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Biomedical subjects

G De Leon

Publications and source records attributed to G De Leon.

At least 19 recordsLinked to original sources
PubMed2001

A client-treatment matching protocol for therapeutic communities: first report.

The present study is the first report on a client-treatment matching protocol (CMP) to guide admissions to residential and outpatient substance abuse treatment settings. Two cohorts, a field test sample (n = 318) and cross-validation (n = 407) sample were drawn from consecutive admissions to nine geographically distributed multisetting therapeutic communities (TCs). A passive matching design was employed. Clients received the CMP on admission, but agencies were "blind" to the CMP treatment recommendation (i.e., match) and assigned clients to treatment by the usual intake procedures. Bivariate and logistical regression analyses show that positive treatment dispositions (treatment completion or longer retention in treatment)) were significantly higher among the CMP-matched clients. The present findings provide the empirical basis for studies assessing the validity and utility of the CMP with controlled designs. Though limited to TC-oriented agencies, the present research supports the use of objective matching criteria to improve treatment.

Adult↗
PubMed2001

Treatment process in prison therapeutic communities: motivation, participation, and outcome.

Although the largest effects of prison-based therapeutic community (TC) programs are associated with entry into aftercare, only a minority of prisoners volunteer for these aftercare programs. The study addresses the gap in our knowledge concerning these low rates of voluntary entry. A theoretical formulation of the TC process involving the effect of the interaction of clients' motivation and participation in the activities of the TC on entry into aftercare was tested on a sample of 110 volunteers in a prison-based TC for whom there were client and staff ratings of 3-month participation and 12-month follow-up data on relapse and recidivism. Path analyses support a model in which the interaction of motivation and 3-month participation ratings have a direct effect on the selection of aftercare, and aftercare has a direct effect on relapse and recidivism. The use of a combination of enhanced motivation and early program participation as a means of increasing the utilization and effectiveness of aftercare is discussed.

Adolescent↗
PubMed2000

Measuring client clinical progress in therapeutic community treatment. The therapeutic community Client Assessment Inventory, Client Assessment Summary, and Staff Assessment Summary.

The therapeutic community (TC) Client Assessment Inventory (CAI), Client Assessment Summary (CAS), and Staff Assessment Summary (SAS) are instruments developed from a comprehensive theory of TC treatment and recovery. They measure client self-report and staff evaluation of client progress along 14 domains of behavior, attitude, and cognitive change. The present article reports on the development of the instruments and findings from an analysis of data on 346 clients in TC treatment; including scale properties and cross-sectional client differences by treatment tenure. The instruments were administered over a 1-year period at two residential TC facilities. Findings indicate that both client and staff instruments reliably differentiate client clinical changes during treatment and client self-ratings are initially consistently higher than staff ratings. Clarifying and measuring changes in the individual during treatment is the first step in the effort to understand the change process and what steps can be taken to improve treatment effectiveness.

Adult↗
PubMed2000

Therapeutic communities. Enhancing retention in treatment using "Senior Professor" staff.

Evaluation research documents a firm relationship between retention and treatment outcomes among substance abusers in therapeutic communities (TCs). However, most admissions leave treatment prematurely, particularly in the first months after admission. This paper reports findings from a controlled study that assessed the efficacy of an intervention to reduce early dropout in a residential TC. In the "Senior Professor" (SP) intervention, the most experienced clinical and managerial staff in a TC program were utilized to conduct program induction seminars during the first weeks of admissions, traditionally the period of the highest rate of dropout. Rates of short-term retention (30 days of treatment) were compared for the experimental cohort (N=362), who received the intervention, and a cohort of admissions (N=243), who received standard or non-enhanced treatment. Findings showed that the SP intervention significantly reduced the likelihood of early dropout compared with controls. The enhanced effects are most evident for the new inductees with the lowest levels of motivation. Some theoretical and clinical implications are discussed as to the utilization of experienced staff to increase retention among new inductees with relatively lower motivational levels, who are at greatest risk for early dropout.

Humans↗
PubMed2000

Service use and cost by mentally ill chemical abusers: differences by retention in a therapeutic community.

