Assessing Effectiveness of Modified Johnson Intervention

Assessing the Effectiveness of the Modified Johnson Intervention at
Engaging and Retaining in Treatment Clients with Dual Diagnoses

Investigator: Barry Loneck, Ph.D.

PROJECT GOALS

Engaging and retaining consumers of mental health services in treatment is a significant problem, and legal coercion increasingly a consideration. Engagement and retention of individuals with dual diagnoses of mental illness and substance abuse are particularly problematic as many within this group often deny both their alcohol or other drug (AOD) problem as well as their need for help. In dealing with substance abuse, the Johnson Intervention method has been used successfully in engaging and retaining individuals with AOD problems in treatment. The Intervention is a therapeutic technique in which members of the person's social network, following a period of formal training and rehearsal, confront the individual about the damage his or her drinking or drug abuse has caused and the actions that will be taken if help is not accepted.

This project is focused on developing and testing the effectiveness of a modified version of the Johnson Intervention for individuals with dual diagnoses. Development of the Modified Johnson Intervention will be based on focus groups with consumers, family members of consumers, and mental health professionals. Effectiveness of the new technique will be tested by comparing clients who undergo a modified Johnson Intervention with clients who do not undergo the process; outcome will be determined by successful engagement and retention in services in the community.

RESEARCH ACTIVITIES AND RESULTS

Institutional Review Board approval for the focus groups has been obtained from the Capital District Psychiatric Center (CDPC) which will serve as the research site, the New York State Office of Mental Health, and the University at Albany, State University of New York. Potential clinical and administrative staff participants have been identified and contacts with relevant staff who will assist with the recruitment of consumers and family members have been made.

In the second phase of this project, dually diagnosed individuals will be randomly assigned to either a Modified Johnson Intervention or to standard referral services. However, prior to the implementation of this phase, a pilot test of the technique will be conducted to further refine the model.

INCLUSION OF GENDER AND MINORITY SUBJECTS

The focus groups to be held with consumers and family members, a total of 16 individuals, will reflect as closely as possible the characteristics of the setting (CDPC). The gender distribution is 60% men and 40% women, and the racial/ethnic distribution is 17% African-American, 3% Hispanic and 80% white, non-Hispanic.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

The modified Johnson Intervention is seen as an alternative to waiting for voluntary participation, on the one hand, and to legal coercion, on the other. It uses the individual's existing social network to move him or her to the next step in the treatment continuum. If the modified intervention is effective, costs incurred by utilizing the judicial system to coerce clients in the next phase of necessary treatment would be significantly reduced by using this less expensive procedure.

From the perspective of managed care, the modified Johnson Intervention may significantly reduce the long-term treatment costs of clients with dual diagnoses. Research on the Johnson Intervention for individuals with substance abuse disorders has demonstrated that it is highly effective in engaging and retaining these clients in treatment. Thus, the modified Johnson Intervention has the potential for reducing the number of clients who either: (1) do not start treatment only to return at a later time, presenting with more severe symptoms and needing more intense (and expensive) treatment; or (2) enter treatment but do not successfully complete it, only to return at a later time, again needing the full, more costly range of services.

PLANS

IRB applications for pilot testing and conducting an experiment with the new protocol were submitted. Pilot testing and implementation of this experiment was scheduled for 1999. This will be followed by data collection on client engagement in treatment.

Publications and Presentations

Articles and Chapters:

Loneck B.M. (1994). Practitioner-researcher perspective on the integration of qualitative and quantitative research methods. In E. Sherman and W. Reid (Eds.), Qualitative Research in Social Work (pp. 445-451). New York: Columbia University Press.

Loneck, B. (1995) Getting persons with alcohol or other drug problems into treatment: Teaching the Johnson Intervention in the practice curriculum. Journal of Teaching in Social Work, 11 (1/2), 31-48.

Loneck, B., Banks, S.M., Coulton, C.J., Kola, L.A., Holland, T.P., and Gerson, S.N. (1995). Stress and outcome in the alcoholism intervention: A preliminary investigation. Alcoholism Treatment Quarterly, 13(2), 33-42.

Loneck, B., Garrett, J.A., and Banks, S.M. (1996a). A comparison of the Johnson Intervention to four other methods of referral to outpatient treatment. The American Journal of Drug and Alcohol Abuse, 22(2), 233-246.

Loneck, B., Garrett, J.A., and Banks, S.M. (1996b). The Johnson Intervention and relapse during outpatient treatment. The American Journal of Drug and Alcohol Abuse, 22(3), 363-375. (To be abstracted in Epikrisis, Research Triangle Park, NC: North Carolina Governor's Institute on Alcohol and Substance Abuse, Inc. )

Loneck, B. and Way, B. (1997). Using a focus group of clinicians to develop a research project on therapeutic process for clients with dual diagnoses. Social Work, 42(1), 107- 111.

Loneck, B., Garrett, J.A., and Banks, S.M. (1997). Engaging and retaining women in outpatient alcohol and other drug treatment: The effect of referral intensity. Health and Social Work, 22(1), 38-46.

Loneck, B. and Way, B. (1997). A conceptual model of therapeutic process for clients with a dual diagnosis. Alcoholism Treatment Quarterly, 15(3), 33-46.

Loneck, B. (1997). How particular social environments affect alcoholics. In W.N. Shelton & R.B. Edwards (Eds.), Advances in bioethics: Values. Ethics. and Alcoholism (pp. 171-205). Greenwich, CT: JAI Press, Inc.

Loneck, B., Banks, S., Way, B., and Bonaparte, E. (revising and resubmitting). An empirical model of therapeutic process for clients with dual disorders in a psychiatric emergency room. Submitted to Social Work Research.

Presentations:

Loneck, B. (1991, August). Practitioner-researcher perspective on integration of the [quantitative and qualitative] methods. Paper presented at the Research Conference, Qualitative Methods in Social Work Practice Research, Albany, New York.

Loneck, B. (1992, April). Treatment of persons with mental illness and chemical abuse (MICA!: Current research and future directions. Paper presented at the Workshop, Building Social Work Knowledge for Effective Mental Health Services and Policies, Bethesda, MD. (Sponsored by the National Institute of Mental Health.)

Loneck, B. & Way, B.B. (1993, December). Therapeutic process and mentally ill chemical abusing (MICA) clients. Paper presented at the Sixth Annual New York State Office of Mental Health Research Conference, Albany, NY.

Loneck, B. (1994, March). Getting problem drinkers into treatment: Teaching Alcoholism Intervention in the practice curriculum. Paper presented at the Council on Social Work Education Fortieth Annual Program Meeting, Atlanta, GA.

Loneck, B. (1996, February) Therapeutic process and referral outcome for clients with dual disorders in a psychiatric emergency room. Paper presented at the Sixth Annual Conference on State Mental Health Agency Services Research and Program Evaluation: Mental Health Services Research and Evaluation: Creative Ideas for Austere Times, Arlington, VA.

Loneck, B. & Cassidy Gould, C. (1998, September). The problem solving approach: Assessment. treatment. planning. intervention. and evaluation. Presented at the Faculty and Practitioner Skills Institute: Integrating Alcohol and Other Drug Knowledge - Best Clinical Practice and Research - Into the Preparation and Ongoing Professional Development of Social Workers, New York City, NY.

Updated: 4/5/1999

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