IntroductionIntroduction Results and ConclusionsResults and Conclusions

On demographic variables, analyses revealed that ATR clients were more likely to be Hispanic and employed, whereas non-ATR clients were more often White, male, and older. ATR clients reported more problem days in the month prior to admission related to social issues and substance use; conversely, non-ATR clients reported greater problem days associated with physical illness and psychological issues. In the area of substance use patterns, the ATR group was more likely to use cocaine and marijuana as their primary substance and the non-ATR group reported a greater history of IV drug use. Both groups demonstrated similar percentages of polysubstance use. Although the groups did not differ in the frequency of primary substance use over the past 6 months, the non-ATR clients reported more days of use during the month prior to admission to treatment. Non-ATR clients had higher rates of both previous detox and non-detox addiction treatment, whereas a greater proportion of ATR clients had attended AA/NA during the month prior to treatment entry. The groups were equivalent in the incidence of emergency room visits during the past year. At discharge, ATR clients had higher percentages of treatment completion, past 30-day abstinence, and AA/NA attendance during the month prior to discharge. The ATR group also had a significantly shorter length of stay in treatment relative to the non-ATR group. Analyses of voucher expenditures among the ATR client group indicated that ATR clients who completed treatment were significantly more likely to receive recovery support services rather than treatment services alone.

Results indicate that in this sample, criminal justice clients who participated in the ATR program achieved more successful addiction treatment outcomes at discharge relative to criminal justice clients who did not participate in the program. These findings suggest that the components of independent assessment, free client choice of service providers, and the provision of voucher funds to procure treatment and recovery support services may improve client outcomes. Further, ATR clients who completed treatment were more likely to receive recovery support services rather than treatment alone, suggesting that the receipt of recovery support in addition to treatment may also enhance outcomes. Future controlled studies are needed examining the individual components of the ATR recovery-oriented systems of care model to determine specific features that contribute to improved client outcomes, as well as longitudinal studies to explore the effect of these services on sustaining the process of recovery.

AcknowledgementsAcknowledgements

Presented at the Addiction Health Services Conference, Athens, Georgia, October 16, 2007

Demographic and Social Characteristics

Problem Days During Month Prior to Admission

Primary Substance of Abuse

Treatment History and Substance Use

The Access to Recovery (ATR) grant funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) is designed to expand system capacity to improve access to addiction treatment and recovery support services. Core components of the ATR program include: 1) independent assessment to determine appropriate levels and types service needed; 2) genuine, free, and independent client choice among treatment and recovery support service providers; 3) establishment of a wide network of community and faith based providers to ensure clients have at least one service provider choice among the array for which the client has no religious objection; and 4) a voucher program that provides voucher monies directly to clients for independent purchase of all assessment, treatment, and recovery support services. Allowable services under the Texas ATR voucher program include clinical assessment, care coordination, residential and outpatient addiction treatment, individual recovery coaching, spiritual support group, relapse prevention group, life skills group, recovery support group, transitional housing, GED preparation, employment coaching, and marital/family counseling. In Texas, the ATR program targets individuals involved in the criminal justice system, either through drug court, probation, or Child Protective Services.

The ATR program design reflects a recovery oriented systems of care model, which includes provision of individualized recovery support services in addition to traditional addiction treatment. Although limited research has been conducted examining the effect of wrap-around services and peer support on client outcomes in mental health treatment, studies assessing the role of recovery support services in enhancing addiction treatment outcomes are lacking. The current study compares client characteristics and outcomes of two groups of criminal justice clients receiving state-funded addiction treatment; clients who participated in the ATR program and legally-involved clients who did not receive ATR services.

The authors acknowledge Lesli San Jose, Decision Support Research Specialist for the Texas Department of State Health Services (DSHS), Mental Health and Substance Abuse Services Division, for her extensive assistance in retrieving data for this study. The author has no financial relationships associated with the topic of this presentation.

The findings and conclusions of this in this presentation are the opinions of the

authors and do not necessarily reflect the official position of DSHS.

