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Johnson K, Collins D, Wandersman A. Developing a sustainability readiness strategy for health systems: Toolkit, interactive tools, and virtual support system. EVALUATION AND PROGRAM PLANNING 2023; 97:102241. [PMID: 36702007 DOI: 10.1016/j.evalprogplan.2023.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/08/2022] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
While the literature strongly supports the need for sustainability of evidence-based interventions (EBIs), we present a review of the literature that indicates only three articles discuss a health-focused sustainability strategy. The aims of our sustainability readiness strategy (SRS) are to increase infrastructure capacity and EBI advocacy to impact the level of sustainability readiness. In this article, we describe the development of an evidence-informed promising practice sustainability readiness strategy (SRS) with three evidence-based components. This strategy: 1) is based on an adaptation of the Getting To Outcomes® (GTO) evidence-based implementation process, 2) includes a logic model with documented evidence of the connection between targeted readiness factors and sustainability outcomes, and 3) describes resources considered necessary to support implementation of the readiness strategy, namely a step-by-step Toolkit, Excel™ Tools, webinar coaching and evaluation guides, and a coaching and evaluation training guide. The national SRS survey results are presented. Lessons learned and future dissemination and implementation plans are described.
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Affiliation(s)
- Knowlton Johnson
- Pacific Institute for Research and Evaluation Louisville Center, 401 West Main Street, Suite 2100, Louisville, KY 40202, USA.
| | - David Collins
- Pacific Institute for Research and Evaluation Louisville Center, 401 West Main Street, Suite 2100, Louisville, KY 40202, USA.
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Horák M, Somerlikova K, Kocarova R, Verter N, Aldama Gonzalez HS, Cruz de Souza Tronco M. Effective factors of addiction treatment communities in Peru, Nicaragua and Czechia. THERAPEUTIC COMMUNITIES 2021. [DOI: 10.1108/tc-06-2020-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to explore the effective factors that influence the treatment of drug addiction in therapeutic communities (TCs) and to determine its essential elements in the Peruvian, Nicaraguan and Czech context.
Design/methodology/approach
The qualitative data were collected during semi-structured interviews with inpatients/clients of seven TCs based in Peru (Takiwasi), Nicaragua (Centro de Especialiades en Adicciones, Centro de Rehabilitación del Alcohólico y Adicto a Otras Drogas and Albergue de Miembros Adictos en Recuperación) and the Czech Republic (Renarkon, Sejrek and Kladno-Dubi). All 90 interviews were manually transcribed, and content analysis was performed. Codes were created using the grounded theory method.
Findings
The effective factors of TC, treatment in Peru, Nicaragua and Czechia are identical in conditions such as the presence of a personal therapist, the use of psychotherapy and the importance of group cohesion. In Peru, the administration of medicinal plants and diet was perceived as a principal part of the treatment. Nicaraguan TCs were specific for practicing 12 steps. In Czechia, an emphasis is put on the therapeutic program, workshops and leisure activities. Spirituality and religion play a main role in the Peruvian and Nicaraguan TCs only.
Originality/value
The current study presents a unique insight into the factors considered effective by inpatients/clients of TCs in different socio-cultural contexts.
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Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2018; 47:140-147. [PMID: 30017036 DOI: 10.1016/j.rcp.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/18/2017] [Accepted: 01/29/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. DESIGN A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. METHODS A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. RESULTS Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. CONCLUSIONS The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.
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Gómez-Restrepo C, Maldonado P, Rodríguez N, Ruiz-Gaviria R, Escalante MÁ, Gómez RÁ, de Araujo MR, de Oliveira ACS, Rivera JSC, García JAG, Ferrand MP, Blitchtein-Winicki D. Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:53. [PMID: 29262838 PMCID: PMC5738167 DOI: 10.1186/s13011-017-0129-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 10/16/2017] [Indexed: 11/15/2022]
Abstract
Background In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction. Methods Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs. Results Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were “Requesting a professional qualification to former addicts that belonged to the program” and “Work as part of the therapeutic program”. Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws. Conclusion The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Department of Clinical Epidemiology and Biostatistics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia.
| | | | - Nelcy Rodríguez
- Department of Clinical Epidemiology and Biostatistics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Rafael Ruiz-Gaviria
- Department of Clinical Epidemiology and Biostatistics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Miguel Ángel Escalante
- Unity of Epidemiological Studies in Mental Health, Psychology Faculty, National University of Cordoba, Cordoba, Argentina
| | - Raúl Ángel Gómez
- Unity of Epidemiological Studies in Mental Health, Psychology Faculty, National University of Cordoba, Cordoba, Argentina
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Abadi MH, Shamblen SR, Courser M, Johnson KW, Thompson K, Young L, Browne T. Gender differences in Afghan drug-abuse treatment: an assessment of treatment entry characteristics, dropout, and outcomes. ETHNICITY & HEALTH 2014; 20:453-473. [PMID: 24920072 DOI: 10.1080/13557858.2014.921898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The current study examines gender differences in drug-abuse treatment (DAT) entry, dropout, and outcomes in seven DAT centers in Afghanistan. This is the first study to examine gender differences in DAT programming in Afghanistan. DESIGN A prospective cohort design of 504 women and men in seven DAT centers in Afghanistan was used in this study and the analyses examined whether gender differences exist for patients (1) at treatment entry, (2) at treatment dropout, and (3) for treatment outcomes. RESULTS Gender differences were found at baseline for patient characteristics, drug use, crime, and social and occupational functioning. Results showed a trend that women remained in treatment longer than men. Looking at gender differences in treatment success, results showed greater reductions in drug use and crime, and greater social functioning among women. CONCLUSION Results provide preliminary evidence for potential treatment success of women-tailored DAT programming in Afghanistan. Results also indicate that DAT appears to be successful among Afghan men; however, lower positive outcomes for men when compared to women suggest that more efforts should focus on tailoring DAT programming to the specific needs of Afghan men as well. Study limitations are addressed, and important policy implications are discussed.
