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Table 4 Results #2 – Ongoing engagement may be needed (in some instances) to sustain positive changes

From: Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work

Citation Intervention summary (Qualitative/Quantitative) Main psychosocial/employment outcomes Ongoing engagement
Joe et al. [1997]. The intervention compared: 1) An Individual and group counseling group (utilizing node-link mapping); and, 2) a control group with standard counseling. (Quantitative) According to the researchers, 12 months after the treatment ended the outcomes were mixed. The mapping group was less likely than those in standard counseling to report illegal activity, being jailed or arrested. Yet, "measures of self-esteem, decision-making confidence, and hostility showed mapping clients tended to rate themselves more poorly than standard clients".However, overall ratings at follow-up were moderately positive on all measures in both counseling modalities… (Discussion para 3). 2) Ongoing engagement
As the follow-up occurred one year after treatment ended, it is possible that at least some of the poor ratings on self-esteem, decision-making confidence and hostility among the mapping group were due to the lack of engagement with the intervention. The researchers also suggest, however, (as per finding 1a in Additional file 2) that some of the poor outcomes may have been due to the fact that clients saw their "psychological and social strengths and weaknesses in a more critical light" (Discussion para 3).
Platt et al. [1993]. The intervention compared: 1) Group counseling (vocational cognitive problem-solving); and, 2) a control group with standard methadone treatment services provided by their clinic (e.g., methadone and weekly individual counseling). (Quantitative) According to the researchers, "At six months post-intervention, the experimental group (N = 67) demonstrated a significant increase in employment rate (13.4% to 26.9%); no significant change occurred for controls (n = 63). At 12 months post-intervention, however, overall employment gains declined in the experimental group…" (p. 21). 2) Ongoing engagement
Twelve months after the intervention ended there was a decline in employment gains for the experimental group, which, according to the researchers suggests "the need for [an] additional intervention in order to maintain employment gains" (p. 21).
Woody et al. [1987]. Three groups were compared: 1) A Supportive-expressive Therapy (SE) group; 2) A Cognitive-behavioral Therapy (CB) group; and, 3) A drug counseling group. Follow-up evaluation was done 6 months after treatment ended. (Quantitative) Positive outcomes were maintained overtime. Follow up evaluation occurred 6 months after treatment ended, and the intervention ran for 6 months. Hence, at 12 months following the baseline, "all treatment groups [n = 3] showed improvements. However, the two psychotherapy groups showed more improvements than the drug counseling group over a wider range of outcome measures, with marked changes in the areas of employment, legal status, and psychiatric symptoms" (p. 595). 2) Ongoing engagement (Not needed)
This evaluation suggests that changes in clients' attitudes and behaviours can continue for a period of time even after the intervention ends.