Rupa Kalahasthi, Jacob Wadsworth, Cory A. Crane, Jonathan Toole, Cassandra Berbary and Caroline J. Easton
Homelessness is a growing concern across the globe that has multiplied during the pandemic. According to a recent report by the Department of Housing and Urban Development (HUD…
Abstract
Purpose
Homelessness is a growing concern across the globe that has multiplied during the pandemic. According to a recent report by the Department of Housing and Urban Development (HUD, 2018), 20% of the homeless population have a severe mental illness and 16% chronically used substances. This paper aims to address the effectiveness of in-shelter mental health services provided by qualified clinicians.
Design/methodology/approach
In this study, clients from a homeless shelter were provided in-shelter mental health intake and resources by predoctoral clinicians. Their pre- and postdistress scores were recorded to establish the effectiveness of the intervention.
Findings
Ninety-eight guests were provided services of which 51% reported co-occurring mental health and substance use diagnoses. There was a clinically significant difference in the pre- to postsession distress levels based on the ratings at the intake session. It was noted that making services accessible increased the ability to provide triage services, help with housing options and integrate care with other providers and decrease distress levels.
Research limitations/implications
The current program was implemented in only one shelter in Upstate New York, other similar settings need to be explored in different locations. Objective indicators will be analyzed in the future to establish the effectiveness of services.
Practical implications
This paper outlines a procedure that can guide and help future projects to establish clinical care at homeless shelters across the USA and globally. This paper provides examples of the intake form, list of resources and basic coping strategies that can aid other clinicians and researchers to establish similar programs.
Social implications
This paper sheds light on the mental health needs of an underserved and underrepresented population in the field of mental health – the homeless. The guidelines outlined in this paper can help set up more mental health clinics at homeless shelters and make mental health services more accessible, which can help prevent recurring homelessness.
Originality/value
This paper establishes guidelines for effective single session interventions that help decrease distress levels. This paper also establishes the need for in-shelter services to overcome barriers in mental health care for the homeless population.
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Caroline J. Easton, Cassandra M. Berbary and Cory A. Crane
The purpose of this paper is to review the research on the use of technology in mental health and addiction treatment, focusing on the use of technology-assisted treatment…
Abstract
Purpose
The purpose of this paper is to review the research on the use of technology in mental health and addiction treatment, focusing on the use of technology-assisted treatment. Although initial research investigating technology-assisted treatment for substance use has demonstrated promising results, this paper highlights the need for treatment to address co-occurring substance use and intimate partner violence (IPV). This paper defines the benefits associated with the use of behavioral health avatar coaches in mental health treatment targeting substance use and IPV as well as providing preliminary research results regarding the use of avatar coaches in clinical settings.
Design/methodology/approach
A literature review of the research relating to the use of technology in mental health and addiction treatment is provided. Additionally, a preliminary study aimed to develop an interactive therapy platform that utilizes virtual avatars as therapy coaches to help clients with substance abuse and IPV is presented. In this preliminary study, male participants were shown videos of various technology-based coaches matched on length, gestures and content. Researchers investigated whether patients preferred a virtual reality health coach, a cartoon health coach or a human health coach; as well as patient satisfaction and preference between two versions of the avatar.
Findings
A review of the relevant literature suggests that a majority of research has focused on using technology to replace face-to-face therapy with little research focusing on technology-assisted or augmented mental health and addiction treatment. Although initial research investigating avatar-assisted treatment for substance use has demonstrated promising results, research suggests a high prevalence of co-occurring substance use and IPV, suggesting the need for treatment to address co-occurring substance use and IPV. A preliminary research study was conducted to obtain patient feedback for personalizing avatar development into behavioral health interventions that target addiction and IPV.
Research limitations/implications
Although results of the preliminary study combined with previous research on avatar-assisted treatment for substance use has demonstrated promising results, theory-based research needs to be expanded to focus on randomized controlled trials of avatar-assisted treatment for co-occurring substance use and IPV.
Practical implications
This paper provides an overview of the use of technology-assisted treatment for co-occurring substance use and IPV. The preliminary results regarding patient satisfaction led to the development of additional avatars for use in interactive therapy.
Originality/value
This paper is one of the first to explore the use of avatar-assisted treatment for male offenders with co-morbid substance use and IPV.
