Model of Treatment

Our model of treatment is described later in the Programme section of this paper but this is an outline:

Improving the effectiveness of treatment and quality assurance applications calls for a systematic framework for representing how treatment works. In order to disaggregate the ingredients underlying treatment retention effects, better assessment and d namic process models are required.

TCU Treatment Chart 1

By conceptualizing treatment in discrete phases—e.g., out reach, induction, engagement. Treatment and aftercare—intervention and evaluation strategies come into sharper focus. Our general model of treatment process and outcomes is presented above, showing several key ingredients in the so called “black box” of treatment. In general, there are sequential therapeutic elements that link together over time to help sustain treatment retention and thereby improve outcomes after discharge. More specifically, higher program participation as measured by counseling session attendance is associated with better therapeutic relationships (including rapport), and these factors promote positive psychosocial functioning and behavioral changes later in treatment. Favorable indicators of progress on these measures, in turn, are related to longer retention. Understanding the sequence of change and dynamics of how it occurs is particularly important because clients who stay in treatment beyond minimum “thresholds”—usually about 3 months for drug-free outpatient as well as residential treatments and a year for methadone programs—are 3 to 5 times more likely to have favorable follow-up outcomes on drug use and criminality measures.’

Multivariate analytic models tested in a variety of community and correctional settings have helped to establish more clearly the directional relationships be tween client motivation, treatment process variables (i.e., therapeutic rapport, program participation, behavioral compliance, and psychosocial improvements), retention and follow-up outcomes.