OHSU

Current Research

Military Wives Matter Project

Funded by National Institute of Mental Health


“When a Soldier deploys it’s not just the Soldier. The family deploys”

U.S. Rep. Tim Walz, the most senior-ranking enlisted Soldier of the National Guard ever to serve in Congress

 

“He brought the war home … he never had these problems before the war, and now we both have problems”

The wife of a United State Army non-commissioned officer serving a second tour in Iraq

 

It is widely acknowledged that veterans’ families face considerable challenges associated with combat. They have to cope with the prolonged absence of their loved one, worry about his or her physical safety, and often endure financial strain, extra duties (such as single-parenthood), and emotional challenges.

At the same time, there are several less obvious issues that often threaten military families. Upon return of their loved one, they continue to struggle as veterans in the post deployment phase contend with reintegrating both back into society and into their families.

We believe that a website designed to provide spouses with information about issues military families often face such as post-traumatic stress (PTSD) disorder, depression, traumatic brain injury (TBI), strain in family relationships, helping children adapt, dealing with aggression, tips for developing coping strategies, a forum for discussing their concerns with others going through similar experiences, and a centralized resources page with links to a variety of websites will be useful to military families and may help spouses fill these needs.

Patient Safety

Abstract accepted for 2010 American Psychiatric Association Meeting

Employee perspectives on patient safety inside a behavioral health clinic: A case study

Objective

Each year in the United States more than a million people seek substance abuse treatment.  However, little if anything is known about patient safety in this population. The purpose of this project was to assess staff perceptions of risk for clients in publicly funded outpatient substance abuse treatment.

Method

Participants were treatment counselors and administrative staff at an ambulatory adult substance abuse treatment clinic.  Structured interviews focusing on patient and staff safety were conducted with all staff members .  Additionally, paper surveys were completed by staff so they could anonymously describe any safety errors they had witnessed.  

Results

Approximately half the staff members reported that they had never seen an error.  Among those who had seen something, the majority reported only witnessing one. Participants believed that sharing information about errors is important. However, discussion of and reporting of errors were less common. Further, systems-wide approaches would seem to be under-utilized as 63% of respondents indicated that they “strongly agreed,” or “agreed” with the statement “After an error occurs, an effective strategy is to work harder to be more careful.”
Qualitative themes from the interviews included balancing a heavy workload with service excellence, differing perspectives between administrative and clinical personnel, high turnover, difficulties surrounding paper charts, need for specialized training for administrative personnel for the specific patient population being served, and the physical design of the environment.  Overall, participants’ responses to questions pertaining to their experiences suggested that while they assigned a high priority to patient safety in terms of their beliefs, best practices are not always employed. 

Conclusions

Patient safety within the context of substance abuse treatment is critical to patient outcomes.  This case study demonstrates that systems-level problems can impact staff perceptions of and behaviors pertaining to patient safety. While clinic staff consistently endorsed items indicating they considered patient safety a high priority, there were discrepancies between espoused beliefs and behavior when it came to reporting errors or discussing them with colleagues.  These discrepancies may be partially due to perceptions that the substance abuse treatment culture in general provides little support for dealing constructively with errors, as well as concerns about harsh judgments from colleagues. Moreover, there seems to be some confusion about which kinds of errors need to be reported and limited knowledge of the reporting system. Taken together, these results suggest that substance abuse treatment agencies can benefit from increased staff training about error reporting as well as clarification of procedures pertaining to patient safety.

 

Clinical Skills Assessment

Abstract accepted for 2009 American Psychiatric Association Meeting

Counselor Characteristics Predict Substance Abuse Treatment Recommendations

The American Society of Addiction Medicine Patient Placement Criteria (ASAM PCC-2R) is considered the gold standard for the development of treatment recommendations for persons with substance use disorders. Using six dimensions, clinicians follow a fixed algorithm to create a treatment plan. Research in primary care has shown that physician gender and age can influence recommendations for treatment of depression. If, similar to findings with physicians, substance abuse counselor characteristics account for discrepancies in patient placement, implications for addictions treatment abound. Since counselor characteristics vary widely, this may help explain why the reliability and validity of the ASAM PCC-2R have produced mixed results.

Thirteen drug and alcohol clinicians (persons self-identified as substance abuse counselors or those in training) conducted an assessment interview with a standardized patient (SP) who was portraying a heroin addicted male. SPs are paid professionals specially trained to portray the persona of a patient role and consistently present the same symptoms to multiple clinicians.

For this study, clinicians were asked to place the SP on each of the six ASAM PPC-2R dimensions or areas of assessment and then recommend an overall level of treatment.  Regression analyses showed that counselors “not in recovery” (N= 9) or counselors in training (N = 5) recommended significantly higher overall levels of treatment (more intensive) than counselors “in recovery” (N = 4) or counselors who had completed training (N = 8).

Thus, certain types of counselor “experience” are associated with less intensive treatment recommendations. This pilot study suggests that counselor characteristics may influence ASAM patient placement recommendations. Further research with a larger sample is needed to understand what other factors are important for patient placement in substance abuse treatment.