substance abuse training and perceived knowledge

SUBSTANCE ABUSE TRAINING AND PERCEIVED KNOWLEDGE: PREDICTORS OF PERCEIVED PREPAREDNESS TO WORK IN SUBSTANCE ABUSE

Rena Bina

Joohee Yum

University of Maryland, Baltimore

Westat Inc.

Diane M. Harnek Hall

Lynda Sowbel

Towson University

Hood College

Angela Mollette

Jayshree Jani



Aiexa Smith-Osborne University of Texas at Arlington

As frontline mental health care providers, social workers need to be prepared to confront and properly manage substance abuse issues in practice. This study examined predictors of recent master of social work (MSW) graduates' perceptions of preparedness to practice in the area of substance abuse. A crosssectional design was used, and 232 recent MSW graduates completed a mail-in survey (65.7% response rate). Respondents were more likely to perceive themselves as prepared to work with substance abuse issues if they received more formal academic trairiing in substance abuse and had higher knowledge of substance abuse concepts and models. The findings support the need to includesubstance abuse education in social work curricula.

SUBSTANCE ABUSE is a widespread problem in American society. In 2003 approximately 9% of the total U.S. population age 12 or older was classified with substance dependence or abuse (Substance Abuse and Mental Health Services Administration, 2003). Because of its relatively high prevalence, social workers in many settings come in contact with cUents who have substance abuse problems (Hall, Amodeo,

Shaffer, & Vander Bilt, 2000). The National Association of Social Workers (NASW, 2001) reports that more than 25% of social workers' clients had a primary or secondary diagnosis of substance abuse, and 71% of social workers indicated taking actions in relation to clients with substance abuse disorders. Despite the high percentage of social workers dealing with substance abuse issues.

Journal of Social Work Education, Vol. 44, No. 3 (Fall 2008). Copyright © 2008, Council on Social Work Education, Inc. All rights reserved.

JOURNAL OF SOCIAL WORK EDUCATION

social workers, especially those just entering the profession, have little or no training on this topic (Hall et al., 2000; McCarthy & Galvani, 2004). Lack of training was foxind to negatively impact social workers' knowledge of substance abuse content, attitudes toward their clients who were dealing with substance abuse issues, and the quality and effectiveness of the treatment they provided to these clients (Amodeo, 2000; Hall et al., 2000). Studying the connection between training, knowledge, and attitudes is therefore extremely important in understanding the process social workers go through when confronted with substance abuse issues, as well as the importance of substance abuse education for social workers.

social work curriculum before social workers can become highly educated and able to reclaim the area of addictions for social work intervention. In consideration of this claim the current study included a review of today's graduate social work education offerings in the field of addictions. Following the approach of VoUand, Berkman, Phillips, and Stein (2003) in surveying health courses in graduate social work programs, a 30% random selection of the 2007-2008 course catalogues for the 187 Council on Social Work Education-accredited graduate schools of social work (N=56) was reviewed for substance abuse specializations and specialty courses, using the key words

Past studies in the social work field describe social workers as having a host of negative reactions toward substance-abusing clients. They are pessimistic about treatment outcomes with substance abusers and stereotype them, and as a result are negative regarding substance abuse treatment, are not particularly interested in working with substance abuse clients, and avoid working with them (Amodeo & Fassler, 2000; Stein, 2003). Rhodes and Johnson (1996) suggest that negative reactions toward substance abuse issues may occur because social work students receive a mixed message regarding the ability and willingness of the social work profession to train them to deal effectively with substance abuse clients. They claim that schools of social work do not offer enough addiction content in their courses and fail to express a clear role for the social work professional in the field of addiction. Rhodes and Johnson add that more substance abuse content must be added into

substance abuse, addictions, addictive behaviors,

or drug abuse. Two of the 56 programs were eliminated from the review because 1 was accredited conditionally and the Web site for the other was under revision and therefore unavailable. Of the 54 remaining programs, none offered a substance abuse specialization, and 26 (48%) offered at least one substance abuse course. Of these 26 programs, 12 (22%) offered more than one substance abuse course. Substance abuse education has been found to have a positive effect on social workers' practice. Students with social work education in substance abuse are more likely to assess clients for substance abuse issues (Lemieux & Shroeder, 2004; Gassman, Demone, & Albilal, 2001). Gassman and colleagues examined the outcomes for social work students in a substance abuse specialization compared with students not in this specialization; they found that students in the substance

