1 development of a social work practice model for out-patient psychosocial treatment of opiate...

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Development of a social work practice model for out-patient psychosocial treatment of opiate addicted clients in substitution.

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Andreas Fassler

Katholische Stiftungsfachhochschule, München

University of Georgia, Athens Substance Abuse Treatment, Caritas

Miesbach Virginia Commonwealth University http://andreas-fassler.de

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Field of practice: Substance abuse treatment

Substitution with methadone Psychosocial treatment

Model development research

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Methadone Maintenance Treatment Phases-Concept

Medication

Psychosocial Services

Entry Stabilization Transition

Time line

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Field of practice: Substance abuse treatment The physiological opiate addiction is treated with

medication Methadone (more recently buprenorphine) as a

substitute for opiate reduces craving and enable clients to attend treatment and to work.

Psychosocial services delivered by social work address problems in living and psycho-social functioning, increase treatment retention, and provide case management.

Additional benefits: reduction in crime and HIV-infection

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Barriers to availability Majority of opioid dependent patients do

not receive substitution treatment Barriers to expansion of substitution

treatment include: Regulations Cost Education Treatment philosophy (Fiellin, NIDA)

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Efforts needed

substitution is not available everywhere psychosocial services are even less available:

Political advocacy is needed

models for psychosocial services have potential for development:

A research task for the social work profession

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Social injustice through “war on drugs”-policy

vs. harm reduction and treatment 2 Millions in prison (drug related) disproportionately minorities imprisoned of 3% of children: parents behind bars African-American women 10x more reported 72% of women in federal prison drug related diminished constitutional rights

hits hardest minorities and women

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1) If we want to heal, then medication only is not enough.

Substance abuse problems are bio-psycho-social-spiritual. Instead of competing the professions need to work in multidisciplinary teams.

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The Social Work Generalist Model

Social

Spiritual

Social

Bio

Psycho

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Issues and research problem One set of tasks for social work:

solving problems of living,

increasing motivation (often in non-voluntary treatment)

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problems to solvechild care

employment

mental health

AIDS/HIV

family

housing

transportation

financial

problems &needs

legal

education

medical

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2) If we do not know what we are doing, how can we know it was well done?Practice needs to apply guidelines

(evidence–based practice movement).

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What is a practice model in social work prescribes what to do can be used in multiple fields of practice includes a “style” includes sequences includes techniques preferably is empirically tested

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3) If we confine ourselves to only one school of thought then we might miss something.

Let’s go shopping to get the best.

(from technical eclecticism to synthesis)

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Two practice models

The task-centered model (TCM) originated from social work 1970s www.task-centered.com

Motivational interviewing (MI) originated from alcohol treatment 1980s www.motivationalinterview.org

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The task-centered model - stepsTask Planning and Implementation Sequence

(Doel & Marsh, 2005)

generating task options choosing the task (client makes decision) planning implementation details enhancing commitment: provide rationale considering possible obstacles providing guidance client (and or practitioner) carries out task task review at next session

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Transtheoretical model of changeStages of change

Precontemplation Contemplation Preparation Action Maintenance

(Prochaska, DiClemente, & Norcross, 1992)

Contemplation

(Relapse?)Maintenance

Precontemplation

Preparation

Action

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MI – basic principles

a new understanding of motivation collaboration and autonomy evocation

MI - style Express empathy, Develop discrepancy, Roll with resistance, Support self-efficacy

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Merging of models

Motivational Interviewing

(Style)

Task- centered model

(Structure)

1) combined model

2) adapted to use in agency/methadone maintenance

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The combined model

Steps 1 prioritize problems

2 develop tasks 3 prepare tasks

4 carry out tasks 5 review tasks continue with 2

use MI techniques within steps

assess readiness develop motivation educate/reflect avoid confronting

resistance

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4) If we want to be accountable professionals, then we can as well develop our practice in a systematic way.

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Model development research practitioner experience tradition intuition

Social work and practice research

the model development paradigm 1970s modeled after industrial R&D Rothman &Thomas (1994)

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Model development phases problem analysis and project planning information gathering and synthesis designing early development and pilot testing evaluation and advanced development dissemination

Rothman & Thomas (1994)

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5) If we want to develop social work practice, then we need the competencies of clients, practitioners, and researchers.

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Collaboration: Stakeholders with differing interests

Clients

Agency management

Social workers

Researcher

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Collaboration with stakeholders Careful contracting and planning with the

management Needs assessment with clients Model design teams with practitioners Training Supervision during pilot testing Feedback through developmental process notes Client interviews (interpersonal process recall) Client focus groups Practitioner focus groups (member check)

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Implementation: Watch the issues Fidelity enhancing features

Training Prepare practitioners for research Supervision Use of forms

Structure vs. flexibility Time-limited treatment vs. prolonged

treatment Consider non-voluntary treatment goals Assessment connects with measurement

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Applied research needs

Access to decision makers Commitment regarding time and financing

(design & training vs. work load)

Applied research faces Agency change dynamics Agency policies vs. latest research (research

practice gap)

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Positive experiences from implementation of practice research Assists in agency policy development

(organizational development) :assessment, contracting, describing available services

Client motivation through research and more structure

Improving social work practice skills More effective through task focus and

observing client readiness

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THANK YOU !

Andreas Fassler Virginia Commonwealth University

fasslera@vcu.edu

www.andreas-fassler.de

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Perspectives

Social work needs to do its own research Social work is practice; therefore research needs to be done in

agencies; we need to link research and practice; There is an inherent conflict in merging practice and research

Compromise is necessary, Research skills (in practitioners and agencies) and resources

(devoted by agencies) are necessary; dissemination and tenacity is necessary; the future: Promotion of SSD e.g. Mansoor A. F. Kazi (1998) Teaching institutions more connected with agencies Quality standards may lead to more evaluation of practice and

therefore to practice research More research from the bottom up vs. top down

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It’s only research: Just do it!(Bob Green, VCU)

Dare to do it, don’t restrict yourself with too much rigor.