Publications by authors named "Wayne E K Lehman"

23 Publications

  • Page 1 of 1

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

Critical Factors Influencing Interorganizational Relationships Between Juvenile Probation and Behavioral Health Agencies.

Adm Policy Ment Health 2021 03;48(2):233-249

National Institute On Drug Abuse, North Bethesda, USA.

Although interorganizational relationships (IORs) are essential to the effective delivery of human services, very little research has examined relationships between juvenile justice agencies and behavioral health providers, and few studies have identified the most critical organizational and individual-level characteristics influencing IORs. Across 36 sites, juvenile probation officials (n = 458) and community behavioral health providers (n = 91) were surveyed about characteristics of their agencies, themselves, and IORs with each other. Generalized Linear Mixed Models were used to analyze the data. The strongest predictors included Perceived Organizational Support and individual Adaptability. Implications for research, theory and practice are discussed.
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http://dx.doi.org/10.1007/s10488-020-01066-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854784PMC
March 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

: A self-administered android tablet application for helping individuals on probation make better decisions pertaining to health risk behaviors.

Contemp Clin Trials Commun 2018 Jun 31;10:86-93. Epub 2018 Mar 31.

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

This paper describes the development and protocol for feasibility and efficacy testing of a risk reduction intervention designed to improve behavioral health outcomes among drug offenders on probation under community supervision or in residential substance abuse treatment centers. is a self-administered tablet-based intervention for teaching better decision-making skills regarding health risk behaviors, especially those involving HIV risks. We are using pre/post, experimental/control group randomized clinical trial (RCT) in both community and residential probation settings with goals to 1) assess the feasibility and acceptance of by examining participation rates and satisfaction measures, and 2) examine the impact of on decision-making skills, confidence and motivation to avoid sex and drug risks, willingness to discuss health risks and concerns with helpful others, and engagement in health risk behaviors. consists of 12 brief sessions and utilizes an evidence-based decision-making schema, called WORKIT, which guides participants through steps for identifying the problem and options, evaluating the options and making a decision about which option to carry out. Multiple sessions of provide a practice effect so that the WORKIT steps become easily accessible to participants when making decisions. Three of the sessions provide participants a choice of activities designed to provide additional information about HIV and reinforce lessons learned during the WORKIT sessions. Preliminary data demonstrate feasibility and high levels of satisfaction with .
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http://dx.doi.org/10.1016/j.conctc.2018.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047315PMC
June 2018

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

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

Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes.

Drug Alcohol Depend 2015 Jul 9;152:230-8. Epub 2015 Apr 9.

University of Connecticut, United States.

Background: This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery.

Methods: To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites.

Results: Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility.

Conclusions: Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects.
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http://dx.doi.org/10.1016/j.drugalcdep.2015.03.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458146PMC
July 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

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

Organizational Readiness for Change in Correctional and Community Substance Abuse Programs.

J Offender Rehabil 2012 Jan 7;51(1-2):96-114. Epub 2012 Mar 7.

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

Significant needs exist for increased and better substance abuse treatment services in our nation's prisons. The TCU Organizational Readiness for Change (ORC) survey has been widely used in community-based treatment programs and evidence is accumulating for relationships between readiness for change and implementation of new clinical practices. Results of organizational surveys of correctional counselors from 12 programs in two states are compared with samples of community-based counselors. Correctional counselors perceived strong needs for new evidence-based practices but, compared to community counselors, reported fewer resources and less favorable organizational climates. These results have important implications for successfully implementing new practices.
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http://dx.doi.org/10.1080/10509674.2012.633022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325111PMC
January 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

Integration of treatment innovation planning and implementation: strategic process models and organizational challenges.

Psychol Addict Behav 2011 Jun;25(2):252-61

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

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A two-phase procedural approach is therefore presented based on the integration of Texas Christian University (TCU) models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings.
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http://dx.doi.org/10.1037/a0022682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454479PMC
June 2011

Individual and network interventions with injection drug users in 5 Ukraine cities.

Am J Public Health 2011 Feb 15;101(2):336-43. Epub 2010 Apr 15.

Division of Substance Dependence, Department of Psychiatry, School of Medicine, University of Colorado Denver, 1741 Vine St, Denver, CO 80206, USA.

Objectives: We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities.