TRAINING AND KNOWLEDGE AS PREDICTORS OF PREPAREDNESS

abuse specialization were more capable of assessing clients for substance abuse issues and more likely to do so. Social work education is not the only source of substance abuse knowledge for professional social workers. Most social workers, 85% of NASW members, have had some type of training (i.e., continuing education, formal coursework, clinical supervision, field placement, volunteer work, an unidentified "other" type of training, or more than one of the previously listed types of training) in substance abuse treatment (Weismiller, Whitaker, & Smith, 2005). However, according to Hall et al. (2000) a needs assessment involving a random sample of substance abuse facilities in New England revealed that 61.5% of social workers reported needing more training in this area. A similar need was found in a recent survey of NASW members, in which 54% reported needing more training in the area of substance abuse (Weismiller et al., 2005). Predictors of Change in Attitude Further investigation of social workers' attitudes toward working with substance abusing clients has been examined by identifying predictors of more positive attitudes. Strozier (1995) found that more experience predicted social workers' positive views of treatment outcomes, along with being female and having a history of substance abuse issues. Likewise, Cartwright and Gorman (as cited in Amodeo, 2000) concluded in their study that substance abuse training was found to increase workers' positive therapeutic attitudes toward substance-abusing clients. Cartwright and Gorman added that one of

these positive attitudes was role adequacy, which they defined as a belief of preparedness to work with substance abusers. A change in attitudes as a result of training was assessed by Amodeo and Fassler (2000) as well. They performed a follow-up study with social workers who had participated in substance abuse training shortly after receiving the master of social work (MSW) degree. Participants had taken the course from 2 to 11 years prior to the follow-up study. Responses from the trainees were compared to a sample of similar MSW graduates who had not participated in the training. The researchers found that those who had participated in the training were more likely to have substance-abusing clients and felt more competent working in the area of substance abuse than those who had not received the training. This study highlights the important connection between trairüng and attitude; however, there is minimal research in this area, especially in examining the connection between substance abuse training and education during MSW studies and its impact on perceived competency and preparedness to work with substance abusers. Studies of change in attitude as a result of MSW education were found in other areas and provide evidence for the possibility of such a connection in the area of substance abuse. Martin, Pine, and Healy (1999) found that advanced management curriculum, field practicum, and foundation social work curriculum prepared social work students for practice in managerial positions. Furthermore, Kramer (1998) found that a grief course helped students perceive greater competence

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in their knowledge, skills, and sense of preparation for working with grieving clients. In addition to change in attitudes, benefits of training in substance abuse have been found to have a long-term impact on social work practice. Cartwright and Gorman (as cited in Amodeo, 2000) foimd that perceived preparedness to work with substance abusers, together with a belief that cUents and colleagues perceive the worker as capable of doing substance abuse related work, form the basis for willingness and commitment to work with substance abusers and raise the likelihood that workers will act on a client's substance abuse problem. Amodeo (2000) adds that perceived competence and confidence in working with clients with substance abuse issues lead to treating more clients with substance abuse problems and to higher expertise in substance abuse-related work. Furthermore, trainees were more likely to continue receiving substance abuse training and contributing to the area professionally (Amodeo, Fassler, & Griffin, 2002). Perceived preparedness, therefore, seems to be an important variable in the long-term commitment to treating clients with substance abuse issues. Although it has long been recognized that attitude is an antecedent to behavioral intention, some cognitive theorists maintain that the more connected an attitude is to a cognitive process, the more motivated we are to change our behavior (Stein, 2003). The literature supports this connection by reporting a positive association between level of knowledge relevant to the preparedness area, level of perceived preparedness, and level of performance (Blumenthal, Gokhale, Campbell, & Weissman, 2001; Rafeek, Marchan, Naidu, &

