Treatment Engagement (treatment + engagement)

Distribution by Scientific Domains


Selected Abstracts


Relational Factors and Family Treatment Engagement among Low-Income, HIV-Positive African American Mothers

FAMILY PROCESS, Issue 1 2003
Victoria B. Mitrani Ph.D.
Clinically derived hypotheses regarding treatment engagement of families of low-income, HIV-positive, African American mothers are tested using univariate and multivariate logistic regression models. Predictors are baseline family relational factors (family support, mother's desire for involvement with family, and family hassles) and mother's history of substance dependence. The study examines a subsample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy (SET). SET is a family-based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS. Participants in the subsample were randomly assigned to SET and attended at least two therapy sessions. Findings reveal that family relational factors predicted family treatment engagement (family support, p < 004; mother's desire for involvement with family, p < 008; family hassles, p < 027). Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother's own treatment engagement (p < 016). History of substance dependence was neither associated with family treatment engagement nor family support. Post hoc analyses revealed that family hassles (p < 003) and mother's desire for involvement with family (p < 018) were differentially related to family treatment engagement in low-versus high-support families. Implications for clinical practice and future research are discussed. [source]


Testing mechanisms of action for intensive case management

ADDICTION, Issue 3 2008
Jon Morgenstern
ABSTRACT Aim This study identified factors that predict, mediate or moderate the effects of intensive case management (ICM) on longer-term drug abstinence outcomes in women on welfare. Design In a parent study women were assigned randomly to usual care (UC) or intensive case manangement (ICM). Treatment was provided for 12 weeks and follow-up continued for 15 months after study intake. A set of hypothesized mediators was assessed at month 3 and a rigorous four-step mediational model was tested using outcomes in months 4,15. Participants Participants were 302 drug-dependent women applying and eligible for federal welfare and not currently in drug abuse treatment. Interventions ICM provided intensive treatment engagement including voucher incentives for treatment attendance and case management services; UC provided primarily referral to community treatment programs. Measurement Substance use outcomes were assessed using the time-line follow-back interview and confirmed using biological and collateral measures. Findings Participants in ICM had more case manager contacts, better treatment engagement and more self-help attendance than did those in UC. Each of these variables predicted, and was shown to be a mediator of outcome, but case management contact was an especially robust mediator. Further, ICM effects were strongest for those who attended treatment least. Contrary to prediction, greater psychopathology and environmental stressors did not predict worse outcomes. Conclusions Findings suggest that case management is an active intervention that may both facilitate and substitute for formal drug abuse treatment. [source]


Relational Factors and Family Treatment Engagement among Low-Income, HIV-Positive African American Mothers

FAMILY PROCESS, Issue 1 2003
Victoria B. Mitrani Ph.D.
Clinically derived hypotheses regarding treatment engagement of families of low-income, HIV-positive, African American mothers are tested using univariate and multivariate logistic regression models. Predictors are baseline family relational factors (family support, mother's desire for involvement with family, and family hassles) and mother's history of substance dependence. The study examines a subsample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy (SET). SET is a family-based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS. Participants in the subsample were randomly assigned to SET and attended at least two therapy sessions. Findings reveal that family relational factors predicted family treatment engagement (family support, p < 004; mother's desire for involvement with family, p < 008; family hassles, p < 027). Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother's own treatment engagement (p < 016). History of substance dependence was neither associated with family treatment engagement nor family support. Post hoc analyses revealed that family hassles (p < 003) and mother's desire for involvement with family (p < 018) were differentially related to family treatment engagement in low-versus high-support families. Implications for clinical practice and future research are discussed. [source]


Integrative outpatient treatment for returning service members

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2008
Sonja V. Batten
Abstract Veterans returning from Operations Enduring and Iraqi Freedom (OEF/OIF) frequently present with multiple psychological and physical symptoms. The authors propose an innovative approach in which primary care providers, polytrauma specialists, vocational rehabilitation specialists, and mental health clinicians work together to provide care that is not simply concurrent, but truly integrated. All members of this interdisciplinary team must provide a consistent message that supports treatment engagement and progress. The authors illustrate this approach with a case report of a soldier deployed to both OEF and OIF, requiring subsequent treatment for joint pain, headaches, mild traumatic brain injury, posttraumatic stress disorder, depression, and substance abuse. Despite the emphasis on early intervention, treatment engagement and retention remain challenges in this population. 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1,12;, 2008. [source]


Using systemic reflective practice to treat couples and families with alcohol problems

