The method to which Substance abuse administrators plan, organize, and manage the day-to-day operations of Substance Abuse Services delivery systems was researched. This research was conducted in regards
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Substance Abuse Administrators and their Adversity in Maintaining Accessible and Effective "Best Practices" in Treatment Centers
Donna L. Braveboy
Southern Illinois University Carbondale
HCM 450 Management Problems in the Health Care Industry
Assignment #3
Abstract
The method to which Substance abuse administrators plan, organize, and manage the day-to-day operations of Substance Abuse Services delivery systems was researched. This research was conducted in regards to the efficacious gap between treatment approaches or practices and research that implement "best practices". The issue is that the onset of substance abuse, underage drinking, and tobacco use is at its best without the aid of "best practices" within substance abuse treatment centers (Mersy, 2003). Without intervention and application of an emerging base of "evidence-based models" in substance abuse treatment, our society will progress towards a more complex and deep-rooted association with delinquency, addiction, crime, and prison making the failure of substance abuse treatment more costly (Information, 2003). Literature and statistics shows that the lack of accessible and effective substance abuse services that is implemented and managed by substance abuse administrators is one of the most vigorous public health crises in America.
Substance Abuse Administrators and their Adversity in Maintaining Accessible and Effective "Best Practices" in Treatment Centers
A vast amount of research has indicated that in the substance abuse treatment field, like other practice disciplines, has long been characterized by incoherent idiosyncratic practices based on one's personal practice, perception, particular styles of conversing, and/or myths (Brendel, Bennett, & Albert, 2003). Administrators within these treatment facilities have a wide array of responsibility. Administrators maintain and evaluate ongoing training and technical support for substance abuse providers. They also maintain the professional knowledge and keep abreast of changes in job related rules, statues, laws, and new business trends. Nonetheless the gap between the treatment approaches or practices that research has shown to be efficacious and what is actually done in substance abuse treatment agencies is enormous. Research that was done by the Institute of Medicine report on "Bridging the gap between practice and research" and the National Treatment Plan was a call for connecting practice to research (Brendel, et al.). It was estimated that nineteen percent of medical practice was based on science, but the majority was based off of opinions, "soft science", clinical experience, or tradition (Brendel, et al.). Which brings one to the assumption that even less of substance abuse practice is based on science, given the state in which substance abuse practice and research is in?
Today, most substance abuse treatment is administered by community-based organizations (Brendel, et al.). Administrators of substance abuse treatment facilities have the obligation to readily incorporate recent advances in understanding the mechanisms of addiction and treatment. This gap between practice and everyday treatment represents a large portion of missed opportunity at this critical time in substance abuse treatment (Brendel, et al.). Drug abuse treatment has been shown to provide cost-effective benefits in terms of reduced drug use, trafficking, crime, reduced incidence of AIDS and other infectious diseases (National, 2003). Both because of these benefits and as a sample humanitarian response to a serious health problem, there is a clear rational need to provide adequate treatment for substance abusers.
Issues with treatment and access to "quality of care" and "best practices" in the substance abuse sector have been a dilemma for some time now. Statistics shows that it is in ones' best interests to provide quality care, and best practices with in our society. The state of the economy today and substance abuse being a contributing factor creates an even more challenging quandary to deal with. Studies show that the costs to society when dealing with substance abuse, is enormous. Drug trends across the United States are indicators of the drug use, abuse, addiction, domestic violence, and child abuse (National). The National Institute on Alcohol and Alcoholism estimates that alcohol and drug abuse are associated with 100,000 deaths per year and cost society more than $100 billion per year. For instance, in 2002 an estimated 22 million Americans suffered from substance dependence or abuse due to drugs, alcohol or both. A survey in 2002, found that 14.6 Americans use and abuse the most commonly known illicit drug, marijuana. One third of this number; 4.8 million, used the drug over 20 times in one month (University, 2003). Another common and highly competitive drug in the economy is tobacco. It is found that tobacco smokers make up 30 percent of the population, 12 and older. This number is closely related to 71.5 million or more using tobacco in the United States (U.S.) today. Also in 2002, studies found that cocaine use was at its best with more that 2 million users. Of the cocaine users, 567,000 of them used crack (University).
