Dwayne Simpson, Ph.D., IBR Director
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
Innovation Planning and Implementation Issues for
Addiction Treatment Services
Joining the Dots:
Criminal Justice, Treatment & Harm Reduction
(25-27 March 2009, Kraków, Poland)
Innovation Planning and
Implementation Issues for
Addiction Treatment Services
Dwayne Simpson
Institute of Behavioral Research
Texas Christian University, Fort Worth
Principles of Drug Abuse Treatment
for Criminal Justice Populations:
A ResearchResearch-Based Guide (2006)
Highlights
• Assessment is 1st step
National Institute on
Drug Abuse (NIDA)
•
•
•
•
•
•
•
•
•
Tailor services to fit needs
Engage/retain offender in TX
Monitor progress in TX
Balance rewards & sanctions
Medications are part of TX
Target criminality issues
HIV/HepC risks
Mental health & HIV/HepC
re--entry
Plan for community re
CJ/TX Systems integration
© 2009
Copyright 2009 Texas Institute of Behavioral
Research at TCU, Fort Worth, Texas.
Web site: www.ibr.tcu.edu
Page 1 of 7
Dwayne Simpson, Ph.D., IBR Director
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
Innovation Planning and Implementation Issues for
Addiction Treatment Services
“Adaptive” Treatment
Assessments of Client Needs/Progress
Client Recovery Stages in Treatment
Treatment
Readiness:
Early
Engagement
• Needs
• Severity
• Motivation
• Participation
• Therapeutic
Relationship
Orientation: Treatment:
Phase 2a
Phase 1
Retention &
Continuing
Change
Oth
Other
Treatments
or
Support
Networks
Early
Recovery
FollowFollow-up
Outcomes
Changes in -• Thinking
• Acting
A ti
• Drug use
• Crime
• Social
Functions
Treatment:
Phase 2b
Re-Entry:
RePhase 3
Interventions (Behavioral & Cognitive)
Simpson, 1995, 2001, 2004, 2006
© 2009
Measures of Offender Functioning
Motivation
•
•
•
•
Problems
Desire for Help
TX Readiness
Needs/Pressures
Social
Functioning
•
•
•
•
Hostility
Risk Taking
Social Support
Social
Desirability
Psychological
Functioning
•
•
•
•
Self Esteem
Depression/Anxiety
Decision Making
Expectancy
Criminal
Thinking
•
•
•
•
•
•
Entitlement
Justification
Irresponsibility
Power Orientation
Cold Heartedness
Rationalization
Treatment
Engagement
•
•
•
•
Satisfaction
Rapport
Participation
Peer Support
Joe et al, 2002; Simpson, 2004 (JSAT): Simpson & Knight, 2007 (CJB)
Copyright 2009 Texas Institute of Behavioral
Research at TCU, Fort Worth, Texas.
Web site: www.ibr.tcu.edu
© 2009
Page 2 of 7
Dwayne Simpson, Ph.D., IBR Director
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
Innovation Planning and Implementation Issues for
Addiction Treatment Services
Assessing Client Needs and
Progress During Treatment
Stages of Treatment
Early
y
Engagement
Treatment
Readiness:
• Participation
• Therapeutic
Relationship
• Needs
• Severity
• Motivation
Early
y
Recovery
Intake
Interview
Motivation
(from CEST)
Engagement
(from CEST)
Engagement
(from CEST)
(eg,
eg, ASI)
Psychological
(from CEST)
Psychological
(from CEST)
Psychological
(from CEST)
Background
Risk Info
Social
(from CEST)
Social
(from CEST)
Social
(from CEST)
Fam/Friends
Networks
Criminal
Thinking
Thinking((CTS)
CTS)
Fam/Friends
Networks
Criminal
Thinking
Thinking((CTS)
CTS)
Short ID &
Retention
& Change
Changes in
• Thinking
• Acting
© 2009
“TCU Mapping” Interventions for
Adaptive Treatment Planning
Stages of Treatment
Treatment
Readiness:
Early
y
Engagement
Early
Recovery
• Needs
• Severity
• Motivation
• Participation
• Therapeutic
Relationship
Changes in
• Thinking
• Acting
Orientation
Treatment A
Treatment B
G tti
Getting
P
Preparing
i
Motivated for Change
Using Client Mapping
Assessments Care Plans
R
Reducing
d i
Unlocking
Anger
Thinking
CM/Reward
Strategies
Mapping
Journey
Better
B tt
Comm
Retention
& Change
Re--Entry
Re
B ildi
Building
Networks
Workshop Workshop
for Women for Men
Downward
Spiral
“TCU Mapping-Enhanced Counseling”
Mapping
’12 Steps’
HIV Ri
Risk
k
Reduction
Parenting
Skills
Transition
to Re
Re--entry
© 2009
Copyright 2009 Texas Institute of Behavioral
Research at TCU, Fort Worth, Texas.
