The limited availability of medication-assisted treatment has created a treatment gap leaving man... more The limited availability of medication-assisted treatment has created a treatment gap leaving many opioid dependent individuals without access to appropriate treatment. Survey data from a national random sample of 545 addictions physicians with waivers to provide buprenorphine treatment under The Drug Addiction Treatment Act of 2000 are presented. During the first year, an estimated 63,204 opioid dependent patients were treated with buprenorphine; many were dependent on prescription opioids and were new to drug treatment. Prescribing physicians reported high treatment effectiveness and patient satisfaction, with minimal adverse reactions or evidence of diversion. However, many waivered physicians had not provided buprenorphine treatment. Prescribers identified challenges such as induction logistics, recordkeeping requirements, the 30-patient limit, DEA involvement, and limited patient compliance. Buprenorphine treatment could potentially reduce the treatment gap by providing safe and effective treatment for opioid dependence and by attracting patients who do not typically seek care at opioid treatment programs.
Journal of Vascular and Interventional Radiology, 2002
The Legs For Life(R) National Screening and Awareness Program for Peripheral Vascular Disease (PV... more The Legs For Life(R) National Screening and Awareness Program for Peripheral Vascular Disease (PVD) was launched in 1999. A critical component of the screening program was an independent evaluation to provide additional information about the results of the program. This evaluation considers the health education impacts of the screening program; participants' knowledge about appropriate providers; and some of the outcomes associated with the program. The evaluation is based on a representative sample of 700 individuals who participated in the screening program and responded to a six-page closed-ended mail questionnaire 6 months after the screening. The sample was drawn in a two-stage cluster. A sample of 1,000 individuals was drawn using random selection of low-risk participants and oversampling of all high- and medium-risk participants from 22 sites. More than 80% of the respondents remembered the name of the test (ankle-brachial index) given during the screening program. More than half the respondents reported being informed during the screening that leg pain when walking was a symptom of PVD, and 40% reported being told that numbness in the leg was a symptom. The majority of respondents were able to identify ways to prevent or slow the progression of PVD, whereas just under 50% were able to identify those individuals that would be at higher risk for PVD. Respondents most frequently identified vascular surgeons (42%), family or primary care physicians (22%), and cardiologists (19%) as the type of doctor to see for PVD treatment, whereas only 4.8% of screening participants recognized interventional radiologists as specialists appropriate to dealing with PVD. Evidence from participants in the Legs For Life(R) National Screening Program suggests that the program has met its initial goals of education, identification, and treatment for those identified with PVD. While many specialties manage this condition, the evaluation indicates there is much to be done in increasing the awareness of interventional radiologists and their role in the diagnosis and treatment of PVD.
Retaining clients in treatment who are homeless presents a particular challenge for substance abu... more Retaining clients in treatment who are homeless presents a particular challenge for substance abuse treatment providers. A National Institute on Alcohol Abuse and Alcoholism Cooperative Agreement Program offered the first opportunity to systematically study program retention in a multisite study of interventions for homeless persons with alcohol and other drug problems. This article presents results from analyses conducted across 15 interventions implemented at 8 Cooperative Agreement sites. Both qualitative and quantitative data were collected and analyzed. Key findings were that (a) retention problems with homeless clients are as or more pervasive than in the general addicted population; (b) the provision of housing increases retention, but the increases tend to be nullified when the housing is bundled with high-intensity services; (c) homeless clients leave treatment programs for a multitude of reasons; and (d) midcourse corrections to increase retention are frequently successful. The discussion focuses on service components related to retention, the importance of attending to phase transitions, and the importance of being programmatically responsive when serving this population.
Like measures of outcome, measures of implementation are most useful and analytically powerful wh... more Like measures of outcome, measures of implementation are most useful and analytically powerful when measured at client-level and are quantitative. However, high-quality, individual-level, quantitative service utilization data can be expensive, intrusive, or otherwise impractical to obtain. Cruder data—for example, presence versus absence of a given service—are often more feasible to collect, as well as more likely to be available. Consequently, evaluators can benefit by finding ways to better exploit such data at the analysis phase to compensate for shortcomings at the collection phase. This article documents one such instance in which this was done. Specifically, it describes how quantitative, client-level implementation scales were derived from qualitative (categorical) data and used to support a cross-site synthesis of implementation and outcome analyses in a multisite evaluation. It also suggests additional scenarios in which quantitative implementation scales might be derived form qualitative services data.
