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de Waal MM, Blankers M, Lommerse NM, Kikkert MJ, Dekker JJM, Goudriaan AE. Economic Evaluation of the SOS Training to Reduce Victimization in Dual Diagnosis Patients. J Dual Diagn 2021; 17:333-343. [PMID: 34569438 DOI: 10.1080/15504263.2021.1965409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyze the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU). METHODS We performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up. RESULTS There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [-€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [-0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs. CONCLUSIONS At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.
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Affiliation(s)
- Marleen M de Waal
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands.,Trimbos Institute, Utrecht, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Martijn J Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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2
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Mantler T, Jackson KT, Walsh EJ. Integration of Primary Health-Care Services in Women's Shelters: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:610-623. [PMID: 29916310 DOI: 10.1177/1524838018781105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Women who have experienced intimate partner violence (IPV) have significant detrimental physical and mental health consequences associated with the violence as well as numerous barriers to health-care and social service utilization. Service integration offers a solution to help support women who have experienced violence overcome negative health consequences as well as barriers to system navigation and use. The purpose of this scoping review was to examine research activity pertaining to IPV and primary health-care and women's shelters integration. Namely, the aim was to determine the extent, range, and nature of research related to the effects of integrating primary health-care services and women's shelters. Nineteen sources were identified as potentially relevant from four electronic databases, with four articles meeting the inclusion criteria of integration of primary health-care and women's shelter services where outcomes were presented related to the efficacy of primary health-care received and integration. Numerical analysis revealed considerable homogeneity among articles in terms of methodological approaches, patient populations, and type of integration. Inductive thematic content analysis revealed three themes that resulted from integration: (1) increased access to and acceptability of services, (2) bridge back to health-care, and (3) decreasing future health-care burden. The findings from this scoping review represent a first attempt to summarize the literature, indicate a need for additional research, and suggest implications for practice.
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Affiliation(s)
- Tara Mantler
- School of Health Studies, Western University, London, Ontario, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Edmund J Walsh
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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3
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Winstanley EL, Mahoney JJ, Lander LR, Berry JH, Marshalek P, Zheng W, Haut MW. Something to despair: Gender differences in adverse childhood experiences among rural patients. J Subst Abuse Treat 2020; 116:108056. [PMID: 32741501 DOI: 10.1016/j.jsat.2020.108056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 01/27/2023]
Abstract
Existing research has demonstrated that patients in treatment for an opioid use disorder (OUD) have high rates of adverse childhood experiences (ACE) compared to community-based samples. While research has documented important gender differences in ACEs in patients with OUD receiving treatment in urban areas, research has not shown whether these findings would generalize to rural and Appalachian areas, which are known to have lower ACE scores. We conducted a secondary analysis of existing clinical data, utilizing intake assessment data from a rural Appalachian outpatient buprenorphine program. We restricted the sample to patients with an OUD who presented for treatment between June 2018 and June 2019 (n = 173). The clinical intake assessment included a modified 17-item ACE instrument that patients self-administered. More than half (54.3%) of patients reported having experienced 4+ categories of adverse childhood experiences. On average, females endorsed 4.5 categories of adverse experiences, whereas males endorsed 3.3 (p < 0.00); female patients were significantly more likely to have experienced sexual abuse (42.4% versus 10.6%, p < 0.00). Alarmingly, 25.9% of females and 8.2% of males reported being forced to have sex before age 18. Disproportionately high rates of childhood adversities, particularly among females, may partially explain despair in rural Appalachian areas. OUD treatment programs should conduct clinical assessments of trauma and integrate trauma-informed care into drug treatment, especially for female patients residing in rural Appalachia.