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Cassandra Berbary, Camila Fernandes, Cory A. Crane and Caroline J. Easton
Research suggests that homework compliance within cognitive behavioral therapy is associated with treatment adherence and positive treatment outcomes through generalization of…
Abstract
Purpose
Research suggests that homework compliance within cognitive behavioral therapy is associated with treatment adherence and positive treatment outcomes through generalization of learned skills. The purpose of this paper is to determine whether there were differences in aggression and substance use between participants who did and did not complete therapy homework assignments.
Design/methodology/approach
Secondary analyses were conducted using data from Easton et al.’s (2017) randomized controlled trial of substance abuse domestic violence (SADV) treatment among substance dependent intimate partner violence (IPV) offenders. Analyses of covariance were conducted in order to determine whether homework completion had a significant effect on aggression and substance use. Correlational analyses were conducted to determine the association between quality of homework and outcomes.
Findings
Participants (n=63) who completed at least two homework assignments had fewer days of alcohol use during treatment compared to those who did not complete any assignments, p=0.03. There was not a difference in the number of days participants engaged in violence based on homework completion. Analyses indicated that those who displayed aggression proximal to alcohol use during treatment completed significantly fewer homework assignments compared to those who did not display aggression proximal to alcohol use (p=0.04).
Research limitations/implications
This research was limited to a sample of male substance using offenders of IPV within the US additional research utilizing a larger sample size in order to investigate differences in homework completion across treatment groups is needed. Further analysis of the barriers to and predictors of homework compliance among this population is recommended.
Originality/value
This research highlights the need for incorporation of homework and further exploration of methods and treatment modalities to ensure homework compliance among substance using male offenders of IPV.
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Camila Fernandes, Cassandra Berbary, Cory A. Crane and Caroline J. Easton
The purpose of this paper is to assess the rates of HIV risk-taking behavior and sexual violence among clients with co-occurring addiction and intimate partner violence (IPV). The…
Abstract
Purpose
The purpose of this paper is to assess the rates of HIV risk-taking behavior and sexual violence among clients with co-occurring addiction and intimate partner violence (IPV). The current study also aims to determine whether HIV risk-taking behaviors (e.g. trading sex for money or drugs, having unprotected sex with multiple partners) differ among substance using IPV offenders with and without a history of sexual aggression.
Design/methodology/approach
Secondary analyses were conducted from Easton et al.’s (2017) randomized controlled trial of substance use domestic violence treatment among substance using IPV offenders. Correlational analyses were conducted to assess the relationship between pre-treatment sexual aggression, HIV risk-taking behaviors, substance use and aggression. Analyses of covariance were conducted in order to determine differences in participants’ HIV risk-taking behaviors based on their history of sexual aggression while controlling for hours of contact with the female partners.
Findings
In a sample of 63 participants, males with higher rates of sexual aggression were more likely to engage in sexual risk-taking behaviors. This study encountered a correlation between pre-treatment risk-taking behavior and verbal and physical aggression, as well as a correlation between pre-treatment risk-taking behaviors and cocaine use. Results neither suggest a relationship between sexual aggression and alcohol use nor HIV risk-taking behaviors and alcohol use at pre-treatment.
Research limitations/implications
The present study is limited by sample size and power.
Originality/value
This study is among the first of its kind to investigate HIV risk-taking behaviors among substance using offenders of IPV. This study provides support for the inclusion of treatment targeting HIV risk-taking behaviors among IPV offenders.
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Cassandra M. Berbary, Cory A. Crane and Caroline J. Easton
The purpose of this paper is to investigate whether aggression and substance use assessed during treatment differ based on risk level for substance-using male offenders of…
Abstract
Purpose
The purpose of this paper is to investigate whether aggression and substance use assessed during treatment differ based on risk level for substance-using male offenders of intimate partner violence (IPV).
Design/methodology/approach
Secondary analyses were conducted using data from Easton et al.’s (2017) study on substance-dependent IPV offenders. A cluster analysis was utilized in order to classify participants into typology groups. Analyses of covariance were conducted in order to determine group differences in aggression and substance use during treatment.
Findings
The paper provides results-related response to treatment based on offender typology. Results appear to reflect two typology groups with significant differences in psychopathy among groups. High-risk offenders demonstrated higher rates of violence throughout treatment compared to moderate- and low-risk offenders; however, no differences in substance use outcomes were found.
Research limitations/implications
A limitation of the study is the extent to which the results can be generalized beyond substance using IPV offenders. Further investigation of treatment outcomes including alternate measures is needed in order to better translate theoretical typologies to clinical settings.
