Use of Sexual Risk Assessment and Feedback at Intake to Promote Counselor Awareness of Subsequent Client Risk Behavior during Early Treatment

Abstract

Background: Sexual risk is an important, oft-neglected area in addiction treatment. Objectives: This report examines computerized sexual risk assessment and client feedback at intake as means of enhancing counselor awareness of client risk behavior during early treatment, as well as any clinical impact of that counselor awareness. Methods: In 2009–2011, new clients at both opiate treatment and drug-free treatment programs endorsed in a computer-assisted assessment at intake 90-day retrospective indices for: being sexually active, having multiple partners, having sex under drug influence, and inconsistently using condoms. Clients were randomly assigned in a 2:1 ratio to receive or not receive a personal feedback report, and those receiving a report chose if a counselor copy was also distributed. Ninety days later, retained clients (N = 79) repeated the assessment and their counselors concurrently reported perceptions of recent client risk behavior. Results: Based on client reports, pretreatment risk behaviors were prevalent among men and women and remained so during treatment. A general linear model revealed greater counselor awareness of subsequent client risk behavior with mutual distribution of intake feedback reports to client and counselor, and at the opiate treatment program. A repeated-measures analysis of variance indicated that counselor awareness did not predict change in temporally stable patterns of sexual risk behavior. Conclusions/Importance: Findings document that computerized intake assessment of sexual risk and mutually distributed feedback reports prompt greater counselor awareness of clients’ subsequent risk behavior. Future research is needed to determine how best to prepare counselors to use such awareness to effectively prompt risk reduction in routine care.

Keywords :

• sexual risk
• treatment innovation
• assessment
• feedback report
• therapeutic process

THE AUTHORS

Bryan Hartzler, PhD, is a Research Scientist in the Alcohol and Drug Abuse Institute at the University of Washington, and current recipient of an early career development award (K23 DA025678, Integrating Behavioral Interventions in Substance Abuse Treatment) funded by the National Institute on Drug Abuse. His research focuses on dissemination and implementation of treatment innovations for substance abusers, with particular focus on practitioner training in empirically supported therapeutic methods.

Blair Beadnell, PhD, is a research scientist at the University of Washington (Seattle, WA) and the Director of Research and Evaluation Services at Prevention Research Institute, Inc. (Lexington, KY). His research interests include risk and protective factors for risky behaviors such as substance abuse and risky sex, testing of promising intervention approaches, and use of advanced quantitative methods.

Don A. Calsyn, PhD, (1950–2013) was a psychologist, researcher, and mentor. As a professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, much of his recent work occurred via affiliation with the UW Alcohol and Drug Abuse Institute as an investigator in the Pacific Northwest Node of the National Drug Abuse Treatment Clinical Trials Network. His professional career spanned five decades, and resulted in 100+ publications that contributed to innovation and scientific understanding in areas of opioid substitution treatment, contingency management, HIV/AIDS, and sexual risk reduction.

Notes

1 This GLM was subsequently re-run with additional inclusion of each of three client-level predictors: 1) baseline sexual risk, 2) gender, and 3) treatment status at follow-up. In each instance, the client-level predictor did not reach statistical significance, did not alter the strength or direction of the established predictors, nor did it improve the overall model's prediction of variance in congruence summary scores.