COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006
What did we find?
•Intent-to-treat model: Patients who were
randomized to the intervention, or TAU,
were included in the analysis even if
treatment was incomplete.
•Most FASST patients who did not
complete sessions had at least 2 sessions
and no more than 4.
•Patients for whom we could not obtain
follow-up data were treated as a “no show.”
• Nearly 64% of patients receiving the
experimental intervention attended the first
scheduled post-hospitalization outpatient
appointment.
•Nearly 36% of control patients attended
the first scheduled appointment.
•Likelihood Ratio (Fischer’s Exact chi –
square) = 12.890; p < 0.001.
% Attendance x Intervention
70
60
50
40
30
20
10
0
FASST TAU
Intervention
Other findings of import…
• Reported monthly income < $341 per month.
• Nearly 78% reported no employment in the past 30 days.
• Male patients engaged in high risk sexual behavior:
• 28% report giving drugs for sex.
• 10% report paying someone money to have sex.
• Female patients engage in high risk sexual behavior:
• 34% report on having sex to get drugs.
• 26% report being paid money or drugs to have sex
• 3% report on having unprotected sex with someone they know to have
HIV/AIDS.
• About 20% of males and females report being worried (moderately
or greater) about getting HIV/AIDS.
• 13% report they may have already been exposed to HIV/AIDS.
Some qualitative session data…
• Antecedents (Triggers) most frequently cited:
• Boredom
• Alone/lonely
• Argument with significant other
• Behavior (with mood):
• Anger/argument.
• Drug use/hallucinations
• Consequences:
• Feel good “real” (cocaine use).
• Worsening relationship with C/SO.
Some more qualitative session data…
Impediments-potential disincentives
• Availability
• Hard for me to get there
• Long wait to get appointment
• Continuity
• Therapist left
• Different person all the time
• Relevance
• Doesn’t help
• Just talk
• Ambience
• Dirty
• Wait too long
What have been our challenges?
• Follow-up extremely difficult.
• Recruiting family member or significant other, FSOCs,
has been difficult:
• 27 consented.
• 5 attended at least 1 session
• 32 phone calls from family member, significant other or
caregiver (FSOC).
• Alternatives:
• Community Mentor.
• Treatment in home (MST and FFT).
• Phone treatment.
• Train case mangers and staff at boarding homes etc.
Concluding remarks…
Social capital
• Relationship between interpersonal trust, social
reinforcement and social engagement.
• Related to income inequality, health outcomes, medical
compliance and civic engagement.
• Determined by network of interacting formal, informal
norms and behavior of institutions, community and
individuals.
Our patients live in communities with diminished
social capital.
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