Treatment Program Evaluation

Public Health Perspectives on Mental Health and Substance Use Disorders

Allyson Kelley

• Éditeur: Routledge
• Année: 2022
• ISBN:
  9781000589313
• Édition: 1
• Sujet: Medicine
• Sous-sujet: Health Care Delivery

This invaluable text provides a rigorous guide to the assessment and evaluation of treatment programs through a multi-disciplinary, holistic model of care. It highlights issues of race, social justice, and health equity, and offers real-world guidance to effect community healing and transformation.

Written by a researcher and experienced evaluator, the book begins by outlining the theories and research which frame our understanding of substance misuse, and upon which treatment programs are based. It then examines the principles which should underpin any evaluation, before detailing the practical various steps required to conduct an evaluation, from data collection to outcome measurement. The book shows, too, through detailed and effective evaluation, policy changes can be made and treatment programs improved. Including practical examples of evaluation and assessment throughout, and also assessing the numerous social systems which can support recovery, the book builds to a four-step public health model for establishing sustainable treatment programs.

In an era where substance misuse has reached epidemic proportions in the United States and beyond, this book will be essential reading for anyone involved in public health policy and practice in this important area.

1 Introduction and Overview

DOI: 10.4324/9781003290728-1

CONTENTS

1. Learning Objectives
2. Orientation
3. A Public Health Approach
4. Definitions Matter: Substances and Substance Use Disorder
5. Substance Use Disorders (SUD)
6. Diagnosing Substance Use Disorder
7. Alcohol Use Disorder (AUD)
8. Mental Illness (MI)
9. Co-Occurring Mental Health Issues and SUD
10. Substance Use Disorder Treatment
11. Reasons Why People Do Not Seek Treatment
12. Mental Health (MH) Services Data
13. Understanding SUD Treatment Programs and Services
14. Treatment Program Levels of Care
15. More on Public Health Approaches, Treatment, and Evaluation
16. The Costs of Drug and Alcohol Abuse Treatment in the United States
17. Social and Economic Costs Due to Drug and Alcohol Abuse
18. Global Race, Age, Place, and Socioeconomic Status
19. Race
20. Sex, Gender, and Special Populations
21. Age
22. Trauma
23. Place
24. Lower Education and Unemployment
25. Socioeconomic Status
26. Global Efforts to Address MHSUD
27. Global Prevalence and Unmet Needs: Prevalence of MI/MH, SUD, and Comorbid Conditions
28. MHSUD Trends COVID-19
29. COVID-19 Populations at Risk and Health Problems
30. Evaluation of Programs and Treatment Methods
31. Our Position as Evaluators
32. My Position
33. Wrap-Up
34. Discussion Questions
35. Additional Resources
36. References

Learning Objectives

After reading this chapter, you should be able to:

• Summarize the history of substance use in our world.
• Define mental health, mental illness, co-occurring disorders, substance use disorders, and prevalence at the United States and global level.
• Describe elements of a public health approach and the evaluation of programs that treat mental health and substance use disorders.
• Understand positionality and how it applies to the evaluation of treatment programs.

Orientation

Thinking about mental health, substance use, needs, evaluation—having everything in one chapter sometimes it feels like a lot to take in. As we begin this journey together, know that throughout this text, I use the term “We” because in my work, I never work alone. I might be talking with a team member about how to evaluate a medication-assisted treatment (MAT) program, interviewing a community member about recovery, or extracting clinical data from an electronic health record. In all these instances, I am more than just me. I am we. I live in the United States of America. Our approaches, research, and ideas about treatment programs might be different from a global perspective. I recognize this and write from my lived experiences, professional knowledge, and public health training. While I do not have the experiences of evaluating programs in Canada, Norway, or Japan … I know their programs, methods, and ideas offer something that we can all learn from. In this text, I add global perspectives and together we will explore some of the best ways to evaluate treatment programs. Together, we can contribute to the knowledge base of what makes treatment programs effective.

