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Due to increasing complexity, modern radiotherapy techniques require comprehensive quality assurance (QA) programmes, that to date generally focus on the pre-treatment stage. The purpose of this paper is to provide a method for an individual patient treatment QA evaluation and identification of a “quality gap” for continuous quality improvement.

A statistical process control (SPC) was applied to evaluate treatment delivery using in vivo electronic portal imaging device (EPID) dosimetry. A moving range control chart was constructed to monitor the individual patient treatment performance based on a control limit generated from initial data of 90 intensity-modulated radiotherapy (IMRT) and ten volumetric-modulated arc therapy (VMAT) patient deliveries. A process capability index was used to evaluate the continuing treatment quality based on three quality classes: treatment type-specific, treatment linac-specific, and body site-specific.

The determined control limits were 62.5 and 70.0 per cent of the χ pass-rate for IMRT and VMAT deliveries, respectively. In total, 14 patients were selected for a pilot study the results of which showed that about 1 per cent of all treatments contained errors relating to unexpected anatomical changes between treatment fractions. Both rectum and pelvis cancer treatments demonstrated process capability indices were less than 1, indicating the potential for quality improvement and hence may benefit from further assessment.

The study relied on the application of in vivo EPID dosimetry for patients treated at the specific centre. Sampling patients for generating the control limits were limited to 100 patients. Whilst the quantitative results are specific to the clinical techniques and equipment used, the described method is generally applicable to IMRT and VMAT treatment QA. Whilst more work is required to determine the level of clinical significance, the authors have demonstrated the capability of the method for both treatment specific QA and continuing quality improvement.

The proposed method is a valuable tool for assessing the accuracy of treatment delivery whilst also improving treatment quality and patient safety.

Assessing in vivo EPID dosimetry with SPC can be used to improve the quality of radiation treatment for cancer patients.

The purpose of this paper is to improve current evaluation designs for Indigenous Australian residential alcohol and drug treatment centres, by understanding the context of treatment in this modified TC context. The aim of the research is to present an analysis of the key features of treatment associated with four Indigenous Australian alcohol and drug treatment centres, as expressed by staff working in these centres.

Ethnographic observations were made at each site between 2008 and 2009 with the first author attending treatment groups, education sessions, staff meetings and other events. The first author conducted informal conversational discussions with all programme staff and board members. In addition, 23 staff and 15 board members participated in a semi-structured interview with an emphasis on gaining views on the essential elements of residential alcohol and drug treatment, potential barriers to effective treatment delivery and “what works” in residential treatment.

A number of key themes emerged, including the importance of the flexibility of programmes to include a wide variety of treatment approaches, the importance of culture (although defined differently) in the delivery of appropriate service, provision of safe spaces that allow for clients and staff interaction, the potential for improvement in the provision of effective client case management, the need to reduce job-related stress through staff professional development and organisational culture change and the need to address the difficulties experienced in the provision of effective aftercare.

Currently, there is very little evidence related to Indigenous Australian approaches to the treatment of alcohol and drug misuse. The paper contributes to the understanding of the key features of treatment delivery, as identified by staff employed in drug and alcohol residential treatment. This understanding is vital so that government agencies can provide appropriate funding to areas of need for treatment services.

This chapter describes Andrews and Bonta's (2006) Principles of Effective Offender Treatment and its relevance for the treatment of sexual offenders. The three principles of this model are Risk, Needs and Responsivity. Each of these is described in some detail with the greatest emphasis being placed on general responsivity which is one of the two parts of the Responsivity Principle. Our interpretation of general responsivity differs from the view of others (e.g. Hanson et al., 2009) who define this aspect of Responsivity in terms of Cognitive Behaviour Therapy (CBT). While Andrews and Bonta indicate that within their meta-analyses, CBT programmes were the ones most likely to succeed; such programmes were not at all effective. It seems to us that a far more important aspect of general responsivity is what Andrews and Bonta describe as the Core Correctional Practices (CCP) which have to do with the way in which treatment is delivered. We review the CCPs in some detail and provide other evidence indicating that the style of treatment delivery is the crucial factor in determining effectiveness.

