Effective places research
selected articles
What are reasonable expectations of service users?
Our opinion
When someone is seeking help, for whatever problem, they want to go somewhere that they feel comfortable and believe that they are getting the best treatment possible. It follows that services need to understand what their service users want and how best to address their needs. Ask: are service users welcomed and treated as individuals? is there an ethos that promotes the sense that everyone can be helped?
Important study :: Service user satisfaction
Congia P, Tarantini F, Pani FP, Loi A (2012) Exploring components and correlates of satisfaction in an outpatient drug addiction service. Italian Journal on Addiction 2: 6-12 PDF available from ResearchGate
This study explores the organisational factors that have an influence on treatment outcomes. There is an association between service users’ satisfaction with treatment and effectiveness of treatment. Both satisfaction and effectiveness of treatment are influenced by organisational factors including the choice of intervention paradigm. The study was undertaken across three Italian community drug clinics. Findings are expressed as correlates of service user satisfaction.
If applied, this strategy should constitute an excellent means of minimising limitations to patients’ quality of life and maximising the benefits of specific therapeutic interventions.
Positive associations with service user satisfaction
Minimising the impact of treatment on daily life: convenient opening hours and as few appointments as are needed.
Having a welcome with accurate and clear information.
Integration of psychosocial and pharmacotherapies.
Adequate numbers of staff available to sort out problems and meet other needs.
Quality of the premises.
Review article :: Integrated services for people with addiction and mental health problems
Drake RE and Mueser KT (2000) Psychosocial Approaches to dual diagnosis Schizophrenia Bulletin 26, 105-118
This study briefly reviewed research on the epidemiology, adverse consequences, and phenomenology of ‘dual diagnosis’, followed by a more extensive review of approaches to services, assessment, and treatment. Comorbidity, that is co-occurring addiction and mental health problems, are quite common and these individuals suffer serious adverse consequences as a result. The evidence for specific treatments for comorbidity is sparse and generally weak. However, the way services are delivered is considered to be very important and best practice is simple enough to implement.
Best practice to deliver comorbidity services...
Service users participate in one programme that provides treatment for two disorders - severe mental disorder and substance use disorder.
The clinicians are trained in psychopathology, assessment and treatment strategies for both mental disorders and/or substance use disorders.
As far as practically possible the mental disorder and substance use disorder are treated by the same clinician.
The clinician offers substance abuse treatment tailored for patients who have severe mental illnesses. These tailored treatments differ from traditional substance abuse treatment.
Does the organisation benefit all of its stakeholders?
Our opinion
The culture of an organisation is all important. Ask: is there a problem-solving environment? is there competent leadership? are the staff valued and involved? are dissent and whistleblowing encouraged or surreptitiously punished? Addiction treatment agencies often report high staff turnover rates. How damaging this might be to services is uncertain, but it has costs, for example, financial costs of recruitment and staff training, loss of skills, knowledge and experience, and difficulty carrying the history and culture.
Important study :: How do you check out organisational health?
Lehman WEK, Greener JM and Simpson DD (2002) Assessing organizational readiness for change. Journal of Substance Abuse Treatment 22: 197-209
The Organisational Readiness for Change tool is a useful way to check on organisational health. It is based on previous research by the Texas Christian University (measures are available free of charge for not-for-profit educational and research purposes).
There is a significant impact on treatment satisfaction and rapport where services ❶ ensure staff have an influence, ❷ the organisational climate allows higher levels of staff autonomy, ❸ there is openness of communication, and ❹ a willingness to change.
Factors defining organisational health
Motivation to change
adopt current best practices :: training needs :: technology change
Adequacy of equipment
offices :: staffing :: training :: computer access :: e-communication
Staff attributes
growth :: efficacy :: influence :: adaptability
Organisational climate
mission :: cohesion :: autonomy :: communication :: stress :: change
Important study :: What factors predict staff turnover?
Garner BR and Hunter BD (2014) Predictors of Staff turnover and turnover Intentions within addiction treatment Settings: change over time matters. Substance Abuse: Research and Treatment 8: 63–71 doi: 10.4137/SaRt.S17133
What rate of staff turnover should be judged too much or too little is a moot point; however, it is important to understand why staff leave an organisation. If someone is unhappy with their workplace in some way, then they may start to contemplate leaving; this study suggests it is systematic and sustained changes that are perceived as being for the worse that most strongly tip the balance and result in someone actually leaving.
A set of work measures and psychological climate measures were created from existing scales and these were used as the predictors of staff turnover. The chart shows those things that were protective, that is, made turnover less likely, and those that likely to cause turnover. As might be expected, change, especially if seen as a downward spiral, was associated with turnover.