Structural Factors that Affect Provision of Vocational/Educational Services in Methadone Maintenance Treatment Programs

Abstract

Much literature points to the existence of common organizational and staff factors that can serve as obstacles to effective utilization of vocational and educational (V/E) services in clinical settings. This paper reports findings from systematic organizational analyses off our methadone maintenance clinics in New York City, which were used to help identify formal and informal arrangements that facilitate or hinder effective utilization of vocational rehabilitation services in this treatment system. The study included 43 face-to-face staff interviews, 50 anonymous staff surveys, and 16 case file reviews. The major structural obstacles found were: (a) client V/E needs are typically given a low priority compared with other service needs, (b) monitoring and supervision in relation to V/E service utilization is generally lacking, (c) the prevalence of critical deficits in counsellors' vocational rehabilitation skills (e.g., targeting, assessment, and caseload management) relate to inadequate and/or inappropriate referral to community-based V/E agencies, and (d) fiscal disincentives (particularly Medicaid dependence) exist for both program and client.