Development and Measurement of the Treatment Perceptions Survey (TPS) for Clients with Substance Use Disorders.

Statistical reliability of the Treatment Perceptions Survey (TPS) questionnaire was examined using data from 19 California counties. The 14-item TPS was designed for clients receiving substance use disorder services at publicly funded community-based programs. The TPS is being used for evaluation of the State's 1115 Medicaid Waiver, external quality review of county-based systems of care, and quality improvement efforts. The survey addresses four domains of access to care, quality of care, care coordination, and general satisfaction that each include multiple items, plus a single item focused on self-reported outcome. Reliability test results of the four domains as composite measures were statistically significant. General satisfaction ratings were the best predictor of self-reported outcome in a path analysis model, followed by ratings of care coordination and quality of care. Separate analyses of TPS data from clients receiving specialty mental health services suggest the questionnaire can also be used reliably in mental health settings.

Clinical characteristics of infections caused by Roseomonas species and antimicrobial susceptibilities of the isolates.

Human infections due to Roseomonas species are uncommon and the vast majority of reported infections are opportunistic and easy to treat. We retrospectively reviewed the computerized database of the Bacteriology Laboratory at the National Taiwan University Hospital to identify patients with infections caused by Roseomonas species during the period January 2000 to December 2010. Isolates of Roseomonas species were confirmed by 16S rRNA gene sequencing analysis. During the study period, 20 patients had cultures positive for Roseomonas species. R. mucosa was the most prevalent isolate (n = 18), followed by 1 each of R. gilardii and Roseomonas genomospecies 5. True infection caused by Roseomonas species was confirmed in 17 (85%) patients. Most (n = 12, 71%) of these infections were health care-associated infection. The majority of the patients (n = 12, 71%) had underlying diseases. Malignancy was the most common underlying disease, and catheter-related bloodstream infection was the most common type of infection. The antimicrobial susceptibility patterns varied among the different Roseomonas species. In conclusion, Roseomonas species can cause infection in children and adults regardless of immune status. Because different Roseomonas species may have different clinical features and susceptibility profiles, molecular studies are necessary to identify Roseomonas isolates to the species level.

Differences in drug resistance profiles of Mycobacterium tuberculosis isolates causing pulmonary and extrapulmonary tuberculosis in a medical centre in Taiwan, 2000-2010.

Few studies have investigated the drug resistance profiles of Mycobacterium tuberculosis (MTB) isolates recovered from different sites of infection. A total of 4521 non-duplicate MTB isolates, including 3723 (82.3%) from respiratory specimens and 798 (17.7%) from non-respiratory sources, were recovered from patients treated at a medical centre in Taiwan from 2000 to 2010. Trend analysis showed a significant decrease (P<0.05) in the rates of resistance to isoniazid, rifampicin and ethambutol, a decrease in resistance to any one of four agents, namely isoniazid, rifampicin, ethambutol or streptomycin, and a decrease in resistance to both isoniazid and rifampicin (multidrug resistance) amongst pulmonary MTB isolates. A similar decrease in resistance to isoniazid and ethambutol was noted amongst non-pulmonary isolates. Rates of drug resistance were significantly higher amongst MTB isolates recovered from respiratory specimens than amongst those from non-respiratory specimens to 0.2 µg/mL isoniazid (15.3% vs. 9.4%; P<0.0001), 1 µg/mL rifampicin (5.5% vs. 3.3%; P=0.0108), 5 µg/mL ethambutol (7.3% vs. 3.8%; P=0.0004), and both isoniazid and rifampicin (4.8% vs. 2.5%; P=0.0051). Resistance rates amongst isolates causing tuberculous lymphadenitis were significantly lower than amongst those causing genitourinary tuberculosis (TB) to isoniazid (3.5% vs. 19.4%, P=0.0012) and to isoniazid, rifampicin, ethambutol or streptomycin (9.6% vs. 22.6%, P=0.0003). In conclusion, the rates of resistance to first-line anti-TB agents and to multiple agents differed amongst MTB isolates obtained from different infectious sources. Continuous monitoring of resistance of MTB isolates from various sites is necessary in order to establish an effective TB surveillance programme.

