Contact Tracing for COVID-19: The Use of Motivational Interviewing and the Role of Social Work.

One method in mitigating the impact of COVID-19 is that of contact tracing. It is estimated that in the US, 35,000-100,000 contact tracers will be hired (and trained) to talk to recently-infected individuals, understand who they have exposed to the virus, and encourage those exposed to self-quarantine. The Center for Disease Control recommends the use of motivational interviewing (MI) by contact tracers to encourage compliance with contact tracing/quarantine. Contact tracers need to sensitively communicate with COVID-19-exposed individuals who may also be experiencing other issues caused by the pandemic, such as anxiety, depression, grief, anger, intimate partner violence, health problems, food insecurity, and/or unemployment. Social workers are particularly prepared to address the mental health and other psychosocial problems that may be encountered in the tracing process. This article describes contact tracing, its use in other diseases, the role of MI, psychosocial issues that contact tracers may encounter, and how social work can respond to these needs. A sample dialogue of contact tracing using MI is presented with a discussion of the content and skills used in the process.

Gender differences in driving under the influence (DUI) program client characteristics: Implications for treatment delivery.

The purpose of this descriptive study was to examine gender differences in the characteristics of clients in a large Driving Under the Influence (DUI) program in Southern California. We analyzed secondary de-identified data from a large DUI program for the years 2009-2014 (n = 19,619). Sociodemographic characteristics, measures of physical and mental comorbidity, and alcohol use severity measures were compared for male and female clients. Women averaged 32.85 years of age (SD = 10.70), while men were slightly older at 34.2 years (SD = 11.19). Females comprised an increasingly greater percentage of the client population over the time period studied (27.6%-30.7%). In a multivariable model, compared to male clients, females were more likely to be White non-Hispanic, not currently married, and younger. Women were more likely than men to report anxiety, depression, and a history of domestic violence. Blood alcohol content at arrest and measures of hazardous drinking did not differ significantly by gender. Results suggested that gender-specific DUI programs might be useful.

Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department.

Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19-29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED.

Feasibility and Acceptability of a Brief Motivational Stage-Tailored Intervention to Advance Care Planning: A Pilot Study.

AIM: This pilot study explored the feasibility and acceptability of a stage-tailored motivational interviewing intervention with education that focuses on changes in end-of-life (EOL) communication, completion of advance directives (ADs), and readiness for advance care planning (ACP). METHODS: One group pretest-posttest design was implemented with 30 low-income older adults. RESULTS: This pilot study showed its feasibility in enhancing ACP. Action for ACP-that is, identifying a proxy for decision making and documenting EOL treatment preference in an AD-increased significantly by 23.3% (n = 7). The participants' readiness for ACP, knowledge, self-efficacy, positive attitudes, and perceived importance of ACP increased significantly after the intervention. CONCLUSION: Health care professionals and service providers who interact with older adults should tailor ACP dialogues in accordance with individuals' motivation.

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BACKGROUND: Although screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals. METHODS: A total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite. RESULTS: Of 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12). CONCLUSIONS: In this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome. TRIAL REGISTRATION: ClinicalTrials.gov NCT01683227.

Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients.

INTRODUCTION: Visits to settings such as emergency departments (EDs) may present a "teachable moment" in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use. METHODS: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis. RESULTS: RESULTS of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change. CONCLUSION: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use.

Linking basic and advanced motivational interviewing training outcomes for juvenile correctional staff in California.

Motivational interviewing (MI) is an evidence-based communication method that can be effective in engaging incarcerated juveniles in substance abuse programming and other treatment services. However, MI can be difficult to learn and often requires several training exposures for skill change. Few studies have examined MI training outcomes over time. This study reports outcomes for 222 juvenile corrections workers trained in MI in a three-day introductory and two-day advanced training. MI skills were measured via video-administered pre- and post-tests and with a written questionnaire. Combined results from a linear mixed model found that overall MI skills were positively associated with staff education level, and negatively associated with age and time between trainings. Those who attended their second training within nine months of the first training were more likely to score in the proficiency range. Motivation to use MI, belief in its efficacy with youth, job classification, and sex were not related to skill attainment.

Methamphetamine abuse and manufacture: the child welfare response.

Methamphetamine abuse is on the rise, particularly by women of childbearing age. This article describes the history and effects of methamphetamine use. The authors examine the ways exposure to the manufacture of this drug affects clients and social workers in the course of their work. Because children are frequently found at the scene of a manufacturing laboratory, the child welfare system often becomes involved, and child protective services and other social work agencies need protocols to address the needs of the children and their parents, as well as those of the legal system. In 1997 California created and implemented drug-endangered children's units in seven counties to address the needs of children from families that manufacture methamphetamine; these units involve collaborative efforts among child protective workers, district attorneys, physicians, and police officers. A case example provides information about the role of social workers and their collaboration with these multiple systems.

A comparison of pregnant women presenting for alcohol and other drug treatment by CPS status.

OBJECTIVE: The purpose of this study was to describe the demographic, substance use, and treatment variables of alcohol and other drug (AOD) treatment seeking pregnant women. This study also compared women on these variables based on Child Protective Service (CPS) status. METHOD: Secondary data of all pregnant women with at least one child entering all publicly funded AOD treatment programs (N=678), in a southwest county, over a 3-year period were analyzed to examine the differences between pregnant women also involved with CPS and those not involved with CPS. RESULTS: Pregnant women reporting CPS involvement were similar to non-CPS women on demographic variables but differed on drug use and treatment variables. CPS women were more likely to report marijuana use as their primary problem drug, be mandated to treatment, attend day treatment and be released from treatment unsatisfactorily compared to the non-CPS pregnant women. Those without CPS involvement were more likely to report cocaine or crack as their primary drug, attend outpatient treatment and be found to have a satisfactory release from treatment compared to those with CPS involvement. Results from the multiple logistic regression analysis found that the significant predictors of CPS involvement were mandated status and unsatisfactory treatment release. CONCLUSIONS: Differences in treatment outcomes may be based on AOD agencies' difficulty in working with mandated clients and/or with the multiple demands placed by CPS on clients as part of their treatment plans. Further research is needed to determine reasons for CPS clients' high failure rates in AOD treatment.