The purpose of this paper is to look at the design and delivery of psychological treatments offered by the UK National Health Service (NHS) and in particular, ask how much treatment is enough, or who should decide when the patient has had enough treatment.

The data reported in this section were collected during routine clinical practice in the NHS in Scotland.

It was found that treatments could be redesigned so that important therapeutic information is provided in time frames that match patient preferences, leading to more efficient and effective services.

Clinicians, predominantly, determine the design and delivery of treatment programmes, whereas the paper suggests that programmes should be focused on the patient and their needs.

Purpose – Treatment for alcohol and drug addiction in correctional settings has become commonplace throughout much of the United States. The delivery of treatment services in prisons is a promising approach and has certain advantages relative to outpatient and voluntary treatment, including (i) certainty of program enrollment and participation by individuals who would not likely seek treatment on their own (i.e., coerced participation/guaranteed delivery of treatment); (ii) program modalities specific to residential settings as treatment options – in effect, more intensive treatment; and (iii) the parole process ensures participation in post-release aftercare services. During this era wherein reentry is a pronounced theme throughout American corrections, substance abuse treatment is fundamental in terms of rehabilitating offenders, increasing public safety, and lowering recidivism rates and, ultimately, the overall prison population.

Methodology – Using data from a process evaluation of an in-prison alcohol treatment program in Texas, this study examines the environmental barriers to effective recovery present in correctional settings and considers the strengths and weaknesses of coercive treatment, generally.

Findings – Findings indicate that offenders can indeed become motivated to change through coerced treatment. However, study findings also suggested that a certain number of offenders will not become engaged in treatment and fail to develop any internal motivation, which can be problematic for a number of reasons.

Practical implications – The highly coercive and restrictive nature of correctional facilities may negate the overall rehabilitative intent of treatment programs.

The purpose of this paper is to report on the success of an initiative involving the transformation of a group of small substance use treatment only or mental health treatment only provider agencies serving uninsured adults into providers of co-occurring disorder treatment.

The paper uses a case study narrative to describe the initiative and the transformation of the participant agencies from being providers of mental health or substance use treatment to providers of co-occurring disorders.

Six agencies serving uninsured adults expanded their scope of patient treatment services to include the capacity to treat adults with co-occurring disorders. This was achieved with modest support funding from a local foundation. The initiative has been ongoing for five years.

The outcome of this initiative demonstrates the financial and practical feasibility of improving and expanding treatment services to low-resourced patient populations. The participating agencies were able to improve their capacity to treat patients with substance use or mental health issues that previously they were not prepared to treat and thus increased their ability to provide integrated care.

The initiative described here shows that the treatment of concomitant substance use and mental health disorders is within the range of many small-scale treatment providers, if provided the leadership and support. Delivery of effective treatments to populations experiencing co-occurring disorders that are underserved and undertreated are achievable in community-based clinical practices. This has implications for developing treatment capacity outside of hospital settings to enable treatment of co-occurring disorders to become more accessible.

It is unclear how consumer participation (CP) can be optimised to transform drug and alcohol treatment services and improve health outcomes. The purpose of this paper is to present the findings of a systematic review examining the types and benefits of activities, and the factors that facilitate CP in drug treatment services.

A structured search of four databases was undertaken to identify peer reviewed primary research literature in English. Screened articles were appraised. A content analysis was applied to examine the types and outcomes of CP and the associated factors affecting the process. In total, 16 articles were included for review.

A range of CP activities were identified, and benefits included increased consumer satisfaction, and improved health service delivery. Factors that facilitated the process of CP included positive attitudes of both consumers and providers and employment of people with a lived experience of drug use. However, the lack of consumer and organisational capacity, negative attitudes of providers and power imbalances between consumers and providers constrained CP efforts.

