On December 14, 2004, client and the SAL developed a Pre-Treatment Agreement that would support the client in meeting the goals of his CPS case plan. Client determined how many 12-step meetings and thinking reports he would complete each week. Client also agreed to abstinence from alcohol so that he “could prove there isn’t a problem”.
Client attended all pre-treatment appointments as agreed. He did leave early on a couple of occasions due to a time conflict with his wife’s drug court sessions; howeve , as a rule, he attended all appointments as agreed.
Client did not comply with his Pre-Treatment Agreement. Regarding the terms of the Pre-Treatment Agreement, client completed eight of 20 12-step groups and 10 of 20 think- ing reports. He often arrived without any of the tasks completed and acknowledged that he continued to consume alcohol. Disparities between client’s stated goals and actual behaviors were addressed. Risks associated with ongoing alcohol use were discussed. Client denied any risks, stating a belief that he was too “smart” about his drinking to get caught. Situations leading to alcohol consumption were explored and client began to acknowledge that alcohol use is related to high levels of stress and that he medicates his feelings with alcohol. This new awareness is a big leap for a person who initially denied drinking alcohol.
One strategy employed by the SAL during these sessions was to inquire if the client wished to continue with the Pre-Treatment Agreement. Client was reminded that the choice was entirely his. Additionally, client was asked how keeping the agreement would assist him in his case plan. On each occasion, client recommitted to the Pre-Treatment Agreement. At one point, the SAL suggested that client stop PTP because it did not appear to be beneficial to client. Client adamantly refused to stop PTP. Client and his wife are scheduled for court soon and client states a desire to continue PTP in hopes of reuniting with his children.
1 Client’s name was purposely withheld from this report.
Summary of Implementation Challenges and Successes
A variety of external and internal circumstances complicated implementation of the project. Externally, state funding for substance abuse treatment was erratic and there were periods when resources were not available to the majority of participants. Internally, parents in the program had extremely serious problems, especially the abuse of methamphetamines. In addi- tion, SALs were overwhelmed with paperwork from IDHW, the state treatment provider BPA, and the data collection needs of this project.
In spite of these challenges, SALs were able to build positive relationships with participants and the IDHW and substance abuse staff members. They implemented MI techniques, and created flexible programming to offset the scarce resources and address the realities of par- ents’ circumstances.
Idaho Pre-Treatment Program