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The Videotaped Addiction Challenge Test A new instrument for qualitative substance abuse assessment, treatment planning and research in therapeutic communities Presentation Eric Broekaert (Ph. D) Department of Special Education Ghent University - Belgium
Presentation contents n n n Introduction Aims Method theoretical background phases of development n n Implementation and procedures Results in relation to staff in relation to residents evaluation n Conclusions
Introduction Research and development project from 1996 to 1999 funded by the European Union Focus on residential programmes and aspects of the traditional, drug-free TC modality of substance abuse treatment - implementation in TC De Kiem (Belgium)
Introduction Development of a clinical instrument to provide a multi-functional methodology for individual treatment planning Context: TC De Kiem programme aimed at substance abusers who want to adopt a different way of life, consists of four phases
Aims Development, implementation and evaluation of the VACT as a qualitative clinical assessment and ressearch instrument The VACT employs a video film depicting the “average life story” of TC-residents with the aim to give a better understanding of their problems and build a more open therapeutic dialogue. Result is a plan for individual treatment allied to client expectations and reducing the risk of relapse.
Method A qualitative research method wherein action and research functions go hand in hand: assessment, action planning, concrete action and evaluation are all part of the same ongoing process of grounding the information
Method – theoretical background Development of the VACT is methodologically situated in the modernist period of qualitative research Existential phenomenological approach which challenges the monopoly of objectivity The assessment, treatment and evaluation of action alternate in a regulative cycle of action
Method – 3 phases of development Phase I: construct a profile of ‘the average resident’ of De Kiem systematical analysis of all social-anamnesis questionnaires since the start of the TC selection of 200 case files through systemic random sampling and recorded in SPSS characteristics that persist in 25% of the investigated files are retained and coded (72 characteristics noted as typical) and used to compile an average life-story
Method – 3 phases of development Phase II: attempt to further identify the most typical characteristics and to refine them to the most essential Case control study and comparison of the results of phase I by taking a sample of 1000 persons. Within a period of 1 month, 104 persons submitted a completed questionnaire. Data-analysis: use of the same criteria and codebook as during first phase second selection, reducing the characteristics to chose Finally 42 characteristics as basis of the video script getting grouped in themes
Method – 3 phases of development Phase III: produce a video script based on the results of phase I and phase II Selection based on highest correspondence in percentages and exclients whose personal characteristics apporximated the profile Ten people remained and were invited to participate in an in-depth interview concerning their life-stories. Results of in-depth interviews were used as a guideline for writing the script Script discussed with current residents of TC De Kiem
Illustration The script depicts a girl neglected by both father and mother. Whilst applying for treatment at the clinic, she underlines that she is a free agent and is free to do as she pleases with her own life. The concrete elaboration of the script reads as follows: (extract of the script)
Illustration “What choice do you have? To return home crestfallen? At home I never could find my niche. With my mother it was reasonably okay, although she was seldom at home. Actually, she understood fairly quickly. She knew that money disappeared, she started to check on me more and more. One evening, I come home and she was searching my room. I hurried up the stairs, but she had already found my supply. She did not know what to say. “What is this filth”, she said, “what is this fith? ” I tried to explain that the stuff wasn’t mine and that I had actually nothing to do with me. But the more I said, the angrier she became. “You are going to stay away from this filth! And you are not to go out without me knowing where you are going!” She screamed and yelled. I had seldom seen her like that. I promised to stay away from it. But we both knew that I would do what I wanted anyway. After all, it is my life. She suffered, my mother, she still does.
Illustration And my dad did not know anything, the fool. He always thought he could regulate things at home, but he never knew how the things stood. “Lazy sods! It is like an old people’s home in here. And I’ll be the one at work!” He never listened, he always had to have the first and last word. He never approved of anything. If I was reading he wanted me to work in the house. If I was working in the house he wanted me to study. If I was studying he came down on me anyway. Son-of-a-bitch! I shall never forget how he reacted to my first holiday job. I had worked for a week in a jute factory and I came home that Friday with my first pay. Actually, I was proud, you know how it is. My dad had just come home from work and was as drunk as a lord. Right, I come in and give him the money. “That comes in handy”, he says. But I need new shoes and I ask him for 3000 fr. He turnes round and looks at me with his frog face. “If you think I need your lousy money you don’t know me very well!” he says. And he throws the money on the floor.
Method – 3 phases of development Next step in phase III: adaptation of the script to the video screen Several specific procedural rules emerged in the implementation of this step
Implementation and procedures Between 1994 and 1997, 38 of 40 residents were interviewed by means of the VACT during the induction phase of their treatment During staff meetings the results of the VACT were discussed and individual action was planned. The final implementation produced a procedure that could be protocolled and used in other TC’s.
Implementation and procedures The purpose of the VACT is to gain new and possibly intimate information. The resident’s informed consent is a prerequisite. After watching the whole video, the resident is asked to complete a questionnaire together with the attending staff member. During and after this dialogue, the staff member and resident try to structure the information obtained and then write down their suggestions and ideas for treatment. The staff member presents this proposal during the regular staff meeting. An individual treatment plan is discussed and developed.
Results – in relation to staff The implementation of individual treatment planning affected not only the residents but also the staff In the final analysis, staff members preferred to use the VACT in a later stage of treatment when the resident’s emotional state had stabilised.
Results – in relation to residents The social anamnesis, life-story and VACT of each resident were compared in order to control for conformity between the group as a whole and each individual We then isolated the cases that had a minimum or maximum degree of correspondence and looked for possible explanations. We determined which items contained the most problems. Lastly, we determined the extent to which the VACT-items contributed new information.
Results – in relation to residents Two groups of master-level students in education worked independently to code the VACT-content After comparison and discussion, all information was coded accordingto a general scheme of communication This scheme was supplemented by the three subcategories: negative, neutral and positive
Results - evaluation The evaluation of the VACT was based on establishing the reliability and validity of the instrument using a sample of 38 residents
Conclusions The VACT provides a coherent methodology whereby the same procedure can be applied in a variety of situations The implementation of the VACT influences the TC as a whole, as increased insight into individual residents leads to a better global understanding and a better evaluation of the treatment programme
Conclusions Implementation of the VACt requires a strong sense of commitment and collaboration between board members, directors, researchers and staff Researchers need to gain the trust and respect of both staff and residents whilst not getting too closely involved The methodological steps should evolve as must the development of the approach
Conclusions The VACT provides an innovative tool for helping to improve individualised research and the assessment process of the TC, within the context of a community approach to the treatment of substance abuse *** Happy presentation end ***