+ + Dwayne Simpson. Client Needs & Readiness Assessment. Brief Mapping- Intervention Modules. Service Organization Readiness for Change

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1 U.S. DISTINGUISHED INTERNATIONAL SCIENTIST COLLABORATION AWARD NATIONAL INSTITUTE ON DRUG ABUSE INTERNATIONAL PROGRAM Strategies for Change: Implementing Innovations for Dwayne Simpson What are ITEP and BTEI, and how are they interrelated? Psychosocial Services: Recovery and Life Skills (RELS) Brief Mapping- Intervention Modules Client Needs & Readiness Assessment + + Service Organization Readiness for Change ITEP BTEI SORC Simpson et al, 09 Page 1 of 10

2 Psychosocial Services: Recovery and Life Skills (RELS) Visual-representation Mapping Communication Motivation Readiness Thinking Decisions Behaviors Retention Short Forms Needs/Risks Motivation Psycho-Social SF SF SF Criminal Thinking Changes Coordinated assessments and brief interventions TCU Mapping: A Visual Representation Strategy 8 Grand kids Married & 3 Children Node-Link Mapping is core technique for ITEP/BTEI Manuals Planning and Implementation ti West Texas Fort Worth Texas Dwayne 2004 Lunch in London Prof of Psychology TCU Addiction Studies IBR (1962) Addiction Scientist NIDA Grants Effectiveness Process FU Outcomes IBR Web Internat l Scientist Award Meetings in Texas & UK ITEP & BTEI Innovation Implementation Ready to Chg Org Functioning Page 2 of 10

3 Tools from ITEP and BTEI for Recovery and Life Skills (RELS) 1. Conceptual framework for treatment process 2. Assessments of client functioning (CEST) 3. Manuals for mapping brief interventions: Motivation/Thinking Interventions (ITEP) Care Planning & Exit Planning (BTEI) 4. Publications growing for evidence-base 5. Field network of innovation early adopters 6. Implementation principles for organizations UK Addiction Services Services Documentation Data Networks Clients CJ t Systems Triage & Referral Process Harm Reduction Services Detox/Maintenance Services Psychosocial Recovery Services We need for more comprehensive strategies to help people who are STUCK in treatment Page 3 of 10

4 Adaptive Assessments of Client Needs/Progress Readiness: Needs-Risk Severity Motivation Referra als (Needs/Ris sks) Client Recovery Stages in Participation Therapeutic Relationship Retention & Continuing Change Recovery Changes in -- Thinking Acting Oh Other s or Support Networks Follow-up Outcomes Drug use Crime Social Functions Interventions (Behavioral & Cognitive) Simpson, 1995, 2001, 2004, 2006 TCU Mapping Interventions for Adaptive Process Stages of Readiness: Needs-Risks Severity Motivation Participation Therapeutic Relationship Recovery Changes in Thinking Acting Retention & Change Orientation A B Re-Entry EI P BTE ITE Getting Motivated Preparing for Change Reducing Unlocking Anger Thinking Better Comm Building Networks HIV Risk Reduction Using Client Mapping Assessments Care Plans Mapping Journey CM/Reward Strategies Workshop Workshop for Women for Men Parenting Skills Downward Spiral TCU Mapping-Enhanced Counseling Mapping 12 Steps Transition to Re-entryentry Page 4 of 10

5 Readiness Training Patient Patient Severity Readiness Program Staff Resources Climate Program Interventions Behavioral Family & Strategies Friends Recovery Program Participation Therapeutic Relationship Cognitive Strategies Behavioral Change Change Sufficient Retention Psycho-Social Change Social Skills Training Simpson, 2001 (Addiction) Personal Health Services Supportive Networks Drug Use Crime Social Relations Posttreatment Social Support Services D. Dwayne Simpson, Ph.D. IBR ABOUT IBR-TCU STAFF PUBLICATIONS PRESENTATIONS PROJECTS NEWSLETTERS OTHER LINKS WHAT S NEW SITE GUIDES: Evidence-Based Model DATOS Selected Presentations See Guide for New Visitors Guide to Intervention Manuals Guide to Assessment Forms Project Updates & Summaries Newsletters, Presentations, and Publications (Abstracts) Counseling Manuals IBR HOME PAGE A National Research Center EVIDENCE for addiction treatment studies MANUALS in community and correctional settings SUMMARY FORMS (over 600 free resource files available) TCU Mapping- EVIDENCE Enhanced Overview of Adaptive Counseling System & Conceptual Models Process Corrections- Based National Evaluations Organizational Readiness Assessment Fact Sheets (with norms) Visitors 600/day 30 mins Page 5 of 10