Carrotte, 2004; Simmonds, Killen, Rohrbach, & Maccoby, 1993). The effectiveness of substance abuse training is demonstrated in the Amodeo (2000) model. According to this model, training leads to improvement in basic role requirements, which include knowledge and skills; this leads to a more positive therapeutic orientation, which refers to attitudes that include interest in working with substance abuse clients, a commitment to work with them, self-perceptions of competence and confidence in working with these clients, and optimism in one's work. Ultimately, there is an increase in the social workers' therapeutic functioning, which includes job-related behaviors as well as clinical skills. A follow-up study with past training participants supported this model (Amodeo, 2000). Previous literature did not examine different types of training as predictors in the same study. Typically, studies included outcomes of training (e.g., Amodeo & Eassler, 2000) or substance abuse education (e.g., Gassman et al., 2001), but not both. These variables may be contributing as predictors of training outcomes in different ways and at varying degrees. Also, studies (e.g.. Stein, 2003) have examined the impact of training on attitudes toward substance abusers and assessment and treatment practices. Currently, it is unclear whether substance abuse training predicts social workers' feelings of being prepared to use the knowledge provided by such instruction. Perception of preparedness to work with substance-abusing clients is a crucial component in working with these clients; therefore, it is important to make sure that social work graduates perceive themselves as prepared to


work with substance abuse issues. It is too early in their professional life to examine work-related outcomes for recent social work graduates; however, detecting their perceived preparedness can serve as an indicator of their future work roles with substance abuse issues. Hence, this study applies the Amodeo (2000) model to answer the question of whether substance abuse informal training (mentoring, supervision, peer consultation, and in-service training), formal training (continuing education tmits [CEUs] and specialty training during and after the MSW program), academic formal trairiing (substance abuse curricula and field work), substance abuse specialization, level of substance abuse perceived knowledge, age, gender, and race predict recent MSW graduates' level of perceived preparedness to work with substance abuse issues in the social work field (see Figure 1 for adapted model).

Method

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dents (76.7%) graduated in May 2004 (n=178), although 19% graduated in July 2004 (n=44), and 3.4% graduated in December 2003 (n=8). Researchers were tmable to determine graduation dates for 2 of the respondents. A survey was sent by mail to all graduates, and 232 completed surveys were returned (65.7% response rate). Ninety-two percent of the participants were female (n=213), 68.1% were Caucasian (n=158), and 86.8% of participants were employed in a social work posifion (n=198). The mean age of the participants was 32 years (SD=1.2); ages ranged from 22-59 years. Compared with stafisfics gathered by the university, the sample was very similar to the student body in the same academic year. Specifically, 90% of the graduating student body was female (n=311, of 345 who graduated in summer 2003, fall 2003, and spring 2004), and 69.8% were Caucasian (n=241).

Procedure

Participants The sample frame consisted of the full population of 359 students who had graduated from a social work school in a mid-Atlantic tiniversity within a year prior to the implementation of the study. Most of the respon-

The study received an exemption from the tmiversity's Institutional Review Board because the cross-sectional survey was for educational and evaluative purposes. Participation was confidential but not anonymous, so that researchers could track responses for foUow-up

FIGURE 1. Adaptation of the Amodeo (2000) Modei to the Present Study Basic Role Requirements Academic Formal, Formal, and Informal Training

Social Work Orientation

Attitude Knowledge Preparedness

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mailings, as explained in the cover letter sent to the respondents. Of the 359 surveys mailed, 6 (1.7%) were returned for incorrect addresses, and four (1.1%) respondents returned surveys but declined to participate. The data collection procedures were based on Dillman's (2000) tailored design method, which entails five waves of survey mailings for maximizing response rate. Time constraints limited us to only four waves of mailings, including a preletter in December 2004, a survey and cover letter distributed a week later, a reminder card in January 2005, and a second final survey sent out several weeks later to those whose surveys had not yet been returned.

received after graduating from the MSW program included CEUs and specialty training. The participants were asked first to respond whether they had received the specific type of training (i.e., informal, formal during MSW, or formal post-MSW). If they had received that type of training, they were then asked to check off which specific types of training within this category they had received (i.e., mentoring, supervision, etc.). Perceived preparedness measurement. Per-

ceiving oneself as well-prepared to work with substance abuse issues in the social work field was assessed using one question with a 5point Likert-type scale ranging from 1 {strongly agree that I am well-prepared) to 5 (strongly

