Drug Treatment Matrix cell C2: Management/supervision; Generic and cross-cutting issues

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Society for the Study of Addiction web site

Society for the Study of Addiction

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Skills Consortium web site. Opens new window

Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

Drug Treatment Matrix

Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Management/supervision; Generic and cross-cutting issues

Key studies on the role of management and supervision across psychosocial and medical treatments of problem drug use. Highlights that “Manners Matter”, asks, “Is there anything more instructive than being the patient?”, explores the role of patient choice and preferences in treatment planning, and queries the ubiquitous stages of change model. See the rest of row 2 of the matrix for more on features common to psychosocial and medical treatments.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S Qualifications do not a counsellor make (1984). Whether counselled by ex-addicts, paraprofessionals or degreed professionals, patients at methadone maintenance and drug-free outpatient services did just as well, findings in line with later work indicating that for these kinds of roles formal qualifications and experience are not indicative of quality. More on recruitment below and in cell C2 of the Alcohol Treatment Matrix.

K First get the staffing right (2004). US study suggests that recruiting the ‘right’ clinicians who have not been trained in appropriate ways to relate to patients would be better than choosing the ‘wrong’ ones who have been, and the former gain most from training. More on recruitment above and in cell C2 of the Alcohol Treatment Matrix.

K Motivating aftercare (2007). US residential centre systematically applied simple prompts and motivators to substantially improve aftercare attendance and sustain recovery. See also later report (2008) from same study. For discussion click here and scroll down to highlighted heading.

K Try walking in their shoes (2008). When senior staff role-played the process of becoming a new client (a ‘walk-through’) at their own US substance use service, the resulting enlightenment helped halve waiting times and extend retention. See also this extension (2012) to the programme and this account (2007; free source at time of writing) of the ‘walk-through’ procedure. Walk-throughs are a key element in the NIATx quality improvement model; see document and web site listed below. For discussion click and scroll down to highlighted heading.

K Systematically link assessments to services (2005). In Philadelphia automatically linking problems identified at treatment intake to relevant local services transformed assessments from clinically redundant paperwork into a practical route to the ‘wrap-around’ care advocated to deepen and extend recovery. For discussion click and scroll down to highlighted heading.

K Responsiveness to patients’ needs means better outcomes (2010). Analysis based on over 3000 US clients found they stayed longer and did better at services which showed responsiveness to need by offering help to get them to treatment and organising needed ‘wrap-around’ services.

K You cannot treat an empty chair (2013; free source at the time of writing). Title is from a report of how 67 US substance use outpatient clinics used the NIATx quality improvement model to reduce ‘no-shows’ through reminder calls (had to be sensitively handled), cutting waiting times, increasing capacity (eg, extra hours), and psychosocial approaches to bolster engagement such as motivational interviewing. More on the NIATx model below and on its application above.

R How to generate evidence-informed practice ([Australian] National Centre for Education and Training on Addiction, 2008). Though they found few studies on substance use treatment, reviewers extracted valuable lessons from health promotion and medical care services on how to implement research-based innovations to improve treatment practice.

R Cycle of change model poor guide to intervention (2001). Its simplicity is beguiling, but can services trust Prochaska and DiClemente’s ubiquitous model to guide them in matching interventions to a client’s ‘stage of change’? This thorough but easy-reading review found little evidence to support this popular strategy. Since it was written not much has changed. For discussion click and scroll down to highlighted heading.

R Care enough to be personal but also to be systematic and persistent (2004). In seemingly mundane tasks like reminding patients of appointments and checking how they are doing after they leave, individualised and welcoming communications characterise retention-enhancing services. Systematising these procedures is not the antithesis of being caring, but a sign that the service cares enough to make the most of every contact. For discussion click and scroll down to highlighted heading.

R Tentative support for matching treatment to patient preferences (2016). The first review to evaluate shared decision-making and matching substance use treatment to patient preferences found some evidence that greater patient involvement in decisions has no negative impacts and can improve outcomes. For discussion click and scroll down to highlighted heading.

