Program structure, staff perceptions, and client engagement in treatment

Abstract

A key goal of drug abuse treatment providers is getting their clients to engage and participate in therapeutic activities as a first step toward deriving longer-term benefits. Much research had focused on personal characteristics that relate to client engagement; program characteristics have received less attention. This study explored client and program differences in engagement ratings using data from a nationwide set of 94 outpatient drug-free treatment programs in a hierarchical linear model analysis. The results show that elements of program context, including structural features (e.g., smaller size and Joint Commission on the Accreditation of Healthcare Organizations/Commission on Accreditation of Rehabilitation Facilities accreditation) and staff's perceptions of personal efficacy, organizational climate, and communal workplace practices, relate to better overall client engagement. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality improvement efforts.

Therapists Talk About the Engagement Process

“…Moreover, the views of the participants are supported by some of the literature. For example, prior experiences with treatment, especially whether clients felt respected, influenced their attitude toward services (Kerkorian et al 2006), and provider perspectives of their agencies were related to client reported satisfaction and participation (Broome et al 2007;Greener et al 2007). Moreover, findings converged across the six groups; even though both rural and urban sites were included, the opinions were remarkably similar.…”

“…There is a lack of theory on the concept and its relationship to other treatment processes (Dearing et al 2005;Macgowan 1997Macgowan , 2000 and little is known about the determinants of engagement (Broome et al 2007). Nock and Ferriter (2005) noted that the lack of a clear conceptualization and definition interferes with communication among researchers and practitioners, as well as with progress in the study of client engagement and participation.…”

Principles of Precision Prevention Science for Improving Recruitment and Retention of Participants

“…For one program, organizational factors such as the staff's perceived rigidity of supervision and content delivery led to lower participant retention (Latimore et al 2017). Broome et al (2007) identified organizational climate and workplace practices to be correlated with client engagement in substance use treatment. Damashek et al (2011) hypothesized that greater participation and retention of families in a salary model versus fee for service reimbursement system may have been because the home visitor could be flexible to family schedules, make unscheduled visits, and allow for intermittent calls to families.…”

Variations in treatment organisation, practices and outcomes within the Norwegian Opioid Maintenance Treatment Programme

“…Long-term OMT programmes have had superior treatment outcomes in terms of drug use and individual functioning compared to short-term programmes (1,3,4). Furthermore, treatment programmes with a low caseload are often associated with positive treatment outcomes such as less drug use and higher retention rates (9,15,16). To address these diversities, regulations and guidelines for OMT at state and national levels are commonly used (17)(18)(19).…”