It is generally believed that homeless individuals—particularly those with substance abuse proble... more It is generally believed that homeless individuals—particularly those with substance abuse problems or mental illness—are unable to access the full range of available benefits and com munity services on their own. In recent years, community service providers have increasingly looked toward case management as the intervention of choice for solving this problem. Yet the evaluation findings of the National Institute on Alcohol Abuse and Alcoholism Community Demonstration Program, which included three case management projects, showed few clear indications of case management effectiveness. The results of these studies—which focused on homeless clients with alcohol and other drug problems—are consistent with studies of case management services for the homeless mentally ill. This article identifies several phenom ena that potentially explain the apparent lack of positive effects and suggests that the reasons for negative findings may lie as much with the evaluations as with the interventions. These phenomena include bias due to differential attrition from measurement, lack of intervention intensity, lack of distinction between groups, contextual factors, and additional design and measurement issues. Suggestions for improving future evaluations of case management effec tiveness are offered.
Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered a question... more Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered a questionnaire made up of scenarios depicting ingratiation tactics directed toward three types of targets (parents, teachers, or peers). The children, 22 of whom were diagnosed as learning disabled, were asked to rate the social desirability of each tactic. Learning disabled and nondisabled children judged the social desirability of the items similarly. The children's judgments were then compared with adult judgments of the social desirability of the same items obtained in a previous study. It was found that children and adults both judged tactics in the context of target or setting, and that they appeared to agree about the desirability of particular tactics directed toward particular targets.
Abstract. Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered ... more Abstract. Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered a questionnaire made up of scenarios depicting ingratiation tactics directed toward three types of targets (parents, teachers, or peers). The children, 22 of whom were diagnosed as learning disabled, were asked to rate the social desirability of each tactic. Learning disabled and nondisabled children judged the social desirability of the items similarly. The children's Judgments were then compared with adult Judgments of the social desirability of the same items obtained in a previous study. It was found that children and adults both Judged tac-tics in the context of target or setting, and that they appeared to agree about the desirability of particular tactics directed toward particular targets. There is now a substantial body of data demonstrating that learning disabled (LD) children are held in relatively low esteem by both adults and peers who are acquainted with them
Abstract. Three studies were conducted. In Study I, 272 children were in-dividually administered,... more Abstract. Three studies were conducted. In Study I, 272 children were in-dividually administered, via tape recordings, a questionnaire designed to assess their preferences for ingratiation tactics given particular targets. It was found that learning disabled children preferred ingratiation strategies which were judged less socially desirable by adults than those selected by non-learning disabled children. Additionally, scores on the questionnaire were not correlated with in-telligence test scores, but were correlated with the child's sociometric ratings from peers and teacher ratings of the child's academic and attentional com-petence. In Study II parents of learning disabled and nondisabled children were compared as to their ratings of the social desirability of various ingratiation tac-tics. While no differences were found which were attributable to parent dif-ferences, parents made reliable discriminations as to the social desirability of various tactics addressed to pa...
It is generally believed that homeless individuals—particularly those with substance abuse ... more It is generally believed that homeless individuals—particularly those with substance abuse problems or mental illness—are unable to access the full range of available benefits and com-munity services on their own. In recent years, community service providers have increasingly looked toward case management as the intervention of choice for solving this problem. Yet the evaluation findings of the National Institute on Alcohol Abuse and Alcoholism Community Demonstration Program, which included three case management projects, showed few clear indications of case management effectiveness. The results of these studies—which focused on homeless clients with alcohol and other drug problems—are consistent with studies of case management services for the homeless mentally ill. This article identifies several phenom-ena that potentially explain the apparent lack of positive effects and suggests that the reasons for negative findings may lie as much with the evaluations...
Many individuals contributed to this report. The authors are grateful to Teresa Brady, Mari Brick... more Many individuals contributed to this report. The authors are grateful to Teresa Brady, Mari Brick, Thomas Bartenfeld and other staff members at the CDC Arthritis Program for their guidance and thoughtful insights throughout the project. All data collection, analysis, and quality control for this task were supervised by Jennifer Berktold. Rachel Gaddes, Erika Bonilla, and Marguerite Beckley assisted in the research. Karin Davis developed and programmed the database. Joseph Sonnefeld and Lei Fan conducted the analysis in SAS (Version 9.2;
Fifty-eight children (mean age 11 years), 22 of whom were diagnosed as learning disabled, were ad... more Fifty-eight children (mean age 11 years), 22 of whom were diagnosed as learning disabled, were administered a questionnaire in which scenarios were presented involving various ingratiation tactics toward three types Of targets (parents, teachers, and peers) and were asked to rate each tactic as to its social desirability. Results indicated that the social desirability of the items were judged similarly by learning and nonlearning disabled children. Both children and adults judged tactics in the context of target or setting and appeared to agree as to the desirability cf particular tactics toward particular targets. Tables with statistical data are included. (SBH)
The limited availability of medication-assisted treatment has created a treatment gap leaving man... more The limited availability of medication-assisted treatment has created a treatment gap leaving many opioid dependent individuals without access to appropriate treatment. Survey data from a national random sample of 545 addictions physicians with waivers to provide buprenorphine treatment under The Drug Addiction Treatment Act of 2000 are presented. During the first year, an estimated 63,204 opioid dependent patients were treated with buprenorphine; many were dependent on prescription opioids and were new to drug treatment. Prescribing physicians reported high treatment effectiveness and patient satisfaction, with minimal adverse reactions or evidence of diversion. However, many waivered physicians had not provided buprenorphine treatment. Prescribers identified challenges such as induction logistics, recordkeeping requirements, the 30-patient limit, DEA involvement, and limited patient compliance. Buprenorphine treatment could potentially reduce the treatment gap by providing safe and effective treatment for opioid dependence and by attracting patients who do not typically seek care at opioid treatment programs.