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Sadir N, Shojaei M, Moadab K, Abbasi R, Bahrampour A, Nakhaee N. Outcome evaluation of therapeutic community model in iran. Int J Health Policy Manag 2014; 1:131-5. [PMID: 24596852 DOI: 10.15171/ijhpm.2013.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 06/16/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Evaluation of treatment programs in addiction field is a prerequisite to improve the quality of care. This study aimed to investigate the effectiveness of Therapeutic Community (TC) program in Iran. METHODS Individuals who had voluntarily enrolled in the TC center within a period of seven years, from early 2005 to late 2011, entered the study. Those who successfully completed the 14-week residential course were considered as 'completers'. They were subsequently called in for urine test and interviews using Maudsley Addiction Profile. Urine test was conducted to determine if they were positive for heroin, opium, methadone, methamphetamine, bupronorphine, hashish, and tramadol. RESULTS A number of 378 individuals with mean (±SD) age of 32.5 ± 7.8 enrolled in the TC program during the study period, 240 individuals of whom completed the 14 weeks course (69.0%). At the end of the sixth year, 22% of the participants were in abstinence. Physical and mental health in abstainers proved to be of better conditions than those of non-abstainers (P<0.05). CONCLUSION Considering the TC outcome in other countries, it seems that TC maintains an acceptable effectiveness in Iran. Prospective controlled studies are warranted to investigate the outcomes in more details.
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Affiliation(s)
- Nasrindokht Sadir
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Reza Abbasi
- Kerman Social Security Organization, Kerman, Iran
| | - Abbas Bahrampour
- Research Center for Social Determinants of Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Johnson KW, Shamblen SR, Courser MW, Young L, Abadi MH, Browne T. Drug use and treatment success among gang and non-gang members in El Salvador: a prospective cohort study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:20. [PMID: 23734635 PMCID: PMC3682862 DOI: 10.1186/1747-597x-8-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/08/2013] [Indexed: 11/10/2022]
Abstract
Background This article focuses on examining drug abuse treatment (DAT) in El Salvador highlighting gang vs. non-gang membership differences in drug use and treatment outcomes. Methods Cross-sectional and prospective cohort designs were employed to examine the study aims. The 19 centers that met the study’s inclusion criteria of one year or less in planned treatment offered varying treatment services: individual, group, family, and vocational therapy, dual diagnosis treatment, psychological testing, 12-step program, and outreach and re-entry aftercare. Most directors describe their treatment approach as “spiritual.” Data were collected from 625 patients, directors, and staff from the 19 centers at baseline, of which 34 patients were former gang members. Seventy-two percent (72%) of the former patients (448) were re-interviewed six-months after leaving treatment and 48% were randomly tested for drug use. Results Eighty-nine percent (89%) of the DAT patients at baseline were classified as heavy alcohol users and 40% were using illegal drugs, i.e., crack, marijuana, cocaine, tranquilizers, opiates, and amphetamines. There were large decreases after treatment in heavy alcohol and illegal drug use, crime, and gang related risk activities. Gang members reported illegal drug use, crime, and gang related risk activity more than non-gang members, yet only 5% of the study participants were gang members; further, positive change in treatment outcomes among gang members were the same or larger as compared to non-gang members. Conclusions Alcohol use is the drug of choice among DAT patients in El Salvador with gang member patients having used illegal drugs more than non-gang members. The study shows that DAT centers successfully reduced the use of illegal drugs and alcohol among gang and non-gang members. Although our study could not include a control group, we believe that the DAT treatment centers in El Salvador contributed to producing this treatment success among former patients. These efforts should be continued and complemented by funding support from the Salvadoran government for DAT centers that obtain certification. In addition, tailored/alternative treatment modalities are needed for gang members in treatment for heavy drinking.
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Affiliation(s)
- Knowlton W Johnson
- Pacific Institute for Research and Evaluation, Inc,, 300 S. Fourth Street, Louisville, KY 40208, USA.
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Malivert M, Fatséas M, Denis C, Langlois E, Auriacombe M. Effectiveness of therapeutic communities: a systematic review. Eur Addict Res 2012; 18:1-11. [PMID: 21997500 DOI: 10.1159/000331007] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/19/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Therapeutic communities (TCs) are drug-free residential settings, focused on psychosocial rehabilitation. While TCs are considered an effective method, the bulk of the research evidence is from poorly controlled studies. The goal of this study was to evaluate TC effectiveness in terms of abstinence and to determine if there were predictive factors of abstinence. METHODS The search used Medline up to January 30, 2011 and was based on a systematic review method. Studies on retention in treatment and/or substance use were considered. RESULTS Of the 321 studies retrieved from Medline, 12 met selection criteria including overall 3,271 participants from 61 TCs. On average, subjects stayed in TC a third of the planned time. The completion rate ranged from 9 to 56%. All studies showed that substance use decreased during TC, but relapse was frequent after TC. Treatment completion was the most predictive factor of abstinence at follow-up. Surprisingly, psychiatric comorbidities did not appear associated with relapse or with dropout. CONCLUSIONS There was a drop in consumption after TC, but long-lasting benefits were uncertain. Further studies are needed in order to compare the efficacy of TC programs and other types of treatment settings for substance-related disorders.
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Affiliation(s)
- Marion Malivert
- Addiction Psychiatry, Laboratoire de psychiatrie et CNRS-USR-3413-Sanpsy, Université Bordeaux Segalen, Bordeaux, France
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