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Effectiveness Bank Alcohol Treatment Matrix

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Organisational functioning

Key studies on the how the functioning of treatment organisations affects implementation and effectiveness. Learn to see the organisational context as part of the treatment, about two evidence-based US quality improvement resources, and consider what makes treatment services engaging and whether they should extend that engagement into long-term continuing care.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Chronic care for chronic conditions (2002). Alternative source. Truly treating addiction of the kind seen by many treatment services as analogous to a chronic disease, demands continuing care which partners with and is attractive to and manageable by the patient, and is evaluated by what happens during treatment. For discussion click here and scroll down to highlighted heading.

S Goal-oriented, well organised and supportive workplaces maximise patient progress (1998). US services which emphasised mission-oriented good organisation, were clear what they expected from staff, and which engaged their staff, also had more engaged patients who made greater progress and were more likely take up aftercare. Similar study (1997) from same research stable found patient participation and outcomes best in services which communicate high expectations for patient functioning, emphasise clear rules and procedures, and have a strong psychosocial treatment orientation. For discussion click here or here and scroll down to highlighted headings.

K UK services open to change have more engaged patients (2009). Clients engaged best when services fostered communication, participation and trust among staff, had a clear mission, but were open to new ideas. In the USA feeding back scores from the organisational health assessment questionnaire used in this study has been found to motivate agencies to improve. For related discussions click here, here or here, and scroll down to highlighted headings.

K Place your agency in front of a potentially unflattering mirror (2007). Free source at time of writing. US study found that feeding back scores from the organisational health questionnaire used in a British study motivated less well functioning agencies to commit to an improvement programme.

K Organisational correlates of post-treatment drug use (2008). Using advanced methods and large sample of services, this US study asked what makes for an effective treatment agency. Being constrained by funders in terms of services and ability to individualise treatments was the clearest negative factor, quality accreditation the clearest positive.

K Few extra benefits from integrating addiction case management with primary care (2013). Disappointing results of first randomised trial of an explicit chronic care management model for drug dependent patients were perhaps due to addiction treatment not being delivered at the clinic but by linkage to other services, which made little difference to whether patients engaged in treatment. For discussion click here and scroll down to highlighted heading.

K Organisational features which help improvement initiatives ‘stick’ (2017). Alternative source at time of writing. Follow-up of a US trial of the ‘improvement collaborative’ model developed by the US NIATx quality improvement resource, investigating what is about some treatment organisations which helps sustainably embed the process in the service’s operations. For discussion click here and scroll down to highlighted heading.

R Policy strategies for improving outcomes (2011). Two of the world’s most respected addiction researchers also with top-level policy experience explore the evidence that patients’ prospects are improved by organisational changes like strengthening managerial capacity and business practices and submitting the organisation to external scrutiny. For related discussion click here and scroll down to highlighted heading.

R Organisational dynamics of the change process (2011). US review structures findings from the most comprehensive and systematic attempt yet (see studies 1 2 from the same team) to map the processes involved in effective treatment, including the organisational dynamics of implementing and sustaining innovations. As in an study and guidance from England, openness to change (“general readiness to embrace innovation”) emerges as important quality. For discussion click here and scroll down to highlighted heading.

R Implementing continuing care interventions (2011). How to ensure patients who need it receive long-term care or aftercare. Since “People treated for substance use often remain precariously balanced between recovery and relapse”, argues for “Assertive linkage to continuing care” and efforts to enhance engagement and retention in recovery resources such as mutual aid groups. Another review found evidence supporting the direct and proactive provision of aftercare services. Related guidance below. For discussion click here and scroll down to highlighted heading.

G Clinical governance in drug treatment ([English] National Treatment Agency for Substance Misuse, 2009). Guidance for providers and commissioners on establishing systems to deliver and demonstrate that the quality and safety of their services are of a high standard that is continually improving.

G English inspectorate’s criteria for quality services ([English] Care Quality Commission, 2015). Official inspectorate of health and social care services ask five key questions of substance use services: whether they are safe, effective, caring, responsive to people’s needs, and well-led. Says governance and management should aim for a service which delivers “high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture”. More on these criteria in appendices.

G Quality standards for alcohol and drug services ([Irish] Health Service Executive and Ana Liffey Drug Project, 2013). Update adopted by the Irish government of the QuADS standards developed for UK drug and alcohol services. Consists of a checklist of practices which for different types of services constitute quality in management, service delivery, and upholding service users’ rights.

G English drug services define their own quality standards (2016). From bodies representing the addictions treatment sector in England, standards developed after consultation and piloting with services. Designed to guide services in assessing how they support people into and through recovery and the quality of vital aspects of their organisations. At web page find also an implementation guide for these standards and standards for residential rehabilitation.

G Strategies to promote continuing care (2009). Expert US consensus on practical strategies to promote aftercare/continuing care based on review of principles of addiction treatment. Related review above. For related discussion click here and scroll down to highlighted heading.

G Assessing readiness for change and the implementation process ([US] Substance Abuse and Mental Health Services Administration, 2009). Practical, hands-on guide to how to assess an organisation’s capacity to identify priorities, implement changes, evaluate progress, and sustain quality-improvement programmes, and how to implement these programmes.

G Theory into practice strategies ([Australian] National Centre for Education and Training on Addiction, 2005). From the world’s leading workforce development agency for the addictions field. Chapter 7 focuses on the organisational factors which impede or promote change and how to manage them. For discussion click here and scroll down to highlighted heading.

G Assessing workforce knowledge, skills and ability (NHS Health Scotland, 2009). Desired competencies and assessing the training needs of Scotland’s substance misuse workforce at all levels, from generic workers who deal peripherally with the issue to specialists. Though mainly for commissioners and local areas, says treatment organisations may also want to use the guide to assess training needs of their employees.

G Organisational features underlying successful improvement programmes ([US] NIATx, accessed 2018). Web-based service supported by US government, whose model for improving addiction treatment services is based on five principles such as understanding and involving the customer and seeking ideas from other fields. See also these case studies of the principles’ roles in improving US services and the Sustainability Model developed with the British NHS to help services choose and implement sustainable improvement projects. Specific aims include cutting waiting times and the number of ‘no-shows’, for which see cell C2. Related study above. For discussion click here and scroll down to highlighted heading.

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For subtopics go to the subject search page and hot topic on why some treatment services are more effective than others.

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