This brings us to the fact that in health care, there is no other medical condition that can be tolerated by such huge numbers unable to obtain the treatment they need. The economy and or society as a whole could not handle such an ordeal. Furthermore, to distinguish the Unites State's (U.S.) usage, statistics shows the levels of drugs and what drugs are being abused, representing how much of a substance abuse problem the U.S. has. Young people from the ages 12-17 had inhalant usage higher than the use of crack cocaine. Currently illicit drug use is highest among adults' ages 18-25 years of age. Youth between the ages of 12-17 are also contributors to about 11.6 percent of the illicit drug use family. Knowing that our economy is recovering from hardships, 2002 studies found that 9.5 million "full-time" workers used illicit drugs. It has also been found that 11 million people ages 12 or older, reported driving under the influence of an illicit drug during a 2002 survey (University, 2003).
The second commonly abused drug in America was that of prescription drugs (non-medical us of). There were an estimated 2.6 percent of 6.2 million people ages 12 or older taking prescription drugs non-medically. The abuse of prescription drugs and alcohol places a heavy burden on health resources because of the subsequent medical problems. There were 362,000, that year that recognized that they needed treatment due to their abuse of drugs and alcohol (University). Of the 362,000 needing treatment, 88,000 tried to obtain treatment for drugs, but were unable to due to the lack of access and scarce treatment. ...
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The second commonly abused drug in America was that of prescription drugs (non-medical us of). There were an estimated 2.6 percent of 6.2 million people ages 12 or older taking prescription drugs non-medically. The abuse of prescription drugs and alcohol places a heavy burden on health resources because of the subsequent medical problems. There were 362,000, that year that recognized that they needed treatment due to their abuse of drugs and alcohol (University). Of the 362,000 needing treatment, 88,000 tried to obtain treatment for drugs, but were unable to due to the lack of access and scarce treatment. Another 266,000 of them tried, but could not obtain treatment for alcohol abuse. In America alone, there are over 40 million adults who have both a substance use disorder and a mental illness. There is an estimate 17.5 million adults age 18 or older with serious mental illness (University). Adults that use drugs are more likely to have a mental illness than those who don't use drugs. Drug trends across the United States are indicators of the drug use, abuse, addiction, domestic violence, and child abuse. The trends shown in figure 1 are the trends for seven of the most active states using and abusing drugs in the U.S., showing the direct correlation in the amount and type of drug seized by federal authorities (University). The drug seizure gives some indication as to what type of drug is being frequently used and abused throughout the U.S. Information used in Figure 1 was obtained from the University of Florida (2003).
Figure 1. Significant substance abuse levels across 7 big states, representing how much of a substance abuse problem the United States has.
With substance abuse being one of the major contributors in the economy's demise, innovating "best practices" in treatment would benefit society and communities at large. Therefore bridging the gap between practice and research has to become less of a problem and more of the actual approach to treatment today. The gap between treatment practices and research has a lot to do with why treatment is inconsistent and ineffective. There are also policy barriers, human attitudes, stigma, suspicion, and skepticism that often hinder progress in substance addiction treatment (Brendel, et al.). The knowledge base in this field is constantly evolving and different agencies have different treatment needs. However, there will never be one way to treat substance abuse in every given agency, but there is a framework for selecting practices or approaches that will have some degree of research evidence that will fit the need of the agency (Stevens & Morral, 2003). There is research for better practices being promoted by organizations such as the Center for Substance Abuse Prevention (CSAP), and Substance Abuse and Mental Health Services Administration (SAMSHA). They provide insight on developments in policies, programs, and services to prevent the onset of illegal drug use, underage alcohol and tobacco use, and to reduce the negative consequences of using substances (Spotswood, 2003).
Certain practices and theories that are utilized within the substance treatment facilities today are the science based prevention practices, which are another innovative form of research in healthcare (Information, 2003). This is the process in which experts' use commonly agreed upon criteria for rating interventions. There is a consensus that experts' reach that tells them the evaluation research finding is credible and can be sustained. This form of practice is also known as evidence-based or research-based prevention. Evidence-based practices usually refer to programs or practices that are proven to be successful through research methodology and have produced consistently positive patterns of results (Information). These practices or model programs that have shown the greatest levels of effectiveness are those that have been established through research studies. The development of an evidence base supported by research is necessary before conclusions can be drawn about any particular practice. Scrupulous assessment entails methodical, standardized description of a targeted population, program practices, and the theoretical relationship between clients served, practices and desired outcomes. These interventions must be shown to develop outcomes that are significant to contributors, and that are calculated without bias in research conducted by sovereign investigators (Information).