Journal of Vascular and Interventional Radiology, 2002
The Legs For Life(R) National Screening and Awareness Program for Peripheral Vascular Disease (PV... more The Legs For Life(R) National Screening and Awareness Program for Peripheral Vascular Disease (PVD) was launched in 1999. A critical component of the screening program was an independent evaluation to provide additional information about the results of the program. This evaluation considers the health education impacts of the screening program; participants' knowledge about appropriate providers; and some of the outcomes associated with the program. The evaluation is based on a representative sample of 700 individuals who participated in the screening program and responded to a six-page closed-ended mail questionnaire 6 months after the screening. The sample was drawn in a two-stage cluster. A sample of 1,000 individuals was drawn using random selection of low-risk participants and oversampling of all high- and medium-risk participants from 22 sites. More than 80% of the respondents remembered the name of the test (ankle-brachial index) given during the screening program. More than half the respondents reported being informed during the screening that leg pain when walking was a symptom of PVD, and 40% reported being told that numbness in the leg was a symptom. The majority of respondents were able to identify ways to prevent or slow the progression of PVD, whereas just under 50% were able to identify those individuals that would be at higher risk for PVD. Respondents most frequently identified vascular surgeons (42%), family or primary care physicians (22%), and cardiologists (19%) as the type of doctor to see for PVD treatment, whereas only 4.8% of screening participants recognized interventional radiologists as specialists appropriate to dealing with PVD. Evidence from participants in the Legs For Life(R) National Screening Program suggests that the program has met its initial goals of education, identification, and treatment for those identified with PVD. While many specialties manage this condition, the evaluation indicates there is much to be done in increasing the awareness of interventional radiologists and their role in the diagnosis and treatment of PVD.
Retaining clients in treatment who are homeless presents a particular challenge for substance abu... more Retaining clients in treatment who are homeless presents a particular challenge for substance abuse treatment providers. A National Institute on Alcohol Abuse and Alcoholism Cooperative Agreement Program offered the first opportunity to systematically study program retention in a multisite study of interventions for homeless persons with alcohol and other drug problems. This article presents results from analyses conducted across 15 interventions implemented at 8 Cooperative Agreement sites. Both qualitative and quantitative data were collected and analyzed. Key findings were that (a) retention problems with homeless clients are as or more pervasive than in the general addicted population; (b) the provision of housing increases retention, but the increases tend to be nullified when the housing is bundled with high-intensity services; (c) homeless clients leave treatment programs for a multitude of reasons; and (d) midcourse corrections to increase retention are frequently successful. The discussion focuses on service components related to retention, the importance of attending to phase transitions, and the importance of being programmatically responsive when serving this population.
Like measures of outcome, measures of implementation are most useful and analytically powerful wh... more Like measures of outcome, measures of implementation are most useful and analytically powerful when measured at client-level and are quantitative. However, high-quality, individual-level, quantitative service utilization data can be expensive, intrusive, or otherwise impractical to obtain. Cruder data—for example, presence versus absence of a given service—are often more feasible to collect, as well as more likely to be available. Consequently, evaluators can benefit by finding ways to better exploit such data at the analysis phase to compensate for shortcomings at the collection phase. This article documents one such instance in which this was done. Specifically, it describes how quantitative, client-level implementation scales were derived from qualitative (categorical) data and used to support a cross-site synthesis of implementation and outcome analyses in a multisite evaluation. It also suggests additional scenarios in which quantitative implementation scales might be derived form qualitative services data.