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Affiliation(s)
- Erin L Winstanley
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States.
| | - James J Mahoney
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Laura R Lander
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - James H Berry
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Patrick Marshalek
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Wanhong Zheng
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States
| | - Marc W Haut
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV, United States; West Virginia University, School of Medicine, Department of Neuroscience, United States; West Virginia University, School of Medicine, Department of Neurology, United States; West Virginia University, School of Medicine, Department of Radiology, United States
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4
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Cations M, Laver KE, Walker R, Smyth A, Fernandez E, Corlis M. The case for trauma-informed aged care. Int J Geriatr Psychiatry 2020; 35:425-429. [PMID: 31840328 DOI: 10.1002/gps.5247] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/07/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | | | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
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5
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Abstract
Objective: The recognition of concurrent disorders (combined mental health and substance use disorders) has increased substantially over the last three decades, leading to greater numbers of people with these diagnoses and a subsequent greater financial burden on the health care system, yet establishing effective modes of management remains a challenge. Further, there is little evidence on which to base recommendations for a particular mode of health service delivery. This paper will further summarize the existing treatment models for a comprehensive overview. The objectives of this study are to determine whether existing service models are effective in treating combined mental health and substance use disorders and to examine whether an integrated model of service delivery should be recommended to policy makers. The following two research questions are the focus of this paper: (1) Are the existing service models effective at treating mental health and substance use disorders? (2) How are existing service models effective at treating mental health and substance use disorders? Methods: We used various databases to systematically review the effectiveness of service delivery models to treat concurrent disorders. Models were considered effective if they are found to be cost-effective and significantly improve clinical and social outcomes. Results: This systematic review revealed that integrated models of care are more effective than conventional, nonintegrated models. Integrated models demonstrated superiority to standard care models through reductions in substance use disorders and improvement of mental health in patients who had diagnoses of concurrent disorders. Our meta-analysis revealed similar findings, indicating that the integrated model is more cost-effective than standard care. Conclusions: Given the limited number of studies in relation to service delivery for concurrent disorders, it is too early to make a strong evidence-based recommendation to policy makers and service providers as to the superiority of one approach over the others. However, the available evidence suggests that integrated care models for concurrent disorders are the most effective models for patient care. More research is needed, especially around the translation of research findings to policy development and, vice versa, around the translation from the policy level to the patients' level.
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Affiliation(s)
- Venu Karapareddy
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,b Vancouver Coastal Health , Vancouver , Canada
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6
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García-Moreno C, Zimmerman C, Morris-Gehring A, Heise L, Amin A, Abrahams N, Montoya O, Bhate-Deosthali P, Kilonzo N, Watts C. Addressing violence against women: a call to action. Lancet 2015; 385:1685-95. [PMID: 25467579 DOI: 10.1016/s0140-6736(14)61830-4] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and implement national plans and make budget commitments to invest in actions by multiple sectors to prevent and respond to abuse. Emphasis on prevention is crucial. Community and group interventions involving women and men can shift discriminatory social norms to reduce the risk of violence. Education and empowerment of women are fundamental. Health workers should be trained to identify and support survivors and strategies to address violence should be integrated into services for child health, maternal, sexual, and reproductive health, mental health, HIV, and alcohol or substance abuse. Research to learn how to respond to violence must be strengthened. The elimination of violence against women and girls is central to equitable and sustainable social and economic development and must be prioritised in the agenda for development after 2015.
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Affiliation(s)
| | | | | | - Lori Heise
- London School of Hygiene & Tropical Medicine, London, UK
| | - Avni Amin
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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7
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Differential service utilization associated with trauma-informed integrated treatment for women with co-occurring disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 39:426-39. [PMID: 21706408 DOI: 10.1007/s10488-011-0362-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women with co-occurring mental health and substance use disorders and trauma histories vary greatly in symptom severity and use of support services. This study estimated differential effects of an integrated treatment intervention (IT) across sub-groups of women in this population on services utilization outcomes. Data from a national study were used to cluster participants by symptoms and service utilization, and then estimate the effect of IT versus usual care on 12-month service utilization for each sub-group. The intervention effect varied significantly across groups, in particular indicating relative increases in residential treatment utilization associated with IT among women with predominating trauma and substance abuse symptoms. Understanding how IT influences service utilization for different groups of women in this population with complex needs is an important step toward achieving an optimal balance between need for treatment and service utilization, which can ultimately improve outcomes and conserve resources.
