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Management/supervision; Generic and cross-cutting issues

The most important seminal and key studies on the role of management and supervision across therapy and medical treatment for drinking problems.

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 Organised caring transforms alcohol clinic (1970). Remarkable series of US studies from the late 1950s proved that an alcohol clinic’s intake and attendance can be transformed by being responsive to need and systematically and caringly keeping in touch with patients. See also slide presentation and video, which end by focusing on the featured studies.

S Alcoholics can learn to moderate their drinking (1973). Not the first, but the most incendiary paper to challenge the orthodoxy that abstinence must be the only treatment goal for dependent drinkers. See also second- (1976) and third-year (1978) follow-up results. This refutation (1982) based on a 10-year follow-up was itself refuted (1984) by the original authors. Discussion in bite’s Issues section.

S The abstinent alcoholic (1962). Classic description of the patient who has sustained abstinence but is nevertheless unhappy, unfulfilled and/or nervously hanging on – in this study from Connecticut alcohol clinics in the 1950s, they were the majority among the non-drinkers. Discussion in bite’s Issues section.

S Relapse-preventing social skills of counsellors can be identified in advance (1981). US study at an inpatient alcohol unit found strong links between the interpersonal qualities and skills exhibited by counsellors in response to written cameos of typical patient/family comments and how many of their patients later relapsed. Related study below. Discussion in bite’s Issues section.

K Identifying rapport-generating counsellors (2002). Responses to written counselling scenarios identified which counsellors would best generate retention-enhancing rapport at a Finnish outpatient alcohol clinic. Partial replication of US study above. Discussion in bite’s Issues section.

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. Discussion in bite’s Issues section.

K Try walking in their shoes (2008). When senior staff role-played the process of becoming a new client it helped halve waiting times and extend retention in US substance use services. 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. Discussion in bite’s Highlighted study section.

K “You cannot treat an empty chair” (2013). Title is from a report of how 67 US substance use outpatient clinics used the NIATx model to reduce ‘no-shows’ through reminder calls, cutting waiting times, increasing capacity (eg, extra hours), and psychosocial approaches to bolster engagement such as motivational interviewing.

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. Discussion in bite’s Issues section.

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

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. Discussion in bite’s Where should I start? section.

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, and that remains the case. Discussion in bite’s Issues section.

R Offer moderation as well as abstinence as a treatment goal (2013). Concludes that dependent drinkers can cut down, that treatments based on this goal are probably just as effective as abstinence-oriented approaches, and that allowing patients a choice improves outcomes. Discussion in bite’s Issues section.

G Inpectors’ criteria for quality substance use services ([English] Care Quality Commission, 2015). Official inspectors of health and social care services ask five key questions of specialist substance use services including, “Are they well-led?”, by which they mean that “leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.” More on what this means in appendices.

G UK staff development toolkit ([English] National Treatment Agency for Substance Misuse, 2003). Recruitment, training and staff development, appraisals and supervision, exit interviews and more. Discussion in bite’s Issues section.

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 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.

G Managing peer supporters (2015) Guidance from the UK Substance Misuse Skills Consortium on how to manage current and former problem substance users who support and mentor other users through and out of treatment.

G Improving efficiency and capacity means more patients can be helped ([US] NIATx, accessed 2014). Web-based service 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’ (see this example) and increasing admissions and retention (see this example).

G Managing non-residential programmes ([US] Substance Abuse and Mental Health Services Administration, 2006). US consensus guidance 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, how these can address cultural, ethical and legal issues, and performance monitoring. Includes an implementation guide for administrators.

G US guide to matching type of treatment to the patient (2013). From the American Society of Addiction Medicine, what the 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 change or cease offering it.

more This search retrieves all relevant analyses.
For subtopics go to the subject search page and hot topics on why some treatment services more effective than others, matching alcohol treatments to the patient, matching interventions to the client’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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