To maximise the benefits of CP in drug and alcohol treatment services, negative attitudes about CP and power dynamics between consumers and health providers need to be addressed. This can be achieved by the strategic use of strengths-based interventions and consumer led education to enhance social capital.

This is the first known review to examine the benefits and facilitators of CP in drug treatment services.

Hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. Approximately 30,000 prisoners are held in Australian prisons at any one time, with more than 30 per cent testing positive for HCV antibodies. Prisoners have been identified in the National Hepatitis C Strategy as a priority population for assessment and treatment. The purpose of this paper is to examine the rates of HCV testing and treatment, as well as barriers and opportunities for development of infrastructure for enhanced services.

Interviews were conducted with 55 stakeholders from the correctional sector in each state and territory in Australia in two stages: service directors to gather quantitative data regarding rates of testing and treatment; and other stakeholders for qualitative information regarding barriers and opportunities.

Of more than 50,000 individuals put in in custody in Australian prisons in 2013, approximately 8,000 individuals were HCV antibody positive, yet only 313 prisoners received antiviral treatment. The barriers identified to assessment and treatment at the prisoner-level included: fear of side effects and the stigma of being identified to custodial authorities as HCV infected and a likely injecting drug user. Prisoners who came forward may be considered unsuitable for treatment because of prevalent mental health problems and ongoing injecting drug use. Provision of specialist hepatitis nurses and consultants were the most frequently recommended approaches to how prison hepatitis services could be improved.

Many personal and systems-level barriers relevant to the delivery of HCV treatment services in the custodial setting were identified. Ready access to skilled nursing and medical staff as well as direct acting antiviral therapies will allow the prison-sector to make a major contribution to control of the growing burden of HCV disease.

The purpose of this paper is to evaluate service quality in a UK privately funded alcohol treatment clinic.

Data were gathered via interviews with two groups of participants using the SERVQUAL questionnaire. The first group comprised 32 patients and the second 15 clinic staff. The SERVQUAL instrument measures service quality expectations and perceptions across five service dimensions and identifies gaps between service expectations and perceptions of what was delivered.

Patients' service quality expectations were exceeded on four of five dimensions. However, staff members felt services fell below expectations on four of five dimensions with the “reliability” service dimension emerging as the common service element falling below expectations for both participant groups. It was concluded that achieving consistent service delivery and increasing empathy between staff and patients improves overall service quality perceptions.

The paper relies on self‐report methods from a relatively small number of individuals.

There have been limited research studies measuring alcohol treatment service quality in the private sector.

Although support exists for the effectiveness of treatment for personality disordered offenders there is limited knowledge about the processes underlying the therapeutic change. The purpose of this paper is to explore the treatment experiences of six male psychopathic offenders who attended a social skills treatment component implemented within a high-secure personality disorder treatment service.

Interview transcripts were analysed by the lead researcher (first author) using interpretative phenomenological analysis (IPA) who compared and contrasted findings to develop superordinate themes across the group. External auditing analysis was conducted by the second author.

Several themes were identified that may indicate the unique ways this client group experienced treatment. These related to the importance of “group cohesion” with treatment progression and shared learning experiences, the significance of “therapeutic alliance” with treatment providers and perceived effectiveness of treatment, and the conflict participants experienced when acquiring and applying skills from their engagement in treatment. Participants identified aspects of the treatment component that facilitated the effectiveness of treatment and were effective in meeting their needs and some that would benefit from improvement.

Positive group dynamics are important. Operational staff inclusion within the facilitation team is beneficial. Attentiveness to participants’ specific responsivity needs is required. Supporting skill application post-treatment is important.

These findings add to the evidence base in relation to factors that support personality disordered offenders’ engagement within treatment. Areas that validate treatment delivery are highlighted, as are suggestions for change to maximise treatment gain for psychopathic and personality disordered offenders.