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8
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Gilbert AR, Morrissey JP, Domino ME. Service Utilization Patterns as Predictors of Response to Trauma-Informed Integrated Treatment for Women With Co-occurring Disorders. J Dual Diagn 2011; 7:117-129. [PMID: 22368532 PMCID: PMC3285402 DOI: 10.1080/15504263.2011.592411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE: The current study examined whether clinical responses to an integrated treatment intervention among women with co-occurring disorders and histories of abuse varied according to their service use patterns at baseline. METHODS: Data were from a national, multi-site, integrated treatment intervention study in 1998-2003. Analyses included 999 study participants assigned to the integrated treatment group and who were symptomatic at baseline. Participants' baseline service use activity was characterized according to five distinct baseline service use clusters. Logistic regression models estimated study participants' odds of good clinical responses to integrated treatment at 12 months across the five service clusters. RESULTS: Participants with high levels of psychotropic medication and medical care use at baseline had significantly lower odds than low-intensity service users of having a good response to integrated treatment at 12 months on mental health, alcohol addiction, and posttraumatic stress measures. A majority of women in this group had serious medical illness or disability and were more likely than their counterparts with other service use patterns to have used homeless or domestic violence shelters. CONCLUSIONS: Women who used high levels of medication and medical services appear to have faced especially difficult barriers in responding well to integrated treatment. Careful assessments of their mental health, trauma, and medical treatment needs may be required as part of integrated treatment in an effort to improve their response to integrated treatment, clinical outcomes and well-being. This information can also be used to target integrated treatment to women who are likely to respond positively and achieve meaningful improvements in their functioning.
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Affiliation(s)
- Allison R. Gilbert
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph P. Morrissey
- Department of Health Policy and Management and Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Deputy Director for Research, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marisa E. Domino
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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9
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Neonatal Outcomes and Mental Illness, Substance Abuse, and Intentional Injury During Pregnancy. Matern Child Health J 2011; 16:979-88. [DOI: 10.1007/s10995-011-0821-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Abstract
There are clear gender differences in the experience of domestic violence and associated mental health outcomes. There is also increasing evidence of chronic, severe and often long-term adverse mental health effects for victims. This paper explores these gender differences and the evidence on how mental health care services should respond to domestic violence. The authors argue that any strategy to reduce the burden of women's mental health problems should include efforts to identify, prevent or reduce violence against women.
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Affiliation(s)
- Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
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11
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Gold L, Norman R, Devine A, Feder G, Taft AJ, Hegarty KL. Cost-Effectiveness of Health Care Interventions to Address Intimate Partner Violence: What Do We Know and What Else Should We Look for? Violence Against Women 2011; 17:389-403. [PMID: 21343165 DOI: 10.1177/1077801211398639] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate partner violence (IPV) creates a substantial burden of disease and significant costs to families, communities, and governments. Building the evidence for effective interventions to reduce violence and its sequelae requires increased use of economic evaluation to inform policy through the analysis of costs and potential savings of interventions. The authors review existing economic evaluations and present case studies of current research from the United Kingdom and Australia to illustrate the strengths and limitations of two approaches to generating economic evidence: economic evaluation alongside randomized controlled trials and economic modeling. Economic evaluation should always be considered in the design of IPV intervention research.