It is generally believed that homeless individuals—particularly those with substance abuse proble... more It is generally believed that homeless individuals—particularly those with substance abuse problems or mental illness—are unable to access the full range of available benefits and com munity services on their own. In recent years, community service providers have increasingly looked toward case management as the intervention of choice for solving this problem. Yet the evaluation findings of the National Institute on Alcohol Abuse and Alcoholism Community Demonstration Program, which included three case management projects, showed few clear indications of case management effectiveness. The results of these studies—which focused on homeless clients with alcohol and other drug problems—are consistent with studies of case management services for the homeless mentally ill. This article identifies several phenom ena that potentially explain the apparent lack of positive effects and suggests that the reasons for negative findings may lie as much with the evaluations as with the interventions. These phenomena include bias due to differential attrition from measurement, lack of intervention intensity, lack of distinction between groups, contextual factors, and additional design and measurement issues. Suggestions for improving future evaluations of case management effec tiveness are offered.
Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered a question... more Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered a questionnaire made up of scenarios depicting ingratiation tactics directed toward three types of targets (parents, teachers, or peers). The children, 22 of whom were diagnosed as learning disabled, were asked to rate the social desirability of each tactic. Learning disabled and nondisabled children judged the social desirability of the items similarly. The children's judgments were then compared with adult judgments of the social desirability of the same items obtained in a previous study. It was found that children and adults both judged tactics in the context of target or setting, and that they appeared to agree about the desirability of particular tactics directed toward particular targets.
Abstract. Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered ... more Abstract. Fifty-eight children drawn from schools in Pennsylvania and Illinois were administered a questionnaire made up of scenarios depicting ingratiation tactics directed toward three types of targets (parents, teachers, or peers). The children, 22 of whom were diagnosed as learning disabled, were asked to rate the social desirability of each tactic. Learning disabled and nondisabled children judged the social desirability of the items similarly. The children's Judgments were then compared with adult Judgments of the social desirability of the same items obtained in a previous study. It was found that children and adults both Judged tac-tics in the context of target or setting, and that they appeared to agree about the desirability of particular tactics directed toward particular targets. There is now a substantial body of data demonstrating that learning disabled (LD) children are held in relatively low esteem by both adults and peers who are acquainted with them
Abstract. Three studies were conducted. In Study I, 272 children were in-dividually administered,... more Abstract. Three studies were conducted. In Study I, 272 children were in-dividually administered, via tape recordings, a questionnaire designed to assess their preferences for ingratiation tactics given particular targets. It was found that learning disabled children preferred ingratiation strategies which were judged less socially desirable by adults than those selected by non-learning disabled children. Additionally, scores on the questionnaire were not correlated with in-telligence test scores, but were correlated with the child's sociometric ratings from peers and teacher ratings of the child's academic and attentional com-petence. In Study II parents of learning disabled and nondisabled children were compared as to their ratings of the social desirability of various ingratiation tac-tics. While no differences were found which were attributable to parent dif-ferences, parents made reliable discriminations as to the social desirability of various tactics addressed to pa...
It is generally believed that homeless individuals—particularly those with substance abuse ... more It is generally believed that homeless individuals—particularly those with substance abuse problems or mental illness—are unable to access the full range of available benefits and com-munity services on their own. In recent years, community service providers have increasingly looked toward case management as the intervention of choice for solving this problem. Yet the evaluation findings of the National Institute on Alcohol Abuse and Alcoholism Community Demonstration Program, which included three case management projects, showed few clear indications of case management effectiveness. The results of these studies—which focused on homeless clients with alcohol and other drug problems—are consistent with studies of case management services for the homeless mentally ill. This article identifies several phenom-ena that potentially explain the apparent lack of positive effects and suggests that the reasons for negative findings may lie as much with the evaluations...
Many individuals contributed to this report. The authors are grateful to Teresa Brady, Mari Brick... more Many individuals contributed to this report. The authors are grateful to Teresa Brady, Mari Brick, Thomas Bartenfeld and other staff members at the CDC Arthritis Program for their guidance and thoughtful insights throughout the project. All data collection, analysis, and quality control for this task were supervised by Jennifer Berktold. Rachel Gaddes, Erika Bonilla, and Marguerite Beckley assisted in the research. Karin Davis developed and programmed the database. Joseph Sonnefeld and Lei Fan conducted the analysis in SAS (Version 9.2;
Fifty-eight children (mean age 11 years), 22 of whom were diagnosed as learning disabled, were ad... more Fifty-eight children (mean age 11 years), 22 of whom were diagnosed as learning disabled, were administered a questionnaire in which scenarios were presented involving various ingratiation tactics toward three types Of targets (parents, teachers, and peers) and were asked to rate each tactic as to its social desirability. Results indicated that the social desirability of the items were judged similarly by learning and nonlearning disabled children. Both children and adults judged tactics in the context of target or setting and appeared to agree as to the desirability cf particular tactics toward particular targets. Tables with statistical data are included. (SBH)
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