PURPOSE: Earlier research estimated the incremental costs and outcomes of a modified therapeutic community (modified TC) for mentally ill chemical abusers (MICAs) relative to a treatment-as-usual (TAU) control group. The present study extended the cost analysis by disaggregating the modified TC group into clients who completed the program (completers) and clients who dropped out (separaters). METHODS: Bivariate and multivariate analyses were conducted to estimate differences in treatment and other service costs among completers, separaters, and TAU. Subjects were sequentially assigned to the modified TC (n = 171) or TAU (n = 47), and the analysis period covered 12 months post-baseline. Using a standardized instrument to collect resource use and cost data, the estimated weekly cost per client in the modified TC was $554, with completers showing a larger average cost of treatment ($27,595) than separaters ($9,986). RESULTS: The average TAU subject had a much higher cost for other (non-modified TC) services ($29,795) relative to separaters ($22,048) or completers ($1,986). These findings suggest that, from baseline to the 12-month follow-up, the total cost of modified TC treatment and other services for completers may be slightly lower than the total cost for separaters or TAU subjects. Since the modified TC group had better outcomes than the TAU group, and the completers had better outcomes than the separaters, the modified TC program could be an effective mechanism to reduce the costs of service utilization as well as improve clinical outcomes. IMPLICATIONS: This detailed investigation into service utilization and cost provides policy-makers and program directors with valuable information regarding potentially cost-effective interventions and further underscores the importance of retention in treatment for this vulnerable population.

Adult↗
PubMed2000

Modified therapeutic community for homeless mentally ill chemical abusers: treatment outcomes.

This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified therapeutic community programs (TC1 and TC2) and to a treatment-as-usual (TAU) control group. Follow-up interviews were obtained at 12 months postbaseline and at time F (on average more than 2 years postbaseline) on a retrieved sample of 232 (68%) clients and 281 (82%) clients, respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychological symptoms, and employment. Individuals in both modified TC groups showed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified TC2, with lower demands and more staff guidance, was superior to modified TC1. Completers of both TC programs showed significantly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients.

Adult↗
PubMed2000

Motivation for treatment in a prison-based therapeutic community.

Current research concludes that participation in postprison aftercare is critical to the effectiveness of prison-based therapeutic community (TC) treatment. This conclusion makes it imperative to understand the client determinants of retention in prison treatment, particularly continuance in postprison aftercare. Currently, however, little data exist as to client predictors of seeking and remaining in prison-based TCs or entering postrelease aftercare. In the present study, significant relationships were obtained between initial motivation (i.e., Circumstances, Motivation, Readiness [CMR] scores), retention, aftercare, and outcomes in a sample of substance abusers treated in a prison-based TC program. Implications are discussed for theory, research, and treatment policy.

Adult↗
PubMed1999

Clarifying the nature of therapeutic community treatment. The Survey of Essential Elements Questionnaire (SEEQ).

This study reports on the extent to which Therapeutic Community (TC) agencies share a common set of beliefs about the essential elements of TC treatment. The Survey of Essential Elements Questionnaire (SEEQ), a TC theory-based instrument, was used in a field survey of 59 directors of agencies identified as TCs through their membership in Therapeutic Communities of America (TCA). Results showed a high degree of concordance in the perceived importance of a common set of treatment elements identified as essential to the TC modality. Two clusters of TC-oriented agencies, identified as Traditional and Modified, were determined based on beliefs in the importance of the elements. Results were seen as validating the TC formulation from which the SEEQ items were drawn. Implications on the potential use of the SEEQ as a means of codifying TC treatment for research, training, and quality assurance are discussed.

Adult↗
PubMed1999

Modified therapeutic community for homeless mentally ill chemical abusers: emerging subtypes.