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Affiliation(s)
- Lisa Gold
- Deakin University, Burwood, Victoria, Australia,
| | - Richard Norman
- University of Technology, Sydney, New South Wales, Australia
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12
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Schäfer I, Verthein U, Oechsler H, Deneke C, Riedel-Heller S, Martens M. What are the needs of alcohol dependent patients with a history of sexual violence? A case-register study in a metropolitan region. Drug Alcohol Depend 2009; 105:118-25. [PMID: 19647957 DOI: 10.1016/j.drugalcdep.2009.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 05/28/2009] [Accepted: 06/17/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual violence has become increasingly apparent as a factor determining more complex treatment needs in patients with substance abuse. However, empirical evidence on specific patterns of differences between patients with and without a history of sexual violence is scarce. METHODS Our sample consisted of alcohol dependent outpatients treated during a two-year period in a German metropolitan region. The analysis was based on a local case register and included all patients for whom information on lifetime sexual violence was available (N=1981; 33.4% female). In a case-control design, patients with a history of sexual violence were compared to patients without such experiences regarding a wide range of clinical and social factors indicative of potential needs. RESULTS More than 35% of the female patients and 6% of the male patients reported a history of sexual violence. Victims differed from non-victims across a variety of domains, including psychiatric symptoms and suicide attempts, legal problems, financial and family problems, previous use of services, and need for additional services during the current treatment. Patient gender emerged as a significant moderator of several of these associations. CONCLUSIONS The findings indicate that an effort needs to be made to link addiction treatment, other parts of the health care system, and further institutions, such as family services and parts of the legal system, so that the complex needs of this vulnerable population can be met in an adequate way.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
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13
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Chung S, Domino ME, Morrissey JP. Changes in treatment content of services during trauma-informed integrated services for women with co-occurring disorders. Community Ment Health J 2009; 45:375-84. [PMID: 19308729 PMCID: PMC2758206 DOI: 10.1007/s10597-009-9192-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/10/2009] [Indexed: 11/29/2022]
Abstract
The experience of trauma is highly prevalent in the lives of women with mental health and substance abuse problems. We examined how an intervention targeted to provide trauma-informed integrated services in the treatment of co-occurring disorders has changed the content of services reported by clients. We found that the intervention led to an increased provision of integrated services as well as services addressing each content area: trauma, mental health and substance abuse. There was no increase in service quantity from the intervention. Incorporation of trauma-specific element in the treatment of mental health and substance abuse may have been successfully implemented at the service level thereby better serve women with complex behavioral health histories.
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Affiliation(s)
- Sukyung Chung
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA 94301 USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1104G McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC 27599-7411 USA
| | - Joseph P. Morrissey
- Cecil G. Sheps Center for Health Services Research and Department of Health Policy and Management, University of North Carolina at Chapel Hill, 725 Airport Road, Chapel Hill, NC 27599-7590 USA
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14
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Grella CE. From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment. J Psychoactive Drugs 2008; Suppl 5:327-43. [DOI: 10.1080/02791072.2008.10400661] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Chung S, Domino ME, Jackson EW, Morrissey JP. Reliability of Self-Reported Health Service Use: Evidence from the Women with Co-occurring Disorders, and Violence Study. J Behav Health Serv Res 2008; 35:265-78. [DOI: 10.1007/s11414-007-9105-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 12/17/2007] [Indexed: 11/24/2022]
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Cusack KJ, Morrissey JP, Ellis AR. Targeting trauma-related interventions and improving outcomes for women with co-occurring disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 35:147-58. [PMID: 17999175 DOI: 10.1007/s10488-007-0150-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
Abstract
National attention to the effects of interpersonal trauma has led mental health systems to adopt policies on trauma-related services; however, there is a lack of clarity regarding targeting of these services. Data from the Women, Co-occurring Disorders and Violence Study (WCDVS) were reanalyzed by grouping women on their baseline PTSD and substance abuse presentation and assessing the differential response to an integrated mental health/substance abuse intervention. Treatment effects were largest for subgroups characterized by high levels of PTSD, whereas the effects for those in the low symptom group were near zero. These findings underscore the need for clinicians to conduct careful assessments of trauma-related symptoms and to target the most intensive trauma-related interventions to individuals with PTSD symptoms.
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Affiliation(s)
- Karen J Cusack
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
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