Methods: Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up.

Results: Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors.

Conclusions: Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors.
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http://dx.doi.org/10.2105/AJPH.2009.172304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020184PMC
February 2011

Interventions with injection drug users in Ukraine.

Addiction 2009 Nov 4;104(11):1864-73. Epub 2009 Aug 4.

Division of Substance Dependence, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, USA.

Aims: To assess the effectiveness of a brief human immunodeficiency virus (HIV) testing and counseling intervention compared to a more time-consuming and expensive street-based intervention with injection drug users (IDUs).

Design: Cross-over experimental design in which 900 IDUs were recruited, followed by a 'wash-out' period with no recruitment, a reversal of intervention assignment areas and an additional recruitment of 900 IDUs with baseline and 6-month follow-up assessments.

Setting: Kiev, Odessa and Makeevka/Donesk Ukraine.

Participants: A total of 1798 IDUs.

Measurements: HIV testing and audio computer-assisted self-interview (ACASI) data on socio-demographics, drug use and injection and sex-related risk behaviors.

Findings: Participants in both conditions reduced their injection and sex risks significantly; however, there was little difference in outcomes between conditions. IDUs who knew they were HIV-infected at baseline were significantly more likely to practice safe sex than those unaware or HIV-negative; those who first learned that they were infected at baseline changed their safe sex practices significantly more than those who already knew that they were infected at baseline and those who were HIV-negative. Younger IDUs and those injecting for a shorter period of time reported higher injection and sex risk behaviors following interventions.

Conclusions: Awareness of HIV infection by street-recruited drug injectors is associated with reduced sex risks. Additional interventions are required for younger IDUs and those injecting for shorter periods of time.
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http://dx.doi.org/10.1111/j.1360-0443.2009.02660.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725954PMC
November 2009

Organizational factors and collaboration and integration activities in criminal justice and drug abuse treatment agencies.

Drug Alcohol Depend 2009 Aug;103 Suppl 1:S65-72

National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, United States.

Despite strong interest in improving collaborations between correctional and substance abuse treatment organizations, there is a lack of empirical data describing the existing practices. The current study used a national survey of correctional administrators to examine organizational factors related to cross-agency collaboration and integration activities between corrections and substance abuse treatment organizations. Using a measure of collaboration that scaled cross-agency activities from less structured, informal networking and coordination to more structured and formalized levels of cooperation and collaboration, we found that different correctional settings (e.g., community corrections, jails, prisons) differed significantly in terms of their collaborative activities with substance abuse treatment agencies. We also found that the organizational characteristics that were associated with different levels of collaboration and integration differed across the correctional settings. Further research is needed to better understand how and why correctional agencies decide to formalize collaborative arrangements with treatment agencies and whether these efforts lead to more favorable outcomes.
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http://dx.doi.org/10.1016/j.drugalcdep.2009.01.004DOI Listing
August 2009

Psychosocial correlates of the perceived stigma of problem drinking in the workplace.

J Prim Prev 2008 Jul;29(4):341-56

Attitudes Ghana, Rennweg 45/8, Vienna, 1030, Austria.

The purpose of this study was to evaluate a questionnaire assessment of the perceived stigma of problem drinking that was designed for use in workplace substance abuse prevention research. Municipal employees from a mid-sized city (n = 315) and a large-sized city (n = 535) completed questionnaire measures of perceived coworker stigmatization of problem drinking, drinking levels, substance-use policy attitudes, workgroup stress and interdependence, alcohol-tolerance norms, and demographic variables. Inter-item correlation coefficients showed that the measure of the stigma of problem drinking had good internal consistency reliability (.76) in both samples. Hierarchical regression analyses showed that higher education, abstinence from alcohol, stress, and perceived temperance norms were all uniquely correlated with perceived stigma. Women and men perceived the same level of stigma from coworkers. Editors' Strategic Implications: This brief, validated measure provides organizations with a way to assess the level of stigma attached to alcohol abuse in their workplace culture, thereby enabling the organization to target and promote effective strategies to decrease the stigma attached to seeking help with the goal of reducing alcohol abuse.
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http://dx.doi.org/10.1007/s10935-008-0140-1DOI Listing
July 2008

Stimulant injectors in Ukraine: the next wave of the epidemic?