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 7 2010
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Accessible summary ,,Alcohol services in the UK generally treat clients from an individual medical and psychiatric perspective. Carers, partners, children and other family members are infrequently actively involved in the clients' care process. ,,A reflective family-based approach was introduced in an attempt to improve treatment engagement with drinkers with relatives. Favourable findings from several self-reporting research and evaluation studies are provided and analysed. ,,The use of this intervention was found to be effective in facilitating change in drinking and relationships. Family members when involved in the care management proved to be influential in the behaviour change process. ,,Family group reflecting interventions should be used more extensively and involvement of partners and family members in care programmes should be promoted. Implications for the extended use of the intervention both in addiction settings and wider health and social care practice are discussed. Abstract In the UK, an adult with a drinking problem is generally treated from an individual perspective with minimal involvement of carers and relatives. In response to this gap in service provision, a systemic reflecting intervention was introduced to assist couples and families experiencing alcohol-related difficulties. The article documents the background and development of this initiative. Findings from evaluation and clinical outcome studies are reviewed and demonstrate how the use of the approach proved to be effective in facilitating positive change both in drinking and family behaviour. In conclusion, the paper explores the implications of how systemic reflective practice with family groups may be extended and be usefully used in wider addiction, diverse mental and general health-care settings. [source]


Depression during pregnancy: detection, comorbidity and treatment

ASIA-PACIFIC PSYCHIATRY, Issue 1 2010
Maria Muzik
Abstract Depression during pregnancy is common (,15%). Routine prenatal depression screening coupled with the use of physician collaborators to assist in connecting women with care is critical to facilitate treatment engagement with appropriate providers. Providers should be aware of risk factors for depression , including a previous history of depression, life events, and interpersonal conflict , and should appropriately screen for such conditions. Depression during pregnancy has been associated with poor pregnancy outcomes including preeclampsia, insufficient weight gain, decreased compliance with prenatal care, and premature labor. Current research has questioned the overall benefit of treating depression during pregnancy with antidepressants when compared to the risk of untreated depression for mother and child. Published guidelines favor psychotherapy above medication as the first line treatment for prenatal depression. Poor neonatal adaptation or withdrawal symptoms in the neonate may occur with fetal exposure in late pregnancy, but the symptoms are mild to moderate and transient. The majority of mothers who decide to stop taking their antidepressants during pregnancy suffer relapsing symptoms. If depression continues postpartum, there is an increased risk of poor mother,infant attachment, delayed cognitive and linguistic skills in the infant, impaired emotional development, and behavioral problems in later life. Bipolar depression, anxiety and substance use disorders, and/or presence of severe psychosocial stress can lead to treatment-resistance. Modified and more complex treatment algorithms are then warranted. Psychiatric medications, interpersonal or cognitive-behavioral therapy, and adjunctive parent,infant/family treatment, as well as social work support, are modalities often required to comprehensively address all issues surrounding the illness. [source]


The Interface Between Physical and Mental Health Problems and Medical Help Seeking in Children and Adolescents: A Research Perspective

CHILD AND ADOLESCENT MENTAL HEALTH, Issue 4 2004
M. Elena Garralda
This paper addresses child and adolescent psychopathology as it presents to general practitioners and paediatricians, and explores psychosocial aspects of unexplained medical symptoms in children and adolescents. High rates of psychopathology have been identified amongst children and adolescents attending general practice and paediatric services, most of it ,,hidden'' at presentation and emotional in nature. It is often linked to poor physical well being and to maternal stress focused on the child. It may be of special relevance to medical help seeking in socio-economically advantaged areas. Co-morbid psychopathology, mainly emotional disorders, is common amongst children with unexplained medical symptoms. However, there are specific psychosocial aspects that differentiate these children from those with emotional disorders. They involve disease beliefs, illness behaviour and predicament. The latter may be characterised by special reactivity to stress in children with personality vulnerability, in a context of parents with high levels of mental distress, unexplained medical symptoms and emotional over-involvement with the child. There is comparatively little interface work between CAMHS and primary health care. An important research priority would seem to lie in the development of interventions that can be adapted for use by primary care staff. Similarly, there are few dedicated CAMHS paediatric liaison teams. Their more extensive development should help attend in a more informed and focused way than at present to children and adolescents suffering from unexplained physical symptoms and disorders. Further research is needed into vulnerability mechanisms and maintaining factors, health beliefs, treatment engagement and interventions. [source]