Practices with good research support will not be implemented if they do not meet practical consideration (Daley & Zuckoff, 2003). On the other hand, if too much weight is put on the practical aspects, the scientific merit may be downplayed and practices that are not the best will continue to be used, just because they are inexpensive and easy to administer. Evidence-based models will always contain enough detail so that all staff can use the practice in the same way. If this is not so, treatment manuals will not enhance fidelity and staff will be inconsistent in their practice. Their focus is on bridging "ground-breaking" prevention to treatment providers (Daley, et al.).
Nonetheless treatment providers in the substance abuse communities have shown trends in non-effective treatment, in some instances, reasons are that of aged treatment and not implementing change (Sparks, 2003). Breaking a substance abuse cycle is a knowingly tedious process. It has been identified in today's changing environment that health care providers in the substance abuse treatment sector make little to no change in the way treatment is conducted in their facilities. It is duly noted in figure 2, from a National Survey on Drug Use and Health (NSDUH), how many was actually being treated for substance abuse (Substance, 2003).
Treatment Received in 2002
Figure 2. This bar graph shows the need for treatment and if it was received in 2002.
Therefore, in regards to the treatment of substance abuse, there need to be a progress to access and the effectiveness of treatment. Health managers in these organizations need to collaborate with the evolving innovative practices and implement where needed on a more frequent basis. Previous strategies used have been shown to be ineffective, and are used year after year. In many communities, effective approaches go unused not because policy makers and citizens are unaware of them, but because of a lack of expertise and the organizational infrastructure to implement them (Information). As providers and researchers in this field, to overcome the problems of dissemination and application of innovative practices (best practices), is a major challenge to hurdle. In the health care field it has been identified that problems of promoting science-based practice are common (Information).
Nonetheless, there are substance abuse patients that are in need of care that will have a positive approach to their condition; which in turn will have a positive approach on society as a whole. Science-based prevention is also an approach to making change (Information). This approach is guided by several different theories of change. Science-based prevention applies evidence from rigorous evaluation research on prevention practices. It follows a process of strategic planning that focuses on the integrating thoughtful assessment, design, implementation, and evaluation into every program. Prevention is a proactive process that empowers individuals and systems to meet the challenge of life events by creating and reinforcing conditions that promote healthy behaviors and lifestyles. These theories include: individual change theories (including theories of addiction), risk and resiliency, intra and inter organizational change theories, and community change theories (including community organizing, policy change, and public health theories) (Information). This theory is also known as the ZYX theory of successful change management (Arora, 2003).
Clients, drugs, treatment concepts are changing. Therefore, if the environment around a problem (substance abuse problem) is an ever-changing environment, then the substance abuse era has to keep abreast of those changes. Numerous challenges face all who are alcohol and drug treatment supervisors, providers, or just professionals in the substance abuse sector (Sparks). Some of these challenges may include consumer demands, and expectations, incorporating the need for standardized practices, and technological advances in treatment delivery. These challenges will determine one's individual ability to meet the needs of our clients and our profession's ability to enhance the quality of care provided (Sparks).
For a firm to change from a former state to the latter state critical organizational transformations have to be mastered (Sparks). Organizational means opening a new chapter in the theory of the firm. However, to keep track of a changing composition of the routines in an industry is perhaps more compelling a device for analyzing how firms and industries co-evolve than for spotting the organizational change within the individual firm. Effective administrators understand theories of change and seek to nurture the need for change within the context of the institutional norms that defend against it (Sparks). Ultimately, leaders cultivate change as an essential means toward the achievement of institutional advancement. Individual change theory expounds on the basis that if wanting to succeed spectacularly at creating or managing change, one would have to reach the right place. This innovative theory was developed by Nigam Arora to help leaders ensure success at creating change (Arora). This theory is believed to uncover reasons behind innovative failures. It ties together new innovations in a more comprehensive and practical framework, to successfully managing change (Arora).
