the PTN was psychometrically sound and predictably associated with results from a more comprehensive assessment of organizational functioning. Importantly, fewer barriers to training and greater staff satisfaction with training were reported for programs with higher levels of organizational functioning. In addition to representing an efficient source of staff's perceptions about organizational operations and needs, the PTN empowers staff with a "voice" through which they can contribute to strategic planning and priority setting for organizational actions.
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http://dx.doi.org/10.1016/j.jsat.2006.12.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1989677PMC
September 2007

Influence of organizational functioning on client engagement in treatment.

J Subst Abuse Treat 2007 Sep 12;33(2):139-47. Epub 2007 Apr 12.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

This study focused on the relationship between organizational functioning factors measured in a staff survey using the Texas Christian University (TCU) Organizational Readiness for Change assessment and client-level engagement measured by the TCU Client Evaluation of Self and Treatment in drug treatment programs. The sample consisted of 531 clinical and counseling staff and 3,475 clients from 163 substance abuse treatment programs located in nine states from three regional Addiction Technology Transfer Centers. Measures of client engagement in treatment (rapport, satisfaction, and participation) were shown to be higher in programs with more positive staff ratings of organizational functioning. In particular, these programs had fewer agency needs and more favorable ratings for their resources, staff attributes, and climate. These findings help establish the importance of addressing organizational factors as part of an overall strategy for improving treatment effectiveness.
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http://dx.doi.org/10.1016/j.jsat.2006.12.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994649PMC
September 2007

Linking the elements of change: Program and client responses to innovation.

J Subst Abuse Treat 2007 Sep 12;33(2):201-9. Epub 2007 Apr 12.

Institute of Behavioral Research, Texas Christian University, Fort Worth, TX 76129, USA.

The process of innovation adoption was investigated using longitudinal records collected from a statewide network of almost 60 treatment programs over a 2-year period. Program-level measures of innovation adoption were defined by averaged counselor ratings of program training needs and readiness, organizational functioning, quality of a workshop training conference, and adoption indicators at follow-up. Findings showed that staff attitudes about training needs and past experiences are predictive of their subsequent ratings of training quality and progress in adopting innovations a year later. Organizational climate (clarity of mission, cohesion, openness to change) is also related to innovation adoption. In programs that lack an open atmosphere for adopting new ideas, it was found that counselor trial usage is likely to be attenuated. Most important was evidence that innovation adoption based on training for improving treatment engagement was significantly related to client self-reports of improved treatment participation and rapport recorded several months later.
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http://dx.doi.org/10.1016/j.jsat.2006.12.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1987382PMC
September 2007