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Little is known about the relationship between treatment organization characteristics and client outcomes or drug-related harms in community opiate substitution therapy. In the absence of sufficient scientific evidence, the organizational configuration of addiction treatment services is often decided on an ad hoc and sometimes politically motivated basis as the evaluation of the impact of policies or practices on clients at the organizational level is limited. The objective of this multi-site cross-sectional study was to identify and understand how client characteristics and staff perceptions of organizational functioning related to client engagement in community-based opiate substitution therapy services in Ireland. This paper reports on a cross-sectional survey of clients (n = 262) and staff (n = 132) questionnaires across 12 discrete community-based prescribing service providers (organizations) in Ireland. Measures of client engagement in treatment were shown to be higher in organizations with more positive staff ratings of organizational functioning. In particular, in organizations where staff reported having greater job autonomy, clients reported better overall engagement. Specifically, greater staff autonomy in organizations related to greater levels of treatment participation (p = 0.034), treatment satisfaction (p < 0.001), and better rapport with staff (p < 0.001). Clients who were the longest in treatment expressed significantly poorer rapport with staff (p = 0.44) and were less likely to seek out support from peers (p = 0.023), while those in stable accommodation reported greater participation in treatment (p = 0.009). Levels of peer support were not related to organizational characteristics, but clients with lower levels of education (p = 0.002) and those in early treatment (p = 0.017) were more likely to seek support from peers. The findings establish the importance of assessing organizational and client attributes as part of an overall strategy for enhancing the quality of treatment. This paper provides valuable information for policymakers and provides an ample basis for further exploration of how treatment organizations work, and not just that they work. Policymakers and planners need to consider introducing specific interventions for clients or staff in the context of a 'whole systems' approach. From an organizational and planning perspective, this should involve further consideration of measures that relate to increasing staff's sense of autonomy. This paper provides further evidence that the success of policy-making or planning relating to treatment organizations can be successfully measured at the client and organizational levels. [ABSTRACT FROM AUTHOR]

Drawing on findings from a psycho-social qualitative doctoral study, this paper considers the intimate and extraordinary emotional intensity, ambivalence and pain associated with the experience of mother social workers engaging with mothers and their infants in the context of child protection work. In this yearlong study undertaken with a group of female Irish child protection social workers, their role as mothers was an unanticipated emergent theme and was found to be inextricably linked to their work and their capacity for realistic decision-making. We consider the wider contexts of societal ambivalence about motherhood, mothering and social work itself, as a way of locating these experiences as fully psycho-social. The work discussion seminars offered as part of the research study afforded a rare opportunity for workers to talk about predicaments, failures and worries, in conditions of containment for anxiety, support for their learning, and a confidential reflective setting. [ABSTRACT FROM AUTHOR]

This article explores the psychodynamics of relationship-based practice from the perspective of young people in residential care. This research involved qualitative semi-structured interviews with 10 care leavers, aged 18-24 years, who had been in residential care in Ireland. Drawing selectively from that research, this article reports their views and experiences of key-working and how relationship-based practice acted as a reparative method within their experiences of care and aftercare. Similar to previous research, this study underscores the necessity to ensure that children in care are cared for and supported by a trusted adult. In addition, based on this study, the role of a key worker appears capable of providing this ideal type of supportive relationship. It also highlights the importance of the care system working to provide consistency and support for the young people and confirms the importance of relationships with trusted adults, such as key workers. [ABSTRACT FROM AUTHOR]