R Involving former problem substance users in promoting recovery (2014). For such a widely implemented and widely supported adjunct to formal treatment, the revelation from this review is how little evidence there is for involving former substance users in promoting recovery from problems similar to those they had experienced – a lack which may simply reflect the paucity of adequate research. However, on balance the evidence we do have is positive. Related UK and US supervision guidelines below.

G UK staff development toolkit ([English] National Treatment Agency for Substance Misuse, 2006). Recruitment, training and staff development, appraisals and supervision, exit interviews and more.

G Criteria for quality in substance use treatment in Scotland (Convention of Scottish Local Authorities and Scottish Government, 2014). Developed to ensure anyone looking to address their problem drug and/or alcohol use receives high-quality treatment and support that assists long-term, sustained recovery and keeps them safe from harm. Can act as a quality-assurance checklist for service managers.

G English inspectorate’s criteria for quality in substance use services ([English] Care Quality Commission, accessed 2020). Official inspector of health and social care services in England asks five key questions of specialist substance use services in the NHS and independent sectors, including “Is it well-led?”, assessed by questions such as “Is the culture centred on the needs and experience of people who use services?” More on what ‘well-led’ means in appendices to prior consultation.

G Assessing whether the workforce has the required knowledge, skills and ability (NHS Health Scotland, 2009). Desired competencies and assessing the training needs of Scotland’s substance use workforce at all levels, from specialists to generic workers who may deal with substance use only peripherally.

G Managing peer supporters ([UK] Substance Misuse Skills Consortium, 2015). Guidance from (now no longer operational) government-supported skills body for the substance use sector on how to manage current and former problem substance users who support and mentor other users through and out of treatment. Related review above and US guidelines below.

G Supervising peer supporters (2017). US checklist and training curriculum for evaluating and developing competence to supervise (ex-)substance using peers to promote recovery among a service’s patients. Related review and UK guidelines above.

G Managing non-residential programmes ([US] Substance Abuse and Mental Health Services Administration, 2006). US expert consensus on running outpatient, counselling and day-care substance use programmes, including strategies to meet “the challenges facing executives and the opportunities for employing available resources and skills to meet program goals”.

G Clinical supervision and professional development of counsellors ([US] Substance Abuse and Mental Health Services Administration, 2009). US expert consensus on supervision methods and models, including how these can address cultural, ethical and legal issues, and monitoring performance. Includes an implementation guide for administrators.

G Workforce development aid for managers ([Australian] National Centre for Education and Training on Addiction, 2005). Evidence-based strategies to address priority workforce development issues such as supervision, team building and performance appraisal, plus resources to help managers implement the strategies. Endorsed by the Australian government.

G Improving efficiency and capacity means more patients can be helped ([US] NIATx, accessed 2020). Web-based service based at University of Wisconsin and supported by US government. Offers practical strategies to improve the management of substance use treatment services. Objectives include reducing waiting times and the number of ‘no-shows’ and increasing admissions and retention; examples above (1 2).

G Implementing change ([US] Substance Abuse and Mental Health Services Administration, 2009). Guide for managers on how to assess an organisation’s capacity to identify priorities, implement changes, evaluate progress, and sustain effective programmes, and how to implement these programmes. Substantially draws on a broader review.

G US guide to matching type of treatment to the patient (American Society of Addiction Medicine, 2013). What the US professional body for addiction medicine society says are the world’s “most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions”. Helps decide what intensity and setting of care to offer and when to stop or change.

more Search for all relevant analyses or for subtopics go to the subject search page or hot topics on why some treatment services more effective than others, matching interventions to the patient’s ‘stage of change’, and individualising treatment. See also a reading list from a leading US analyst intended to help treatment services develop recovery-oriented programmes, and a resource list from the UK Substance Misuse Skills Consortium to (among other topics) help managers recruit and supervise staff, manage organisational change, and foster effective team working.

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