AIDS Behav 2008 Jul 9;12(4):652-61. Epub 2008 Feb 9.

University of Colorado Health Sciences Center, Denver, CO, USA.

This study was designed to assess differences in drug and sex-related risk behaviors between injectors of opiates only, opiate/sedative mix only and stimulants only. Participants were current out-of-treatment injection drug users (IDUs), unaware of their HIV status, recruited through street outreach in Kiev, Odessa and Makeevka/Donetsk, Ukraine. Overall, 22% tested positive for HIV, including 39% among opiate/sedative injectors, 19% among opiate injectors and 17% among stimulant injectors. Despite these differences, stimulant injectors were at higher risk than other IDUs in sharing a used needle/syringe, always injecting with others, injecting a drug solution drawn from a common container, having an IDU sex partner, not using condoms during vaginal or anal sex and on composite measures of injection and sex risks. After controlling for age differences, stimulant injectors remained at higher risk in their needle and sex risk behaviors. Without intervention, it is likely that HIV will increase among stimulant injectors.
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http://dx.doi.org/10.1007/s10461-008-9359-3DOI Listing
July 2008

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

Team awareness, problem drinking, and drinking climate: workplace social health promotion in a policy context.

Am J Health Promot 2004 Nov-Dec;19(2):103-13

Organizational Wellness and Learning Systems, Fort Worth, Texas 76109, USA.

Purpose: (1) To determine the effectiveness of classroom health promotion/prevention training designed to improve work climate and alcohol outcomes; (2) to assess whether such training contributes to improvements in problem drinking beyond standard workplace alcohol policies.

Design: A cross-sectional survey assessed employee problem drinking across three time periods. This was followed by a prevention intervention study; work groups were randomly assigned to an 8-hour training course in workplace social health promotion (Team Awareness), a 4-hour informational training course, or a control group. Surveys were administered 2 to 4 weeks before and after training and 6 months after posttest.

Setting And Subjects: Employees were surveyed from work departments in a large municipality of 3000 workers at three points in time (year, sample, and response rates are shown): (1) 1992, n = 1081, 95%; (2) 1995, n = 856, 97%; and (3) 1999, n = 587, 73%. Employees in the 1999 survey were recruited from safety-sensitive departments and were randomly assigned to receive the psychosocial (n = 201), informational (n = 192), or control (n = 194) condition.

Intervention: The psychosocial program (Team Awareness) provided skills training in peer referral, team building, and stress management. Informational training used a didactic review of policy, employee assistance, and drug testing.

Measures: Self-reports measured alcohol use (frequency, drunkenness, hangovers, and problems) and work drinking climate (enabling, responsiveness, drinking norms, stigma, and drink with co-workers).

Results: Employees receiving Team Awareness reduced problem drinking from 20% to 11% and working with or missing work because of a hangover from 16% to 6%. Information-trained workers also reduced problem drinking from 18% to 10%. These rates of change contrast with changes in problem drinking seen from 1992 (24%) to 1999 (17%). Team Awareness improvements differed significantly from control subjects, which showed no change at 13%. Employees receiving Team Awareness also showed significant improvements in drinking climate. For example, scores on the measure of coworker enabling decreased from pretest (mean = 2.19) to posttest (mean = 2.05) and follow up (mean = 1.94). Posttest measures of drinking climate also predicted alcohol outcomes at 6 months.

Conclusion: Employers should consider the use of prevention programming as an enhancement to standard drug-free workplace efforts. Team Awareness training targets work group social health, aligns with employee assistance efforts, and contributes to reductions in problem drinking.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177956PMC
http://dx.doi.org/10.4278/0890-1171-19.2.103DOI Listing
January 2005

Levels of substance use and willingness to use the Employee Assistance Program.

