Hurlocker Margo C, Carlon Hannah A, Hernandez-Vallant Alexandra
Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States of America; Center on Alcohol, Substance use, and Addictions, University of New Mexico, Albuquerque, NM 87106, United States of America.
Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States of America; Center on Alcohol, Substance use, and Addictions, University of New Mexico, Albuquerque, NM 87106, United States of America.
J Subst Use Addict Treat. 2025 Jan;168:209546. doi: 10.1016/j.josat.2024.209546. Epub 2024 Oct 21.
The initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be what, but how services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process.
Personnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs (N = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process.
Participants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs).
Findings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.
初次接诊环节是门诊成瘾治疗项目中治疗参与度的关键节点。尽管接诊评估更为全面、个性化，且能够将客户与治疗级别相匹配，但成瘾治疗项目的流失率仍然居高不下。因此，导致流失的原因可能不在于提供了什么服务，而在于服务的提供方式。实施研究综合框架（CFIR）提供了一个全面的框架，以关注接诊流程所需创新的来源。本研究采用混合方法设计，以CFIR为指导，从成瘾治疗项目的工作人员那里获取关于当前接诊流程以及改变接诊流程的促进因素和障碍的反馈。
新墨西哥州成瘾治疗项目的工作人员完成了关于其所在项目进行变革的个人和组织准备程度的测量（N = 79；76%为女性，79%为白人，55%为拉丁裔）。从这个样本中，38名参与者完成了一次基于CFIR的半结构化访谈，以确定改变接诊流程的潜在障碍和促进因素。
参与者在组织变革的准备程度和能力方面的得分中等至高。对于定性数据，我们确定了九个广泛的主题，根据（一）当前接诊流程的观点（接诊流程、组织文化、变革观点、内部沟通及客户需求）以及（二）将接诊转变为动机性访谈环节的观点（动机性访谈知识/态度、接诊时的动机性访谈、组织中的动机性访谈、动机性访谈与客户需求的契合度）进行分组。
研究结果表明，接诊内容和流程中的特定组成部分似乎会使客户失去参与度，特定的政策和程序似乎会给工作人员带来过重负担，以及改善接诊流程所需的关键利益相关者和资源。针对组织内部以及与外部机构在接诊特定和程序层面的变革提出了建议，以改善接诊流程。