6 Assessing Client Needs and Progress During Stages of Readiness: Needs-Risks Severity Motivation Participation Therapeutic Relationship Recovery Changes in Thinking Acting Retention & Change Intake Interview (eg, ASI) Short ID & Background Risk Info Fam/Friends Networks Motivation Psychological Social Criminal Thinking(CTS CTS) Psychological Social Fam/Friends Networks e Psychological Social Criminal Thinking(CTS CTS) Short TCU Forms (with Feedback Charts) Measures of Client 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 Satisfaction Rapport Participation Peer Support Joe et al, 2002; Simpson, 2004 (JSAT): Simpson & Knight, 2007 (CJB) Page 6 of 10

7 TCU Short Forms for Client Assessments A. Client Drug Use and Crime Risk Forms: 1. TCU Drug Screen II (DRUG SCREEN II) 2. Global Risk Assessment (A/Y-RSKFORM) 3. Criminal History Risk Assessment (CRHSFORM) 4. Criminal Thinking Scales (CTSFORM) B. Client Health and Social Risk Forms: 1. Physical and Mental Health Status Screen (HLTHFORM) 2. Mental Trauma and PTSD Screen (TRMAFORM) 3. HIV/Hepatitis Risk Assessment (HVHPFORM) 4. Family and Friends Assessment (A/Y-FMFRFORM) C. Client Evaluation of Self and (CEST) Forms: 1. Needs and Motivation (MOTFORM) 2. Psychological Functioning (PSYFORM) 3. Social Functioning (SOCFORM) 4. (ENGFORM) 50% These are interrelated, and they CHANGE over time motivation and psychosocial scores for Client X Page 7 of 10

8 Evidence for Process Motivation Desire for Help Trt Readiness Criminal Thinking Orientation (CTS Scales) (n=998) Participation Rapport Satisfaction (CEST Scales) Self Esteem Depression Risk Taking Social Conscious Peer Support Social Support Client functioning improves over time, and the negative impact of high CTS is remediated by stronger engagement! Counselor Skills/Attributes Organizational Functioning Best, Day et al., 2009 (EAR); Joe et al., in press (JSAT) Innovation Implementation Organizational Infrastructure 1. Program needs/resources? 2. Structure/functioning? 3. Readiness for changes? Services Infrastructure 1. process/dynamics? 2. Needs/progress assessments? 3. Therapeutic interventions? Stages of Implementation Process 1.Training Relevance Accessible Accredited Motivation 2.Adoption A. Decision Leadership Quality/Utility Adaptability B. Action Capacity Satisfaction Resistance Resources Staff Program Attributes Climate Organizational Readiness & Functioning 3.Implementation Effectiveness Feasibility Sustainability/Cost Costs 4.Practice Improvement Outcomes Services Budget Simpson, 2002; Simpson & Flynn, 2007 (Special Issues of JSAT); Simpson, 2009 Page 8 of 10

9 Organizational Readiness for Change (ORC) Motivation: Program Needs Training Needs Pressures Resources: Offices/Staffing Training Equipment Supervision/Mgmt* Staff Attributes: Growth Efficacy Influence Adaptability Satisfaction* ORC Scales Better organizations provide better services Climate: Mission Cohesion Autonomy Communication Stress Open to Change Simpson, 2002; Lehman et al, 2002 ; Simpson & Flynn, 2007 (JSAT) Climate: Cohesion of Staff (Scale scores range = 10-50) Lowest Ready for Change? 23 25% Norm 75% Norm 50% of Programs 35 Similar for other ORC measures Highest UK 45 Programs (ITEP/BTEI Projects) 45 NTA ITEP/BTEI Projects ( ); Simpson et al., 2009 (JSAT) Page 9 of 10

10 Agency Needs/Pressures SN Staff Needs PN Program Needs TN Training Needs PC Pressures Change 50 Resources OFF - Offices 45 STF - Staffing TRN - Training EQP Equipment 40 INT Internet t SUP - Supervision 35 Staff Attributes GRO - Growth EFF fficacy 30 INF Influence ADP - Adaptability 25 SAT - Satisfaction Organizational Climate20 MIS Mission COH Cohesion 15 AUT Autonomy COM Communication STR Stress 10 CHG Change ORC Mean Scores for 4 Programs Scale Scores (10-Low; 50-High) Feedback for Organizational Change? SN PN TN PC OFF STF TRN EQP INT SUP GRO EFF INF ADP SAT MIS COH AUT COM STR CHG Agency 14 (n= 16) Agency 16 (n= 26) Agency 28 (n= 24) Agency 32 (n= 15) Needs/Pressures Resources Staff Attributes Organizational Climate Batch 24 3/12/2009 Organizational Survey for Staff (ORC-TS) TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved. Questions for Further Study of Recovery and Life Skills (RELS) 1. Does better care planning yield better engagement g and retention in treatment? 2. Are the assessments reliable measures of client change? (Intake, CESI, CEST, CTS, TOP ) 3. Is more mapping related to better engagement and retention in treatment? 4. Do brief interventions show measureable effectiveness? 5. Can treatment organizations change their functioning and client performance levels? Page 10 of 10