Factors that Influence Retention in Greek Therapeutic Communities Erianna Daliani MSc (Gerasimos...
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Transcript of Factors that Influence Retention in Greek Therapeutic Communities Erianna Daliani MSc (Gerasimos...
Factors that Influence Retention Factors that Influence Retention in Greek Therapeutic in Greek Therapeutic CommunitiesCommunities
Erianna DalianiErianna Daliani MSc MSc (Gerasimos (Gerasimos Papanastasatos) Papanastasatos) KETHEA Research Dept.KETHEA Research Dept.
11th European Conference on Rehabilitation & Drug Policy
Why retention?
Retention in treatment has been the most consistent and important predictor of post-treatment outcome
It is an index that captures the effect of the various client characteristics, as well as that of different treatment characteristics
11th European Conference on Rehabilitation & Drug Policy
Previous research
11th European Conference on Rehabilitation & Drug Policy
Drug – and alcohol related
problems
Family/social problems
Psychiatric problems
(?)
Gender (?)Higher rates of retention
Employment problems
Law problems
Aims of the present study
Investigation of the effect of type of treatment programme on retention
Investigation of the effect of client characteristics on retention
Investigation of their combined effect
Population & Sample
Population: Drug addicts that were admitted for treatment in one of 9 Therapeutic Communities for adults (4 residential and 5 open care)
Sample: Clients that had completed EuropASI questionnaire during intake
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Sample (b)
86.8% men
Mean age:26.6 years
Ν = 1496
70.8% in residential treatment setting
29.2% in intensive outpatient facility
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Data Collection
Personal interviews
Questionnaire: EuropASI, European
modification of the Addiction Severity Index
Duration: 01.01.2002 – 31.12.2005
11th European Conference on Rehabilitation & Drug Policy
7 problem areas
2 summary indices for each area
Both indices combine quantitative
information and client’s subjective ratings
of the current importance of the problems
and the need for treatment
Composite scores are calculated
automatically based on questions about the
present that are subject to change
EuropASI summary indices – EuropASI summary indices – Methodological issuesMethodological issues
11th European Conference on Rehabilitation & Drug Policy
Severity ratings are established by the Severity ratings are established by the interviewers after following a standard interviewers after following a standard procedure. Existence and severity of procedure. Existence and severity of lifetime problemslifetime problems is taken into account is taken into account together with client’s present condition together with client’s present condition and need for treatmentand need for treatment
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EuropASI summary indices – EuropASI summary indices – Methodological issuesMethodological issues
Clients’ Profile – Clients’ Profile – Lifetime and Lifetime and recent problems in 7 areasrecent problems in 7 areas
0,26
0,36
0,26
0,67
0,28
0,47
0,34
0,21
0,43
0,12
0,22
0,32 0,33
0,21
0,00
0,10
0,20
0,30
0,40
0,50
0,60
0,70
0,80
medical employment* alcohol drugs* legal family/ social* psychiatric
severity
composite
11th European Conference on Rehabilitation & Drug Policy
*intercorrelations ≤ 0.3
Outcomes of several follow up studies show that
length of stay in treatment is directly related to
positive outcomes
Greek Therapeutic Communities, residential and
open care, expect clients to stay in treatment for
12 months in order to complete it
After TC clients enter a less intensive,
rehabilitation phase that last for another 12
months
"Completers" are the clients who stay in
treatment for at least 12 months, while
"Dropouts" are the clients that leave the
therapeutic programme before they complete the
one-year period
Annual Retention Annual Retention
11th European Conference on Rehabilitation & Drug Policy
Annual retention
81,50
74,30
69,1064,80
60,6056,80
53,7051,40
48,6045,60 44,20
42,00
0
10
20
30
40
50
60
70
80
90
100
0 30 60 90 120 150 180 210 240 270 300 330 360
retention (in days)
11th European Conference on Rehabilitation & Drug Policy
Annual retention - type of treatment
retention (in days)
11th European Conference on Rehabilitation & Drug Policy
78,8
70,4
64,9
60,2
55,5
50,847,5
44,942,2
39,137,5
35,1
87,9
83,5
79,476,2
72,871,2
68,967,3
64,161,3 60,4
58,8
0
10
20
30
40
50
60
70
80
90
100
0 30 60 90 120 150 180 210 240 270 300 330 360
residence
outpatient
Annual retention – gender and type of treatment
retention (in days)