Web site: www.ibr.tcu.edu
Page 3 of 7
Dwayne Simpson, Ph.D., IBR Director
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
Innovation Planning and Implementation Issues for
Addiction Treatment Services
Innovation Implementation
Services Infrastructure
Organizational Infrastructure
1. Treatment process/dynamics?
2. Needs/progress assessments?
3. Therapeutic interventions?
1. Program needs/resources?
2. Structure/functioning?
3. Readiness for changes?
Stages of Implementation Process
1.Training
1.
Training
•Relevance
•Accessible
•Accredited
A. Decision
•Leadership
•Quality/Utility
•Adaptability
2.Adoption
2.
Adoption
B. Action
•Capacity
•Satisfaction
•Resistance
3.Implementation
3.
Implementation
•Effectiveness
•Feasibility
•Sustainability/Cost
4.Practice
4.
Practice
Improvement
• Outcomes
• Services
• Budget
Staff
Program
Costs
Attributes
Climate
Organizational Readiness & Functioning
Motivation Resources
Simpson, 2002; Simpson & Flynn, 2007 (Special Issues of JSAT); Simpson, in press
© 2009
Organizational Readiness for Change (ORC)
Motivation:
Motivation:
• Program Needs
• Training Needs
• Pressures
ORC
Scales
Resources::
Resources
•
•
•
•
Offices/Staffing
Training
Equipment
Supervision/Mgmt*
Staff
Attributes::
Attributes
• Growth
•
•
•
•
Efficacy
Influence
Adaptability
Satisfaction*
“Better
organizations”
provide “better
services”
Climate:
Climate:
•
•
•
•
•
•
Mission
C
Cohesion
h i
Autonomy
Communication
Stress
Open to Change
Simpson, 2002; Lehman et al, 2002 ; Simpson & Flynn, 2007 (JSAT)
Copyright 2009 Texas Institute of Behavioral
Research at TCU, Fort Worth, Texas.
Web site: www.ibr.tcu.edu
© 2009
Page 4 of 7
Dwayne Simpson, Ph.D., IBR Director
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
Innovation Planning and Implementation Issues for
Addiction Treatment Services
Climate: Cohesion of Staff
(Scale scores range = 1010-50)
Lowest
Ready for Change?
23
25%
Norm
75%
Norm
50% of
Programs
35
Highest
Similar for
other ORC
measures
UK
45
45 Programs (ITEP/BTEI Projects)
NTA ITEP/BTEI Projects (2006-07); Simpson et al., In Prs (JSAT)
© 2009
Program X Scores (with 25
25--75% ORC Norms)
50
45
Needs
Resources
Staff Attributes
Organizational Climate
Chances of successful “implementation”?
40
35
30
25
20
15
10
75th %tile
25th %tile
Group X
TCU Organizational Readiness for Change (ORC-S) Scores
Simpson & Dansereau, 2007 (Science & Practice Perspectives)
© 2009
Copyright 2009 Texas Institute of Behavioral
Research at TCU, Fort Worth, Texas.
Web site: www.ibr.tcu.edu
Page 5 of 7
Dwayne Simpson, Ph.D., IBR Director
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
Innovation Planning and Implementation Issues for
Addiction Treatment Services
TCU Collaborators in NIDA Projects
• TX Resources
• Effectiveness
• Implementation
• Costing Tools
England
© 2009
“Chain of Evidence” for Change
12 Months
Before
4-6 Months
Before
Strategic
Planning
Training
4-6 Months
After
6-9 Months
After
12 Months
After
Program
Staff
Program
Clients
Program
Staff
Innovation
A
Innovation
Program
Staff
Program
Staff &
Clients
Needs
B
Innovation
C
Functioning
Evaluation
Changes
Functioning
Functioning
(ORC
ORC--1)
(ORC/CEST--1))
((ORC/CEST
((WEVAL))
(WAFU)
(CEST--2))
((CEST
(ORC
ORC--2)
1.
Is there staff
agreement on
innovation
needs? What
are they?
2.
Is program
functioning
related to
innovation
readiness?
4.
Is trial
implementation
related to
staff training
& barriers?
5.
Do CLIENT
RATINGS of
program
services
improve?
6.
Do staff
perceptions
of program
needs change
over time?
3.
Is quality
of training
related to
adoption
decisions?
Simpson, Joe, & Rowan-Szal, 2007 (Special Issue of JSAT)
Copyright 2009 Texas Institute of Behavioral
Research at TCU, Fort Worth, Texas.
Web site: www.ibr.tcu.edu
© 2009
Page 6 of 7
Dwayne Simpson, Ph.D., IBR Director
Innovation Planning and Implementation Issues for
Addiction Treatment Services
1st Conference of the Connections Project:
“Joining the Dots: Criminal Justice, Treatment and
Harm Reduction”
(25-27 March 2009, Kraków, Poland)
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