Lillian Turner Eby, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): [unreadable] The healthcare industry has staff turnover rates that are higher than any other industry. In particular, a recent national study of substance abuse treatment centers reports that the annual turnover rate among substance abuse counselors of 18.5% (Roman, Blum, & Johnson, 2002). Turnover renders direct (e.g., staff replacement costs) and indirect (e.g., lower quality patient care, loss of institutional knowledge) costs to substance abuse treatment centers and is a recognized problem in the field. The proposed project provides a comprehensive examination of turnover among substance abuse counselors and clinical supervisors, focusing on the effect that the clinical supervisory relationship has on the turnover of both parties. Both positive (i.e., benefits) and negative (i.e., costs) supervisory experiences are examined, from the perspective of both counselor and clinical supervisor, based on the growing recognition that clinical supervisory relationships can yield benefits as well as costs for both parties. Specific aims of the research are to: (1) examine the predictors of turnover among substance abuse counselors and clinical supervisors, (2) explore the mediating role of work attitudes (e.g., burnout, job satisfaction, commitment) in the relationship between clinical supervision and turnover, (3) track changes in the counselor-clinical supervisor relationship over time it develops and/or deteriorates, demonstrating how changes in the relationship predict career and work attitudes, as well as turnover, and (4) examine the role of counselor and clinical supervisor experience as it relates to turnover and other study variables. Counselor-clinical supervisor dyads will be studied over time in a longitudinal study of turnover. This project responds to program announcement PA-03-011 "Services Research in the National Drug Abuse CTN". Substance abuse treatment centers that are affiliated with the Clinical Trails Network will provide data for the project. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): On July 24, 2008 New York State (NYS) became the first in the nation to require all 1,419 state- funded or state-certified addiction treatment programs overseen by the NYS Office of Alcoholism and Substance Abuse Services (OASAS) to be 100% tobacco-free (www.oasas.state.ny.us/pio/press/pr-7-23-07.cmf). The goal of creating healthier workplaces for employees and fostering tobacco independence in clients is laudable and may yield positive effects over time (e.g., lower rates of smoking, better treatment outcomes). However, the implementation of the regulation will be a major change for substance abuse treatment centers in NYS and the failure rate associated with implementing innovations is high (Rogers, 2002), particularly when they are externally imposed (Bolman &Deal, 2006;Rogers, 2002). Moreover, the OASAS regulation is highly restrictive, broad in scope, and challenges deeply-held beliefs about how to best treat substance using clients. As such, as the regulation is implemented over time it may have wide-ranging effects on clinicians'work reactions and work experiences. Specific Aims of the proposed project are to: (1) provide an analytic description of the implementation of the OASAS Tobacco-Free Regulation in NYS treatment settings over time, (2) examine longitudinally the relationship between clinician perceptions of how extensively the OASAS regulation has been implemented at their treatment center and their psychological need fulfillment, strain reactions, and (3) examine longitudinally how clinician involvement in the implementation process relates to both proximal implementation outcomes (procedural justice perceptions, self-efficacy for change) and distal (strain reactions, clinical practice behaviors) implementation outcomes. The project also will provide a fine-grained analysis of change over time as the regulation becomes implemented in NYS treatment centers. PUBLIC HEALTH RELEVANCE: Clinicians'perceptions of the implementation of the OASAS tobacco-free regulation are expected to relate to psychological and cognitive reactions, which in turn are proposed to relate to psychological, behavioral, and physical strain. Clinicians working in substance abuse treatment facilities are already working in a high stress, high burnout occupation. Thus, understanding the additive effects of the implementation of this top-down driven, restrictive, state-mandated regulation on clinicians has substantial individual health and health policy implications.

DESCRIPTION (provided by applicant): The prevalence of smoking among individuals seeking treatment for a co-occurring substance abuse condition is very high, between 70%-95% (Burling &Ziff, 1988;Fiore et al., 2000;Kozlowski et al., 1986;McCarthy et al., 2002). However, many drug treatment facilities do not encourage smoking cessation during treatment, even though patients are often show interest in quitting smoking. Research finds that not only are low income people more likely to smoke, but the resources for smoking cessation may not be as accessible as those who have higher income (Novotny &Giovino, 1998;MMRW, November 9, 2007;Barbeau et al., 2004;Honjo et al., 2006). Therefore, substance abuse treatment is a context where evidence-based treatments (EBTs) for smoking might have the best chance of reaching low-income smokers. Treating patient smoking concurrent with other drugs is important since research demonstrates that addiction to nicotine may cause changes in brain chemistry and structure which could trigger drug and alcohol cravings, decreasing the chance of prolonged sobriety (Britt &McGehee, 2008;Yeh et al., 2007). The proposed project pursues two objectives related to understanding the adoption, implementation, and sustainability (or conversely discontinuation) of EBTs for smoking in substance abuse treatment contexts. The first aim examines longitudinally the availability of EBTs for smoking among those seeking treatment for co-occurring substance abuse and explores the predictors of changes in service availability over time in treatment programs. Key categories of predictors include the percentage of low-income clients served by the treatment center, organizational and policy factors, and workforce characteristics. The second aim also uses a longitudinal design to examine the evidence-based clinical practice behaviors that counselors engage in with clients. This is important because individuals implement EBTs not organizations or treatment programs (Fixsen et al., 1995). Integrating theory and research from implementation science, public health, organizational change, substance abuse treatment, and health services delivery four categories of moderator variables are examined to understand why and under what conditions counselors are likely to engage clients in smoking cessation efforts with clients. PUBLIC HEALTH RELEVANCE: The health-related risks of smoking make it a major public health concern, particularly in light of recent research suggesting that the addictive properties of nicotine are similar to that of opiates. There are also health disparities in both smoking behavior and smoking treatment as a function of socio-economic status and race/ethnicity. Many low-income people also lack access to high quality medical care (Warnecke et al., 2008) and are over-represented in substance abuse treatment contexts. By focusing on the availability, implementation, and sustainability of evidence-based treatments for smoking in the context of substance abuse treatment the proposed application has clear public health (including public health policy) relevance.

PROJECT SUMMARY
The PI proposes to conduct a 2-year empirical study that will: (1) identify the mentoring structures that are empirically observable in undergraduate research experiences at research universities, in terms of the strength and function of relationships within the undergraduate-postgraduate-faculty triad; (2) examine how different mentoring structures relate to the cognitive, behavioral, and affective outcomes undergraduates realize from participating in research; and (3) determine the extent to which women and underrepresented minority undergraduates experience different mentoring structures or realize outcomes differentially in comparison to majority students.