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

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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
Model development research
Psychosocial treatment
Substitution with methadone
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Methadone Maintenance Treatment Phases-Concept
Medication
Psychosocial Services
Stabilization
Transition
Entry
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-spi
  ritual.
• Instead of competing the professions need to work
  in multidisciplinary teams.

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The Social Work Generalist Model
Social
Bio
Spiritual
Psycho
Social
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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 solve
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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
  (evidencebased 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.

• Lets 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 - steps

• Task 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 change

• Stages of change
• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance
• (Prochaska, DiClemente, Norcross, 1992)

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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 RD
• 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_at_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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Its only research Just do it!(Bob Green, VCU)

• Dare to do it, dont restrict yourself with too
  much rigor.