Theories of addiction can lead to blind alleys and bad treatments in which therapists adopt every fad and reach into a bulging bag of tricks for whatever is in hand or intuitively meets the immediate moment (Arora ). However, there have been findings of three myths about alcoholism and other addictions: nothing works, one particular approach is superior to all others, and that everything works about equally well. There are certain things about individuals; the environment in which they live in, and about the substances involved that must be factored into theories of change. The most likely truth about addiction is that has been speculated is that it's not a single, basic mechanism, but several problems are labeled addiction (Arora). The world of health care has seen more than its share of change in recent years, and more is still to come. Change hits each of from many directions, reflecting various roles as individuals, as caregivers for patients, and as managers of medical practices. There tends to be views of these as completely separate spheres. But succeeding as people, caregivers, and as managers demands a common set of skills those that help manage change. Managers build an atmosphere of mutual trust and respect. As a manager in any health care setting, you can do this by treating your staff fairly and keeping them informed of events good and bad that may affect their work lives (Arora). Interacting with these entities is creating new and often dreadful challenges for health care professionals. But you can help your staff adapt to the changes that infiltrate down from them by helping to shape change from the beginning. As an effective manager going through change, through research Arora has indicated some ways to achieve success through change:
* Being patient and willing to accomplish objectives over time,
* Be willing to settle for partial success or quit when goals are not achievable,
* Know the people on the other side of the table; their perspectives, goals, prejudices, range of authority and ability to respond to requests,
* Keep cool,
* Look for win-win solutions,
* Hold fast to conviction that patients come first, but try to express it by constructive example rather than preaching (2003).
Whether changes originate from outside a particular practice or from typical flashes of insight, managers have the responsibility to help staff cope with them. When changing one's environment within the substance abuse sector, skillful alcohol and drug counselors are needed (Arora). Nonetheless, since there is change the client and family need to be educated enough about what to expect from the treatment provider and how to alert counselors about problems with the new treatment plan (Arora).
Over the years there have been major studies towards substance abuse prevention. Research has made great strides in identifying effective programs, strategies, and principles that focus on preventing and reducing substance abuse risk behaviors. Some effective key principles of abuse prevention have been identified by the SAMHSA (Spotswood). From many key principles found in an approach to deter substance abuse, SAMHSA found seven that has affected toe substance abuse sector in a positive way. These seven principles are policy, enforcement, collaboration, communications, education, early intervention, and alternatives (Spotswood). SAMHSA concluded that when using multiple strategies in multiple settings and working towards a few common goals, could offer the best chance to prevent people from using alcohol tobacco, and other drugs. SAMHSA have also found that managers in the substance abuse setting should use a decision support system with in a substance abuse facility's "change" process (Spotswood).
The first step in this process is assessing the facility's needs. When assessing the facility's needs, first determine the problem, then build a team, next consider risk and protective factors, then select indicators/measures of the problem within the community, lastly collect data related to the problem. The second step in the decision support system is to develop a capacity. In this step one would have to determine the internal capacity, external resources, and develop a strategic plan. The third step in this process is to select programs. When selecting programs one has to establish program criteria, consider program requirements, and set benchmarks for evaluation. In the fourth step, programs are implemented. In this step, you have to develop detailed action steps, mobilized resources, schedule training, consider adapting issues (culture, respect, community issues), and ensure sustainability. Lastly, the fifth step is the ultimate success builder for administrators. In this step a manager would look for outcomes, process, continuous quality, improvement, and program sustainability (Spotswood).
Throughout this whole process (all five steps), there are risk factors. Indicators of potential occurrence or vulnerability are risks (Sparks). However, effective managers maintains resiliency to overcome all turmoil. Therefore the ability to recover from or adjust easily to misfortune or change is resilience (Sparks). It is evident that the research completed towards better practices within the substance abuse community has been identified; however the implementation process has not thoroughly made its breakthrough (Sparks).
The overall issue is that there is a gap between practice and research and there is a need for it to be revolutionized. Change is a big issue in why there is a slow innovative process within organizations. As the world turns, technology increases and innovative research gets better empowered. However, the process to implementing innovation is where the "downfall" is. Innovators within organization need to be motivated to increase collaboration between various clinical groups. With the same respect, motivators within the organization (groups) should develop a long lasting culture with innovation (Daley, et al.). It is a challenge, yet it is needed to understand the trials and tribulations that innovation might have during the implementation process within the organizations. Through it all, developing a way to overcome the challenge implementing innovation within the organization, could lead better practices.