11th European Conference on Rehabilitation & Drug Policy
77,8
70,3
60,0
51,047,7
45,0
83,2
78,875,1
71,5 69,967,3
65,462,3
59,4 58,456,5
71,3
60,8
55,9
49,746,2
90,9
85,583,6 83,6
81,880,0 80,0 80,0
76,474,5 74,5 74,5
55,5
65,1
35,8
42,7
38,239,7
87,4
63,6
85,3
30,8
39,2
32,935,0
44,1
0
10
20
30
40
50
60
70
80
90
100
0 30 60 90 120 150 180 210 240 270 300 330 360
men/ residence
men/ open care
women/ residence
women/ open care
Logistic regression was performed for annual
retention as the dependent variable and type of
treatment, gender, age, number of previous
treatment episodes, EuropASI composite and
severity indices as independent variables
(predictors)
Both composite (recent) and severity (lifetime)
indices were used since intercorrelations
between them were not high in absolute
magnitude
Interactions between type of treatment and
other predictors were entered simultaneously to
include the affect shown in annual retention
diagram
Data analysisData analysis
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Significant Predictors of Treatment Completion
•p<0.1 **p<0.05 ***p<0.01
Beta SE df Odds RatioTreatment type (open care) *** 1,67 0,43 1 5,33Drug problems (composite)*** -1,31 0,39 1 0,27Psychological problems (severity)*** -1,22 0,30 1 0,29
InteractionsFamily/Social (composite) X treatment type (open care) * -1,14 0,62 1 0,32
Drugs(severity) by X treatment type (open care) ** -1,99 0,82 1 0,14
Legal (severity) by X treatment type (open care) ** -1,23 0,48 1 0,29
Family/Social (severity) X treatment type (open care) ** 1,30 0,61 1 3,66
Psychological (severity) by treatment type (open care) ** 1,75 0,70 1 5,75
Main EffectsMain Effects
11th European Conference on Rehabilitation & Drug Policy
Type of treatment – clients in open care
(outpatient intensive) are more likely to
complete treatment
Clients with heavier drug use during the period
before admission are more likely to dropout from
treatment
Clients with more severe lifetime psychological
problems are less likely to stay for a year in
treatment
Investigating the interactions – family/ social support and type of treatment
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Family/ social relations and support is an important predictor for completion of outpatient treatment
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Severity of lifetime drug use related problems is always a predictor – more so in outpatient programmes
Investigating the interactions – drug problems and type of treatment
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Investigating the interactions – legal problems and type of treatment
Severe legal problems are related with dropout from outpatient treatment
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Investigating the interactions – psychological problems and type of treatment
Clients with medium – severe psychological problems are usually referred to outpatient treatment – no statistical difference between "dropouts“ and "completers“ (open care)
Discussion (a)Discussion (a)
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More drug problems before admission are related
with higher rates of dropout, regardless of
treatment setting. Further analysis will determine
the actual time of dropout
Outpatient settings are associated with higher
treatment completion rates. Residential clients
tend to have more problems than outpatient
clients in most of the examined areas
Clients with more severe lifetime psychological
problems are less likely to stay for a year in
treatment. This effect is stronger in residential
treatment.
Discussion (b)Discussion (b)
11th European Conference on Rehabilitation & Drug Policy
Gender factor was initially found to be important
when combined with type of treatment. This
difference did not remain after we controlled for
problems’ severity
Previous studies have shown that family/ social
problems are related to lower rates of retention. In
this study this effect was found to be present only in
outpatient treatment
Unlike other studies severity of legal problems was
found to be negatively related to treatment
completion – this effect is more clear in outpatient
treatment
Limitations & Issues for further Limitations & Issues for further researchresearch
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Adequacy and consistency of EuropASI indices
Relation between former therapeutic experience and
retention in treatment
Investigate early – late dropout criteria
Retention is predictive of treatment related
outcomes but there is need for actually measuring
these outcomes – FOLLOW UP study
Significance of interactions between clients
characteristics and treatment settings, stresses the
importance of matching therapeutic interventions to
clients needs