Utilization and outcomes of mental health services among patients in drug treatment.

This study examined utilization of mental health services and treatment outcomes among 1,091 patients with mental health problems recruited from 39 treatment programs in 13 California counties. We compared three groups: one that received dual treatment from drug and mental health programs (N=294), one that received mental health services only within drug treatment programs (N=578), and one that received no mental health services (N=219). Individuals who received dual treatment had more severe substance use and mental health problems, followed in severity by those who received mental health services within drug treatment, and those who received no services. All groups significantly reduced their psychiatric severity at the follow-up, although there were no group differences in treatment retention and drug use outcomes. These findings suggest that individuals with mental health problems can be successfully treated within drug treatment programs and/or in conjunction with mental health providers.

Mothers in substance abuse treatment: differences in characteristics based on involvement with child welfare services.

PROBLEM: Greater awareness of the role of parental substance abuse in child maltreatment makes it imperative that the substance abuse treatment and child welfare systems coordinate services for these parents. Yet little is known about the characteristics of child-welfare involved parents (primarily mothers) who enter into substance abuse treatment. This paper compares the characteristics of mothers in substance abuse treatment who were and were not involved with child welfare services, and discusses the treatment implications of these differences. METHOD: Data were obtained from a statewide treatment outcome monitoring project in California. Clients were assessed at treatment admission using the Addiction Severity Index. Bivariate analyses and multivariate logistic regression were conducted comparing mothers who were (N=1,939) and were not (N=2,217) involved with child welfare. RESULTS: Mothers who were involved with child welfare were younger, had more children, and had more economic problems. They were more likely to be referred by the criminal justice system or other service providers, to have a history of physical abuse, and to be treated in outpatient programs. They had lower levels of alcohol severity, but did not differ with regard to psychiatric severity or criminal involvement. Primary users of methamphetamine were disproportionately represented among this group and had a distinct profile from primary alcohol- and opiate-users. CONCLUSION: Study findings suggest that mothers involved with child welfare enter substance abuse treatment through different avenues and present a clinical profile of treatment needs related to exposure to physical abuse, economic instability, and criminal justice involvement.

Treatment outcomes among women and men methamphetamine abusers in California.

This prospective longitudinal study examined treatment outcomes among 1,073 methamphetamine-abusing patients (567 women, 506 men) from 32 community-based outpatient and residential programs in 13 California counties. Data were collected at intake and at 3 months and 9 months after admission. With one exception, improvements from baseline to follow-up were observed in all areas measured by the Addiction Severity Index for both women and men in either modality. Compared to men, women demonstrated greater improvement in family relationships and medical problems, and similar improvement in all other areas, despite the fact that more women were unemployed, had childcare responsibilities, were living with someone who also used alcohol or drugs, had been physically or sexually abused, and reported more psychiatric symptoms. Implications for service improvement are discussed.

Do patients' perceptions of their counselors influence outcomes of drug treatment?

This prospective longitudinal study examined the influence of patients' perceptions of their counselors on their lengths of stay in treatment and subsequent treatment outcomes. Patients (N = 511) were recruited from 19 substance abuse treatment programs in Los Angeles County. While in treatment, patients rated their counselors on 14 aspects (e.g., empathy, directiveness); 1 year later they were interviewed for follow-up outcomes. Multiple regression analyses were conducted using patients' ratings of their counselors to assess the impact of these ratings on treatment retention and follow-up outcomes (i.e., severity of alcohol use, drug use, and psychiatric status as measured by the Addiction Severity Index). Results revealed that patients' positive perceptions of their counselors were significantly associated with a longer length of stay in treatment for the outpatient drug free/day treatment and residential treatment subsamples. Patients' positive perceptions were also significantly associated with better psychiatric functioning at follow-up, but had a limited relationship to severity of alcohol use and no relation to severity of drug use.