Oberleitner Lindsay M S, Madden Lynn M, Muthulingam Dharushana, Marcus Ruthanne, Oberleitner David E, Beitel Mark, Gaeta Marina, Tamberelli Joseph F, Barry Declan T
Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA.
The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA.
J Subst Abuse Treat. 2021 Feb;121:108191. doi: 10.1016/j.jsat.2020.108191. Epub 2020 Nov 2.
To examine addiction counselors' perceptions and experiences of implementing an open-access model for methadone maintenance treatment (MMT), in which the program rapidly enrolled prospective patients, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Between 2006, when the treatment program initially implemented this model, and 2020, the census of clients receiving methadone maintenance at the study site grew from 1431 to 4500.
Participants were 31 addiction counselors employed at a treatment organization that implemented an open-access model to scale up MMT. We examined counselors' perceptions and experiences of working in programs that employed this model, using individual semi-structured interviews, which an interdisciplinary team audiotaped, transcribed, and systematically coded using grounded theory. The team reviewed themes and reconciled disagreements (rater agreement was 98%). We describe themes that more than 10% of participants reported.
Counselors described perceived advantages of the open-access model for clients (e.g., "individualized to client needs"), clinicians (e.g., "fewer demands"), and the community (e.g., "crime reduced"). Counselors also described perceived disadvantages of the open-access model for clinicians (e.g., "uneven workload") and clients (e.g., "need for more intensive services for some clients"), as well as program-level concerns (e.g., "perceived lack of structure").
Counselors who work in opioid treatment programs that use an open-access framework described multiple benefits to themselves, their clients, and the public; they also outlined disadvantages for themselves and clients, which research should further explore and address to facilitate MMT scale up.
考察成瘾咨询师对实施美沙酮维持治疗（MMT）开放接入模式的看法和经验。在该模式中，项目迅速招募潜在患者，无论其支付能力如何，并提供多种自愿治疗选择的实时接入。从2006年该治疗项目最初实施此模式到2020年，研究地点接受美沙酮维持治疗的患者普查人数从1431人增加到4500人。
参与者为受雇于一家实施开放接入模式以扩大MMT规模的治疗机构的31名成瘾咨询师。我们通过个人半结构化访谈考察咨询师在采用该模式的项目中的看法和经验，一个跨学科团队对访谈进行录音、转录，并使用扎根理论进行系统编码。该团队审查了主题并协调了分歧（评分者一致性为98%）。我们描述了超过10%的参与者报告的主题。
咨询师描述了开放接入模式对客户（如“根据客户需求量身定制”）、临床医生（如“需求较少”）和社区（如“犯罪率降低”）的感知优势。咨询师还描述了开放接入模式对临床医生（如“工作量不均衡”）和客户（如“一些客户需要更强化的服务”）的感知劣势，以及项目层面的担忧（如“感觉缺乏结构”）。
在使用开放接入框架的阿片类药物治疗项目中工作的咨询师描述了对他们自己、客户和公众的多重益处；他们也概述了对自己和客户的劣势，研究应进一步探索和解决这些问题以促进MMT的扩大。