Measures There was no existing instrument available to measure preparedness to work with substance abuse issues. Hence, a measure was developed for this study. The first section of the survey included demographic information and employment trends, and the second was a substance abuse-related assessment section. Training measurement. Level of training

was assessed using six questions that were adapted from a study by Smith and colleagues (2006). This subset of questions measured three types of training received: informal training, formal training received during the MSW program, and formal training received after graduating from the MSW program. Informal training included mentoring, supervision, peer consultation, and in-service (nonCEU) training. Formal training received during the MSW program included field work, foundation curricula, advanced curricula, CEUs, and specialty training. Formal trairüng

disagree that I am well-prepared). For data analy-

sis purposes the coding was reversed (1= strongly disagree to 5=strongly agree). Perceived Knowledge subscale. The knowl-

edge subscale was adapted from the Training Needs Assessment Survey of the Addiction Trairüng Center of New England (Shaffer et al., 2000) to fit the study needs (see Table 1). This subscale consisted of four questions pertaining to current knowledge level regarding substance abuse models, with each question referring to a different substance abuse model; and five questions pertaining to current knowledge level regarding substance abuse concepts, with each question referring to a different substance abuse concept. Participants were asked to rate their knowledge on a 5-point Likert-type scale ranging from 1 (maximum knowledge in this area) to 5 (no knowledge in this area). For data analysis

purposes the coding was reversed (l=no knowledge in this area to 5=maximum knowledge in this

area), and a mean of the nine items was used.


To assess how these nine items group together, a principal components analysis was carried out. One component was retained with an eigenvalue greater than 1, accounting for 64.4% of the variance in the component structure. Furthermore, all nine variables loaded significantly on the one component with all loadings greater than .72. This component is considered to be reliable following criteria provided by Stevens (2002) and indicates that these nine questions actually measure one concept: the level of knowledge regarding substance abuse models and concepts. In addition to assessing the grouping of the nine knowledge items, the reliability of this subscale was evaluated, and a Cronbach's alpha of 0.93 was obtained. This indicates that this subscale has high internal consistency reliability. Content validity was obtained based on an extensive literature review, a cognitive interviewing process and pilot survey, and the expertise of the research team. Data analysis A hierarchical multiple regression analysis was used to examine predictors of preparedness of respondents to work in the area of sub-

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stance abuse. Following Amodeo's (2000) model, training types and current knowledge level regarding substance abuse issues were used as predictors. Perceived preparedness to work with substance abuse issues was the dependent variable. The preparedness variable and the knowledge variable were coded such that higher values reflected more of the construct. Race and ethnicity groupings were recategorized into Caucasian (=1) and other (=0). Academic specialization was dichotomized into substance abuse and employee assistance program (EAP), specializations that include required substance abuse coursework, as reference categories (such that substance abuse specialization or EAP=1; and all other specializations=0). To examine effects of substance abuse education, training questions were combined such that the indicated types of trainings were summed to show the number of types of informal training (mentoring, supervision, peer consultation, and in-service training), formal training (CEUs and specialty training during and after the MSW program), or academic formal training (substance abuse curricula and field work) each respondent had indicated (see Table 1). Age, gender, and race

TABLE 1 . Models and Concepts About Which Participants Rated Their Current Knowledge

Substance Abuse Models The 12-step self-help model Psychopharmacology model Harm reduction model Recovery model

Substance Abuse Concepts Assessing family history of addictions as a risk factor Polysubstance abuse Substance abuse and the criminal justice system Dual diagnosis (substance abuse and mental illness) Relapse

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were entered in step 1; specialization in step 2; iriformal trairung, formal training, and academic formal training in step 3 as a functional set; and knowledge in step 4. The order of entry was determined by previous literature and the Amodeo (2000) model. Resuits Included in the analysis were 211 cases (91.0%). Thirty-five percent of the participants (n=79) received at least one type of academic formal training, 46.7% («=106) received at least one type of informal training, 24.9% («=56) received at least one type of formal training, and 36.0% («=76) received no training at all. The mean of current knowledge level regarding substance abuse models and concepts was between very little perceived knowledge and moderate perceived knowledge (M=2.90, SD=.82). In addition, one third («=69) of participants, when asked how much substance abuse expertise was needed on their job, stated that they considerably or maximally needed such expertise, another third (n=71) moderately needed this expertise, and a third («=71) did not need this expertise or needed it minimally. When asked what percentage of time they had spent on substance abuse-related issues on their job since their MSW graduation, 63.1% («=140) answered that they had spent 25% or less of their time on these issues, 12.6% («=28) had spent 25%-50% of their .time on these issues, and 24.4% («=54) had spent more than 50% of their time on these issues. The assumptions for the analysis were adequately met (Cohen, Cohen, West, & Aiken, 2003). The overall model was signifi-

cant (F=45.09, p