Practical implications
Results provide support for differentiating treatment for substance-using male offenders of IPV based on typology as those with low/moderate risk level appear to be distinctly different and have different treatment outcomes compared to high risk level offenders.
Originality/value
Although the relationship between risk level and treatment outcomes has been researched with Drug Court Offenders, treatment outcomes based on typology has not been evaluated among substance using male offenders of IPV.
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Lourah M. Kelly, Cory A. Crane, Kristyn Zajac and Caroline J. Easton
Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates…
Abstract
Purpose
Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. The authors hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response.
Design/methodology/approach
A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n = 29) to those in DC (n = 34).
Findings
Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (family, strangers, etc.) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up.
Research limitations/implications
This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples.
Practical implications
Integrated CBT buffered depressive symptoms’ impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms.
Originality/value
Although integrated CBT’s efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated.
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Cory A. Crane, Robert C. Schlauch and Caroline J. Easton
Over the course of their service, veterans are exposed to elevated levels of chronic stress that contribute to a greater prevalence of mental illness than observed in the general…
Abstract
Purpose
Over the course of their service, veterans are exposed to elevated levels of chronic stress that contribute to a greater prevalence of mental illness than observed in the general population. When mental illness is present, comorbidity is normative. Convergent evidence suggests that co-occurring substance use and mental illness is among the most prevalent forms of comorbidity within veteran samples. The purpose of this paper is to explore issues associated with dual diagnoses among veterans in the USA.
Design/methodology/approach
Research on dual diagnoses among veterans was reviewed and consolidated for presentation into three substantive content areas consisting of prevalence, associated conditions, and treatment of dual diagnoses.
Findings
Dually diagnosed veterans represent a group at particularly high risk for myriad adverse biopsychosocial and treatment outcomes, including poor health, suicidality, violence or aggressive behavior, arrest, homelessness, and unemployment. A comprehensive strategy has been implemented within the Veterans Health Administration to address dual diagnosis and related problems. Additional research is required to more readily identify co-occurring substance use and mental illness and to refine integrated intervention approaches to minimize burden while improving treatment outcomes for veterans and their families.
Originality/value
The current review includes a wide range of research spanning more than two decades and describing dual diagnosis among combat veterans of all modern eras. Areas in need of further research (e.g. dual diagnosis among female veterans; early detection of psychopathology and fully integrated care among returning veterans) are identified and discussed.
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Cory A. Crane, Lindsay M.S. Oberleitner and Caroline J. Easton
With an established association between post‐traumatic stress disorder (PTSD) and the perpetration of intimate partner violence (IPV), evaluating the effectiveness of emerging…
Abstract
Purpose
With an established association between post‐traumatic stress disorder (PTSD) and the perpetration of intimate partner violence (IPV), evaluating the effectiveness of emerging integrated treatments for dual substance use and partner violent behavior in individuals with a significant trauma history may serve to improve treatment outcomes for clients with axis I psychopathology. The purpose of this paper is to examine the association between sub‐clinical trauma, treatment compliance, and recidivism in a sample of male, substance dependent IPV offenders.
Design/methodology/approach
The described investigation utilized violence perpetration, substance use, and trauma data collected during a larger, randomized control treatment evaluation study. Data were collected from 56 participants at four time points throughout treatment.
Findings
Participants with a significant trauma history comprised 33.9 percent of the sample and demonstrated poorer treatment attendance, as well as heightened partner violence recidivism throughout treatment, as compared to participants who denied experiencing a significant trauma. This finding held across participants receiving substance treatment only and combined treatment addressing substance use and violence.
Practical implications
IPV perpetrators often have a trauma history themselves. The association between sub‐clinical trauma symptomatology and poor treatment outcomes calls for the adaptation of current partner violence intervention models to accommodate the large subset of clients who suffer from either sub‐clinical or clinically significant trauma.
Originality/value
This paper is the first to address the potential influence of sub‐clinical trauma on the integrated treatment of substance use and partner violence within a forensic sample. Suggestions are offered to adapt existing treatment models to accommodate dual diagnosed clients.
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One of the common law duties owed by the employer is his duty to take reasonable care for the safety of his employee. This common law duty is an implied term in the contract of…
Abstract
One of the common law duties owed by the employer is his duty to take reasonable care for the safety of his employee. This common law duty is an implied term in the contract of employment and is therefore contractual in nature. Because of the difficulties which may arise in bringing an action in contract for breach of the employer's duty of care, the employee who has sustained injuries during the course of his employment (although he may sue either in contract of tort will normally bring a tort action.