Evaluation and program planning
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Randomized Controlled Trial Comparative Study
Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model.
We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n=68) were compared to individuals assigned to a usual care condition (n=61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. ⋯ Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.
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This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). ⋯ EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected.
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Because they often set out with a guarantee of only short-term funding, many community partnerships will face a threat to their sustainability almost as soon as the first money runs out. Research into the factors that enable some coalitions and partnerships to meet the challenge when others fail is limited. This study begins to fill this gap in our understanding by examining influences on the process of sustainability planning in the context of a collaborative partnership focused on youth development. ⋯ How well teams functioned in the early stages was found to be strongly related to the quality of their later preparations for sustainability. Recruitment and integration of new team members, and the encouragement they subsequently received were also found to be key factors. The results strengthen the argument for providing technical assistance to meet the needs of those who promote prevention partnerships, and they provide longitudinal empirical data to support the hypotheses of other researchers who have similarly found a correlation between effective sustainability and early planning and support.
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This paper proposes ten steps to make evaluations matter. The ten steps are a combination of the usual recommended practice such as developing program theory and implementing rigorous evaluation designs with a stronger focus on more unconventional steps including developing learning frameworks, exploring pathways of evaluation influence, and assessing spread and sustainability. Consideration of these steps can lead to a focused dialogue between program planners and evaluators and can result in more rigorously planned programs. ⋯ The complexity of the program will need to inform the design of the evaluation. The ten steps that are described in this paper are heavily informed by a Realist approach to evaluation. The Realist approach attempts to understand what is it about a program that makes it work.
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Implementation of an evidence-based modified therapeutic community: staff and resident perspectives.
The widespread successful implementation of evidence-based practices (EBPs) into community substance abuse settings require a thorough understanding of practitioner and client attitudes toward these approaches. This paper presents the first that we know of a qualitative study that explores staff and resident experience of the change process of a therapeutic community to an evidence-based modified therapeutic community for homeless individuals with co-occurring substance abuse and mental illness disorders. The sample consists of 20 participants; 10 staff and 10 residents. ⋯ The change in program structure from TC to MTC were perceived by staff as efforts to accommodate the particular needs of the homeless individuals with mental and substance abuse disorders and feeling they were inadequately prepared with inadequate resources to facilitate a successful transition. Participant descriptions were described in terms of loss of structure, loss of peers and being helped. Findings have potential to shape implementation of evidence-based practices in community substance abuse treatment.