What Do Female Clients Want From Residential Treatment? The Relationship Between Expressed and Assessed Needs, Psychosocial Characteristics, and Program Outcome

Abstract

Objective: Meeting the needs of clients receiving substance use services is related to program engagement and retention. Using Bradshaw's (1972) classic taxonomy of needs as a framework, the purpose of this study was to determine the relationship between clients’ expressed needs for their treatment experiences as compared to their formally assessed or normative needs. How expressed needs are related to demographic and other characteristics and program exit status was also explored. Methods: Secondary analysis of evaluation data gathered for other purposes was utilized. Data including demographic and drug use variables were obtained from client charts (N = 237) in a residential treatment agency serving women with co-occurring disorders who were homeless. Clients were administered the Addiction Severity Index-Multimedia Version (ASI-MV) to assess treatment or normative needs. They were also asked to complete the 69-item needs assessment questionnaire, “What I Want From Treatment” (Miller & Brown, 1994). Items that had the highest mean scores were submitted to a principal components analysis for data reduction to determine expressed needs. Bivariate analyses were used to determine the relationships between three expressed needs factors (alcohol/drug, psychological, and housing/employment) and ASI composite scores, demographic characteristics, and exit status. Results: There was no relationship between expressed needs and ASI scores except between the housing/employment factor and medical needs. Race, ethnicity, criminal justice status and drug of choice had no relationship to expressed needs. Those who were referred by a community agency had higher scores on the alcohol/drug factor as compared to those who were self-referred or referred by the criminal justice system. Clients receiving psychiatric medications were less likely to ask for help on psychological and housing/employment factors. There was no association between expressed needs at intake and program exit status. Conclusions: Race and supervision status did not appear to be barriers to asking for help. Clients’ expressed needs were not related to the severity of their assessed problems, indicating that separate constructs were being measured. Including both expressed and assessed needs may be important in holistic treating planning and intervention.

Keywords:

• expressed needs
• client perspectives
• substance use treatment

ACKNOWLEDGMENTS

This study was supported by Grant Number TI16483 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Its content are solely the responsibility of the authors and do not necessarily reflect the official views of SAMHSA.