J Behav Health Serv Res 2003 Apr-Jun;30(2):238-48

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

Individuals with drinking and drug problems may become particularly reluctant to seek help. To remove barriers to services, more needs to be understood about factors that influence help-seeking decisions. It was hypothesized that certain social psychological influences (attitudes, group cohesion, trust in management) might buffer a reluctance to use services provided by an external Employee Assistance Program (EAP). A random sampling of municipal employees (n = 793) completed anonymous questionnaires that assessed willingness to use the EAP, individual drinking and drug use, attitudes toward policy, work group cohesion, and trust in management. Data from the questionnaires were analyzed with multivariate regression analyses to examine the interacting effects of substance abuse and proposed moderators (gender, race, awareness of the EAP, perceptions of policy, cohesion) on willingness to use the EAP. The results demonstrated that although substance abusers were less willing to use the EAP than were nonusers, substance abusers who were aware of the EAP, who had favorable attitudes toward policy, and who did not tolerate coworker substance abuse were as willing to use the EAP as were nonusers. The results also showed that employees with greater awareness of the EAP, support for policy, and perceptions of work group cohesion reported significantly greater willingness to use the EAP than did employees with relatively less awareness of the EAP, policy support, and cohesion. Workplace prevention efforts that are designed to increase the use of EAP services should intentionally target the workplace environment and social context. Creating the awareness and favorability of the EAP, policy, and work group cohesion might buffer substance abusers' reluctance to seek help.
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http://dx.doi.org/10.1007/BF02289811DOI Listing
May 2003

Assessing organizational readiness for change.

J Subst Abuse Treat 2002 Jun;22(4):197-209

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

A comprehensive assessment of organizational functioning and readiness for change (ORC) was developed based on a conceptual model and previous findings on transferring research to practice. It focuses on motivation and personality attributes of program leaders and staff, institutional resources, and organizational climate as an important first step in understanding organizational factors related to implementing new technologies into a program. This article describes the rationale and structure of the ORC and shows it has acceptable psychometric properties. Results of surveys of over 500 treatment personnel from more than 100 treatment units support its construct validity on the basis of agreement between management and staff on several ORC dimensions, relationships between staff organizational climate dimensions and patient engagement in treatment, and associations of agency resources and climate with organizational stability. Overall, these results indicate the ORC can contribute to the study of organizational change and technology transfer by identifying functional barriers involved.
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http://dx.doi.org/10.1016/s0740-5472(02)00233-7DOI Listing
June 2002

Job risk and employee substance use: the influence of personal background and work environment factors.

Am J Drug Alcohol Abuse 2002 ;28(2):263-86

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

Previous studies have noted that employees who work in jobs with physical risk report more substance use than employees working in nonrisky jobs. This study examined the extent to which this relationship could be explained by personal background, specifically general deviance or psychosocial functioning, or work characteristics, including job stressors, organizational bonding, or work group drinking climate. Results from two worksites (ns = 943, 923) indicated that the relationship of job risk and alcohol problems could be fully explained by personal characteristics, particularly deviant behavior styles. Interaction effects were also found. Employees with more deviance indicators were particularly susceptible to recent drug use and problem drinking when they worked in drinking climates or exposed to co-worker drinking. These results suggest the joint influence of personal and job factors and support prevention programs that target the workplace social environment.
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http://dx.doi.org/10.1081/ada-120002974DOI Listing
December 2002

Supervisor tolerance-responsiveness to substance abuse and workplace prevention training: use of a cognitive mapping tool.

Health Educ Res 2002 Feb;17(1):27-42

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

Supervisor tolerance-responsiveness, referring to the attitudes and behaviors associated with either ignoring or taking proactive steps with troubled employees, was investigated in two studies. The studies were conducted to help examine, understand and improve supervisor responsiveness to employee substance abuse. Study 1 examined supervisor response to and tolerance of coworker substance use and ways of interfacing with the Employee Assistance Program (EAP) in two workplaces (n = 244 and 107). These surveys suggested that engaging supervisors in a dialogue about tolerance might improve their willingness to use the EAP. Study 2 was a randomized control field experiment that assessed a team-oriented training. This training adopted a cognitive mapping technique to help improve supervisor responsiveness. Supervisors receiving this training (n = 29) were more likely to improve on several dimensions of responsiveness (e.g. likely to contact the EAP) than were supervisors who received a more didactic, informational training (n = 23) or a no-training control group (n = 17). Trained supervisors also showed increases in their own help-seeking behavior. Procedures and maps from the mapping activity (two-stage conversational mapping) are described. Overall, results indicate that while supervisor tolerance of coworker substance use inhibits EAP utilization, it may be possible to address this tolerance using team-oriented prevention training in the work-site.
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http://dx.doi.org/10.1093/her/17.1.27DOI Listing
February 2002