A system's approach evolves from prior collaboration and coordination efforts to build relationships among various agencies to provide needed services (Daley et al.). Researchers and practitioners note that these efforts often fall short to provide sufficient and appropriate substance abuse treatment services. The lack of infrastructure threatens the integrity of the intervention, contributed to poor perception of the program and drug treatment. When changing one's system approach, there need to be a design to overcome shortcomings and build the needed infrastructure to support quality treatment programs (Daley, et al.). The role of the supervisor agent in the treatment process requires further exploration to identify differential components of leverage that improve outcomes. Supervision overall is an under-researched era where studies are needed regarding the various functions performed by the agent, different supportive roles of supervision, use of different engagement, and incentive strategies (Daley et al.).
Implementation often depends on factors directly related to the organizational structure such as leadership (agency director's training, education, treatment, philosophy, vision, and creativity), caseload and staffing patterns, decision-making mechanisms, and cultures and subcultures of the agency (Information). Hospital-based programs may differ from community-based programs in many ways, and may be more likely to adopt medically based approaches such as pharmacological treatments. Community-based programs may be more likely to consider group-based psycho-educational treatments because of staffing patterns and organizational philosophy. The age of the organization may be an important factor (Information).
The older agencies are more likely to have a well defined viewpoint or mission statement and may become more deep-rooted in their approach; on the contrary the older agency may be more stable and thus better equipped to try out new approaches because of a stable workforce. The length of time a manager has been in place may also be important, as well as educational degrees and level or type of training of the director (Informaton). This is especially true in the substance abuse environment, with the every changing issue that surrounds its workforce. As substance abuse treatment effectiveness research increases and practices that work are identified, it is critical to study the processes by which these new practices become integrated into the field and how adjustments or revision of these practices affect outcomes (Schmidt, 2003).
Substance abuse treatment research has produced some clear findings about substance abuse treatment practices (longer treatment duration) that are correlated with positive post-treatment outcomes. Yet there is also evidence of significant variation in outcomes across programs that may be associated with the organization, management, and implementation of treatment programs (Schmidt,). The health care environment is increasingly forced to respond to the demand for cost containment; therefore, undertaking mutual endeavors is critical to the future of many programs, especially at the community level. Creative associations can supplement and complement programs, building on their strengths and compensating for their weaknesses (Brendel, et al.). Connections can open avenues to diverse sources of funding to offset the projected withdraw and flow of resources. There are a growing number of funding sources that are granting funds only when presented with evidence of coordinated activities among grant applicants. A board that consists of members who are committed to supporting program goals and overcoming challenges is essential to effective operation (Brendel et al.). Motivated and well-connected directors can, help identify community-funding sources that will support the development of collaborations (change) (Arora). Administrators and managers should seek to create an organizational environment that encourages and supports staff members' collaboration activities, which are often time-consuming. Staff members' new collaborative relationships, as well as their existing relationships with other agencies, are critical to success (Arora).
This information can help efforts to produce "best practices" to increase treatment commitment and retention, as a result improving client outcomes. Now is the time to find ways to enhance the delivery of substance abuse services to clients by putting the next generation of clinical studies into practice. This will require improved training models. Concurrently, program information and management systems should be improved for better documentation of client care and performance (Arora.). Since treatment programs are not equally accessible or reactive to new innovations, organizational functioning and related barriers should be examined in terms of its climate for change (Arora.). Recognizing and implementing interventions appropriately matched to client needs at each conceptual phase of treatment will help improve effectiveness. Modernized client assessments with easy-to-use clinical understanding of needs and progress would assist more programs to meet diagnostic and treatment planning goals, especially if they were linked to particular interventions with supporting evidence of "successful" delivery (Arora).
Research is now expanding around factors that influence how treatment innovations get incorporated into real-world settings. Identifying effective clinical techniques and program management systems is only the first (science-based) step and has to be followed up with studies of execution, including cost-related suggestion (Daley, et al). There is a need to learn much more about this dynamic process, which will likely be one of the greatest challenges facing the U.S. in the next decade.
Reference
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