This text is for anyone who wants to know more about effective treatment programs. One of the statistics that I see first-hand in my life and in my work with treatment programs is that only 10.4% of individuals with a substance use disorder ever receive treatment (Substance Abuse and Mental Health Services Administration, 2019). Of this small percentage of individuals that actually receive treatment, just 33% receive evidence-based treatment, or treatment that is demonstrated effective by rigorous evaluation. Advocates, experts, researchers, evaluators, educators, providers, and communities are calling for a public health approach to address one of the greatest public health crises of our time, drug use, misuse, and related consequences.

A Public Health Approach

This book focuses on a public health approach toward the evaluation of treatment programs.

Public health is the science of preventing disease and injury and promoting and protecting the health of populations and communities (SAMHSA & Office of the Surgeon General, 2017). Public health approaches integrate multiple socioecological factors into the prevention efforts for the greatest population health impact. Public health systems involved in research, evaluation, treatment, and policy change include federal, state, local, and tribal agencies, non-profit organizations, for-profit organizations, community organizations, partners, and more.

A 2017 report from the US Surgeon General's Report on Alcohol, Drugs, and Health calls for change and a public health approach for addressing the factors that contribute to substance use disorders (SUD) in our nation (SAMHSA & Office of the Surgeon General, 2017). This report endorses a public health systems approach to substance misuse (prevention, treatment, and follow-up) including the following areas:

• Define problem through systematic collection of data.
• Identify risk and protective factors.
• Work across public and private sectors to create and test interventions that address SDOH.
• Support broad implementation of effective, evidence-based prevention, treatment, and recovery efforts.
• Monitor the impact of interventions (SAMHSA & Office of the Surgeon General, 2017).

As evaluators, public health advocates, social justice leaders, researchers, students, policy developers, and influencers, we want positive change. The first step in a public health approach is defining what the problem is and shared definitions. A public health approach requires us to consider what aspects of treatment programs and policy are not working, and change them. Throughout this text, we will use the following graphic to explore various aspects of treatment and evaluation.

By using Figure 1.1 as a guide, let's consider the following sections of the public health approach to evaluating treatment programs:

Figure 1.1 A Public Health Approach for the Evaluation of Treatment Programs.

Understanding (steps 1–2)

• What is the problem? Situation analysis, surveillance, stakeholder perspectives, and observation.
• What is the cause? Identify risk and protective factors, acknowledge social justice issues, social determinants of health, socioecological factors at from the individual level to the chronosystem level.
• Which interventions work and for whom? Develop and test strategies and pilot studies; conduct formative research and research synthesis; and incorporate stakeholder perspectives. Do not continue interventions or policy that are ineffective or, in some cases, do more harm than good.
• How do you do the work? Consider the needs, resources, and context.

Evaluating (step 3)

• What are we doing? Activities, interventions, process monitoring, evaluation, and quality assessments.
• Are we doing what we said we would do? Outputs and indicators show us what programs are doing.

Effectiveness (step 4)

• Are interventions effective? Outcome evaluations can tell us about effectiveness.
• Is there widespread adoption of interventions, programs, and policies? Survey and surveillance activities help document adoption of activities and effectiveness.

This chapter focuses on understanding or answering the question, “What is the problem?” (step 1). We answer this question through surveillance efforts, program reports, national surveys, and data at the local, community, state, nation, and global level. Throughout the text, you will learn how to frame the evaluation of substance use programs from a public health lens. By using Figure 1.1 as a guide, the sections in this text include mentions of step 1 to illustrate the process.

First, let's consider your own definitions of the terms that we will be using in this book.

• Public health is _________________.
• Public health systems are ______________________.
• Mental health is _________________.
• Mental illness is _________________.
• Substance use is _________________.
• Substance misuse is _________________.
• Co-occurring disorders are _________________.
• Recovery means _________________.

As a researcher and evaluator, I automatically want to know how all readers define these terms.

However, that is impossible, so let's consider some commonly used definitions for these terms.

• Mental health refers to an individual's well-being and state of mind.
• Mental illness refers to something that impacts an individual's mental state and how they think, feel, communicate, and behave.
• Substance use refers to the use of alcohol or other drugs (illegal or legal).
• Substance misuse and abuse is a pattern of harmful consumption of substances f...