Sample and MethodSample and MethodData from the Behavioral Health Integrated Provider System (BHIPS) were available for 1,049 ATR adult clients who entered and were discharged from addiction treatment during the period of June 2005 and November 2006. BHIPS is the mandatory data collection and outcomes monitoring system for addiction treatment providers funded by the Texas Department of State Health Services (DSHS). Types of data collected through the BHIPS system include client demographics, drug and alcohol use patterns, addiction treatment characteristics, and client reported levels of functioning in a variety of areas such as employment, living situation, medical concerns, and psychological health. Data regarding voucher services received through the ATR program were also available from BHIPS. A comparison group of non-ATR DSHS criminal justice clients was generated through random selection of 1,049 clients who entered DSHS-funded treatment during the same time period. Non-ATR criminal justice clients were identified through a BHIPS data element indicating the client is legally involved. The comparison group was created using the SAS statistical software random selection procedure to provide a group of equivalent size. Further, the groups were matched according to the levels of care at treatment entry that existed in the ATR client group (24% intensive residential, 2% supportive residential, and 74% outpatient).

ATR clients were compared to non-ATR criminal justice clients on demographic and social characteristics, addiction treatment history, substance use patterns, and treatment outcomes at discharge. Continuous variables were analyzed using t-tests for independent groups and categorical variables were assessed using X2 tests. In addition, among ATR clients only, treatment completers and non-completers were compared on incidence of receiving recovery support services in addition to addiction treatment.

Client CharacteristicsClient Characteristics

Discharge Characteristics

The Texas Access to Recovery (ATR) Project: A Comparison The Texas Access to Recovery (ATR) Project: A Comparison of of

Characteristics and Treatment Outcomes of Criminal Justice Characteristics and Treatment Outcomes of Criminal Justice ClientsClients

Laurel Mangrum, Ph.D.Laurel Mangrum, Ph.D.aa, Michelle Steinley-Bumgarner, M.A., Michelle Steinley-Bumgarner, M.A.aa, & Karen Eells, , & Karen Eells, M.S.S.W, L.M.S.WM.S.S.W, L.M.S.Wbb

aaUniversity of Texas at Austin, Addiction Research Institute; University of Texas at Austin, Addiction Research Institute; bbTexas Department of State Texas Department of State Health ServicesHealth Services

Percentage of ATR Clients Receiving Recovery Support Services by

Treatment Completion

ATR Non-ATR(n = 1049) (n = 1049)

Male 61% 67%

Age 31 33

Race/Ethnicity Black 19% 22% Hispanic 49% 28% White 31% 49% Other 1% 1%

Education Less Than High School 14% 10% Completed High School 62% 66% College Level 24% 24%

Employment Employed 48% 42% Unemployed 46% 50% Not In Labor Force 6% 8%

Living Situation With Family 81% 77% Group Quarters 2% 2% Living Alone 11% 11% Insitutional Setting 4% 7% Homeless 2% 3%

* p=.02, ** p = .01, † p=.0001

†

**

†

*

ATR Non-ATR(n = 1049) (n = 1049)

Completed Treatment 66% 54%

Length of Stay in Treatment (Days) 54.9 78.6

Abstinent Past 30 Days 71% 66%

Attended AA Past 30 Days 75% 70%

* p < .02, † p < .0001

† †

† †

*

*

0

2

4

6

8

10

12

14

PhysicalIllness***

Employment Family Social** Psychological** Substance Use*

ATR Non-ATR

* p < .02, ** p < .01, *** p < .001

ATR Non-ATR(n = 1049) (n = 1049)

Substance Abuse Treatment Previous Detox 10% 15% Previous Non-Detox 34% 40% Attended AA Past 30 Days 43% 36%

Emergency Room Visit Past Year 23% 25%

Polysubstance Use 58% 56%

History of IV Drug Use 14% 24%

Frequency of Use of Primary No Use 16% 17% Less than Monthly 8% 9% 1-3 Times Per Month 15% 12% 1-2 Times Per Week 15% 15% 3-6 Times Per Week 16% 17% Daily 29% 29%

Average Days of Use of Primary Past 30 Days 4.5 6.2

* p=.002, † p=.001, ‡ p=.0001

**†

‡

‡

0%

5%

10%

15%

20%

25%

30%

35%

Alcohol Cocaine Crack Opiates Marijuana Other

ATR Non-ATR

p < .0001

0%

5%

10%

15%

20%

25%

30%

35%

Treatment Completer Treatment Non-Completer

p < .01