This paper is one of a series reporting on a clinical field trial evaluating the efficacy of the modified therapeutic community (TC) approach for the treatment of homeless mentally ill chemical abusers (MICAs). The social and psychological characteristics of the treatment sample were described in an earlier paper; the purpose of the present report was to categorize subtypes of homeless MICA clients to predict with greater accuracy their treatability in modified TCs. An index that consistently correlated with treatment-relevant variables was identified for each of three dimensions; Homelessness (residential instability), Mental Illness (current severity), and Substance Abuse (current substance abuse/dependence diagnosis). These indices yielded distributions that captured the variability in the sample with respect to a number of variables, including drug use, criminality, human immunodeficiency virus (HIV) risk (sexual behavior), psychological status, and motivation. Bivariate and multivariate analyses showed that the indices were not strongly related to demographic variables such as race/ethnicity, age, or gender, but were significantly associated with baseline drug use, criminal activity, HIV risk (sexual behavior), psychological symptoms, and motivation and readiness. These findings indicate that, even among those admitted to residential treatment for substance abuse, homeless MICA clients are not homogeneous; rather, subgroup differences emerge among the indices of homelessness, mental illness, and substance abuse. The efficacy of treatment in modified TCs for these subgroups will be assessed in subsequent papers examining the relationships among the three indices, client retention, and outcomes during and subsequent to residential treatment.

Diagnosis, Dual (Psychiatry)↗
PubMed1999

Modified therapeutic community for mentally ill chemical abusers: outcomes and costs.

Several studies have established that the personal and social consequences of substance abuse are extensive and costly. These consequences are frequently compounded by mental illness. Although interventions that target mentally ill chemical abusers (MICAs) present several challenges, the potential benefits of successful interventions are significant. This article presents outcomes and costs of a modified therapeutic community (TC) intervention for homeless MICAs. Outcomes at follow-up are compared with those for a control group of homeless MICAs receiving standard services in a "treatment-as-usual" (TAU) condition. Annual economic costs for the modified TC and the average weekly cost of treating a single client are estimated. Treatment and other health service costs at 12 months postbaseline are compared for modified TC and TAU clients. The results of this study indicate that, suitably modified, the TC approach is an effective treatment alternative for homeless MICAs, with the potential to be highly cost-effective relative to standard services.

Cost-Benefit Analysis↗
PubMed1999

Sequential assignment and treatment-as-usual. Alternatives to standard experimental designs in field studies of treatment efficacy.

Psychosocial treatment research studies encounter obstacles to random assignment (RA). Used together, two procedures offer an alternative to the standard RA design. First, sequential assignment (SA) may create less opposition from administration, staff, and clients. SA operates on the principle that limited bed availability, a common treatment consideration in the field, determines assignment of clients to conditions. Second, treatment-as-usual (TAU) represents an alternative type of control condition. Some clients on the waiting list will, before a slot opens up and they enter an experimental condition, be absorbed into the existing treatment system, in which the amount and type of treatment they receive can vary widely. Substituting SA and TAU for the standard RA design may introduce methodological impurities including certain limited biases.

Bias↗
PubMed1998

Homelessness and mental illness in a professional- and peer-led cocaine treatment clinic.

The combined problems of substance abuse, mental illness, and homelessness among the urban poor represent a major public health issue. The study evaluated 340 patients attending a cocaine day treatment program that integrates peer leadership and professional supervision. Thirty-six percent of the sample had a major mental illness, and 39 percent were homeless. Sixty-nine percent achieved an acceptable final urine toxicology status, and the median number of program visits was 46. Homelessness, a longer history of cocaine use, and a diagnosis of schizophrenia were associated with positive treatment outcomes. The results support the feasibility of a cocaine abuse treatment model combining professional and peer leadership.

Adult↗
PubMed1997

Motivation and readiness for therapeutic community treatment among adolescents and adult substance abusers.

A growing body of research has demonstrated the importance of motivation and readiness among drug abusers in seeking, complying with, and remaining in treatment. To date, however, there is little research on these factors among adolescent substance abusers. The present study reports findings from a large scale investigation of motivation and readiness differences across adolescent (range = 14-18 years, n > 1000) and adult (range = 19-26 + years, n > 1400) admissions to residential therapeutic communities (TCs). Data were collected with an instrument assessing circumstances, motivation, readiness, and suitability for TC treatment (i.e., CMRS). Results showed that: (1) there is a significant positive linear relationship between CMRS scores and age; (2) the CMRS scores were the largest and most consistent predictors of short term retention across all age groups. Although confined to TC samples, the present findings support clinical observations that adolescent drug abusers are less motivated to change or ready for treatment than adults; and they confirm the importance of motivational and readiness factors in the treatment process, regardless of age.

Adolescent↗